April 25 has been recognised globally by the World Health Organization (WHO) as World Malaria Day (previously African Malaria Day), since 2006 to highlight the need for continued investment and innovation. The “butterfly effect” from chaos theory might result in a Tornado, but the “mosquito effect” (through the parasite it carries) has fundamentally altered human migration patterns, enabling European colonisation and reshaping the geopolitical landscape of entire continents. The mosquito, a seemingly insignificant insect, wielded astonishing power and profoundly altered human civilisation. Malaria, derived from the Italian “mala aria,” meaning “bad air”, is a saga of discovery, colonisation, human suffering and scientific breakthroughs.

Miasma to parasite

Before modern science unravelled malaria’s secrets, people believed it was caused by miasma—poisonous air emanating from marshes. It wasn’t until 1880 that the French military doctor Alphonse Laveran observed the malaria parasite from the blood of soldiers who had succumbed to fever in Algeria. However, identifying the parasite was just the first puzzle; the full picture of malaria’s transmission remained elusive. In 1885-86, Camillo Golgi and Angelo Celli demonstrated the cyclical nature of the fever in relation to the parasite. In 1892, Ettore Marchiafava further characterised the five species of the parasite, distinguishing Plasmodium falciparum from others. Of notable mention is Patrick Manson, often regarded as the ‘father of tropical medicine,’ who first established the role of mosquitoes in disease transmission with filariasis and later mentored Ronald Ross. In 1894, Manson hypothesised that mosquitoes could transmit malaria, too. Ross, inspired by Manson’s theory, identified the parasite in the gut of the Anopheles mosquito after studying avian malaria in birds in 1897. His breakthrough paved the way for understanding human disease. Giovanni Battista Grassi made significant contributions by linking human malaria to the female Anopheles mosquito in 1898. By 1898, the complete transmission cycle of malaria was scientifically understood.

Before these discoveries, European colonial efforts in Africa were severely constrained by extraordinarily high mortality rates. In coastal African colonial trade posts, European troop mortality averaged 500 deaths per 1,000 soldiers annually in the 1800s, with those venturing inland facing even worse prospects of up to 60% mortality. In 1865, a British parliamentary committee recommended withdrawing from West Africa altogether due to disease threats. When the Gold Coast (modern Ghana) became a colony in 1874, the first three candidates declined the governor’s position due to “health concerns”, and the fourth died of malaria within a month of taking office. Consequently, until 1870, European powers controlled only 10% of the African continent, with settlements primarily restricted to coastal areas. Africa was known as “the white man’s grave,” a place where European colonial ambitions perished.

The correlation between understanding malaria and colonial expansion is striking. As scientists decoded malaria’s mysteries between 1880 and 1900, European powers dramatically expanded their control across Africa. Following the 1884 Berlin Conference, which regulated European colonisation and trade in Africa, the “Scramble for Africa” accelerated rapidly. By 1914, European powers had seized control of nearly 90% of the continent, with only Liberia, Ethiopia, and a few more maintaining independence. This was no coincidence. With knowledge about malaria transmission, colonial administrators implemented targeted prevention strategies for European settlements: draining mosquito-breeding swamps, establishing segregated European quarters, and creating hill stations at higher elevations with fewer mosquitoes. Scientific findings about malaria transmission quickly percolated into colonial policy. By 1901, the British adopted a policy of segregated living based on new knowledge about Anopheles mosquitoes and the racist perception of Africans as disease reservoirs.

Scramble for Africa

King Leopold II of Belgium epitomised this exploitation in the brutal colonisation of the Congo. Equipped with quinine, mosquito nets, and a scientific understanding of malaria, European troops subdued resistance and established lucrative colonies. Quinine, derived from the bark of the Cinchona tree, was discovered during Portuguese conquests in South America. Its use post-1880s was guided by scientific understanding. But, the success of colonizing Africa was not purely biological. Innovations and technology to build railroads, steamships, enhanced rifles, and telegraphs helped navigate and control vast territories. But, knowledge about malaria transmission was the “keystone technology”. It neutralised nature’s deadliest resistance, allowing soldiers to survive and civil servants to administer colonial machinery.

