You can be playing in soccer in the morning and by the evening youre dead. So malaria is the word that we use to describe the diseases that are caused by this genius of disease and parasites. Host how many types are their . Guest there are for that cause human malaria although there is a monkey malaria that is jumping species. It will become the fifth human malaria. Its in the process of doing that now. This is the way these parasites have survived the ages. They affect the dinosaurs and made it through the ice ages probably in birds. There are many varieties of bird malaria. Then they went on to infect other species including primates, and the primate species are what evolves to infect a. Host how many people a year are infected with malaria . Guest that number is a squishy one because its very hard to measure because so many of the infections go uncounted but the World Health Organization estimates around 300500,000 a year and im sorry, 300500 million a year and about 1 million die every year and most of those are children in africa. Host why hasnt it been eradicated . Guest because the parasites that cause the disease are part of the environment. They are carried by mosquitoes. To get rid of all malarias are carried by mosquitoes, so to eradicate malaria you need to either remove people from mosquito populations or kill all of the mosquitoes. Both have been very difficult to do. So weve had malaria throughout the United States. Malaria was throughout the world up until the 20th century and then when scientists figured out that it was the mosquitoes that carry to come at it wasnt good and bad air malaria comes from an italian word. And back before the turnofthecentury scientists believe that it rose up from swamps and you breathe it in and she became sick because it always came around the Spring Summer time when the waters were warming and you could smell the swamps. Once we figured out it was caused by mosquitoes, which was in 1898 the focus was on killing mosquitoes. Some countries that could come in regions that could afford the antimosquito work and put the screens on homes where people were better off than had health care the malaria rates plummeted and elimination of malaria occurred although there were still some outbreaks. But like in the u. S. South, in italy, in southern europe, because mosquitoes live longer and there are more of them, its much harder to get rid of malaria. Those areas tended to be less economically developed than Northern Europe or northern part of the United States. Host Karen Masterson, where is malaria today . Where to can you find malaria . Guest you can find malaria just about anywhere where people are poor, where people live in poverty. Or where people are fighting wars. Because wars develop the perfect ecosystem for mosquitoes because you care apart the landscape and create swamps where mosquitoes breed. Because of the parasites because the mosquito can survive any climate, one that hides in your liver will wait until the mosquito season to launch an infection in your blood so that when mosquitoes come to bite you they to bite you they drink in hand and the cycle continues. Or in the deep tropics where you tend to find most of the worlds intense poverty, malaria is just intimate and its always there. Mosquitoes live with plenty of blood meals from the population and the population ends up just living with malaria you ran. So thats about 40 of the human population live with malaria. Host who discovered that it was a mosquito that carry malaria . Guest brought across and he won a nobel prize for that. He went on to create the first of looking to be in as the mosquito by greg. His whole focus for england, he was a researcher, a british researcher. Is focus was to try to reduce the mosquito population and the colonies of great britain, mostly africa so that the callers could penetrate deeper into these countries the resources because malaria was blocking the way. He was not successful in places like west africa because the mosquito populations there were so huge and they carry of malaria in most areas of africa is called it is the most efficient carrier of these parasites. Its also what entomologists call a geriatric mosquito because it lives so long and because a mosquito must bite you twice to transmit malaria. May have to bite you to drink in the parasites, and then those parasites actually reproduce in the stomach of the mosquito and then we could to two weeks later depend on the temperature the exact has left behind in the mosquito gut will burst the offspring of the well get in the mosquito saliva and then the mosquito has to bite you again. So skewed as in the north dont really live that long whereas in places like africa they live a long time. And so they can easily carry malaria, survive between the two weeks, the week to two weeks if they need to carry the eggs in their gut and then infect people. Host is there in antidote to malaria . Guest there are drugs that can clear the parasites from your blood yes. They tend not to work for very long because parasites, they dont clear all the parasites in the parasites that survived into getting sucked up by mosquitoes and have developed resistance to the drugs into the mosquitoes spread those resistant parasites. I was at a conference yesterday where the talk about the spread of resistance to the most recent series of antimalaria drugs, and these resistant parasites are spreading from cambodia out to other parts of the world. We are seeing the resistant parasites even in africa, which is quite frightening because this is the frontline drug for african countries, and most of the deaths caused by malaria have been in africa. Host how effective our nets, sleeping thats especially . Guest you know nets are probably the best technology we have against malaria but you need to convince people to use them. And its hard to convince People Living in sweltering heat to put another layer of material between them and what little air they get especially during the summer when its hot. Another problem is that, and this is something that was talked about at the conference yesterday, the mosquitoes, they do what entomologist called refractory behavior. They figure out whats preventing them from getting their blood meal and they change their behavior. So we are seeing in africa where bed nets are being used quite intensely, programs working with villages to make sure that bed nets are used at night especially where there are Young Children involved. And they are seeing mosquitoes writing earlier in the day before people go to bed. So its a good technology. In the United States we put up screens. Screens protect you for longer than a bed net will protect you as soon as you go into the house. Youre cooking dinner and youre doing your nightly chores and you are still protected from a mosquito bite, whereas in africa the bed net, its there for sleeping and sleeping only. When mosquitoes are change their behaviors they can still get access to you. Another problem is that most of the Global Health programs have focused on saving childrens lives and the lives of pregnant women because pregnant women was whats called acquired immunity. Overtime if youre infected enough you develop a certain level of immunity to the deadly symptoms of malaria. So that you will survive, it feels like the flu basically. Its horrible, and you still must lie in bed and you cant go in harvest their crops if you need to but you wont die because you have a certain level of immunity against the disease. Pregnant women lose that and children dont have to get so most of the Global Health programs have to focus on saving lives. Now theyre talking about the need really to get the Larger Population, because the Larger Population of people carry the parasites that the mosquitoes pick up and give to pregnant women and