The impact of malaria extended beyond Africa. In the trans-Atlantic slave trade, Africans with a natural genetic resistance to malaria were preferred labour in malaria-infested regions like the Caribbean and the Americas. Consequently, they were traded at higher prices than European labourers, who succumbed to the disease. It created a racialised labour economy, the aftershocks of which echo even today. The modern racial tensions in American and European societies bear this genetic legacy. The valuation of African bodies not only established brutal slavery systems but also seeded pseudo-scientific justifications for racial superiority. Thus, malaria contributed to the present long-standing racial prejudices and social structures.

Malaria today

With quinine as a base, more refined drugs like chloroquine and artemisinin followed. Insecticide-treated bed nets and indoor spraying revolutionised prevention. Today, the malaria vaccine RTS,S brings new hope, though challenges persist. Malaria remains treatable, but Africa still shoulders 94% of the global burdens (as per the WHO World Malaria Report 2024). Beyond medicine, malaria is increasingly considered in modern environmental impact assessments. Deforestation, water stagnation, and climate change influence mosquito habitats, making disease control part of ecological planning.

While colonial empires have dissolved, malaria’s grip remains strong, particularly in Africa. Today, malaria continues to afflict approximately 263 million people annually, killing over 600,000, with Africa reporting 95% of the mortality. Although the death toll has decreased substantially, in absolute numbers, malaria remains a major public health challenge. The history of the discovery of malaria transmission is a powerful reminder that scientific breakthroughs can have complex and contradictory impacts. The discoveries that eventually saved millions of lives also enabled colonial exploitation. Knowledge intended to heal the troops was wielded to subjugate the natives.

(Dr. C. Aravinda is an academic and public health physician. The views expressed are personal. aravindaaiimsjr10@hotmail.com)

Image for representation only.
| Photo Credit: Getty Images/iStockphoto

Infectious diseases experts have flagged the overuse of a potent antibiotic leading to it losing its efficacy, and drug resistance. The Drugs Controller General of India has been urged to lay down strict pathways for these newer antibiotics, so that they are not misused by practitioners.

Abdul Ghafur, infectious diseases specialist, and founder of the AMR Declaration Trust, has written to Rajeev Singh Raghuvanshi, DCGI, about ceftazidime-avibactam. “One of the most potent antibiotics currently available in our armamentarium is rapidly losing its efficacy due to extensive, irrational, and uncontrolled use.”

The drug which was initially registered with the U.S. FDA in 2015 and after three years it was approved in India, is a last-line antibiotic. It is to be used as targeted therapy for certain carbapenem-resistant gram-negative infections and not prescribed as a general antibiotic.

Dr. Ghafur however claims it is already being misused in the community. “To overcome this resistance, aztreonam is often added to ceftazidime-avibactam, unfortunately, resistance has now emerged even to this combination, due to irrational use.”

The problem, he explains, is that while the DCGI has licenced the drug, it has only provided indications for use. There are no clear-cut pathways laid out, and nothing to deter mis-prescriptions.

This trend could erode the huge gains secured in India primarily with the ban on use of colistin as a growth promotion drug amongst poultry, in recent times. This ‘bold and meaningful action’ from the government resulted in a significant drop in prevalence of colistin-resistant bacteria in hospitals in India, he adds.

Rational use

There are two new very powerful antibiotics that are about to enter the Indian market, Cefierocol and Cefepime-zidebactam. Dr. Ghafur urges the DCGI to kick in with antibiotics stewardship: “We need these drugs in India. However, their use must be restricted strictly to infections where no other effective alternatives exist. Education alone is not enough; we need a clear regulatory pathway to ensure the rational use of these molecules from the moment they are licensed.”

“If we do not act now, we risk losing the few therapeutic options left. Antimicrobial resistance (AMR)is already a serious crisis in our country. Without urgent and strong action, it may escalate to an unmanageable level. We cannot change the past — but we still have time to act for the immediate future,” he says.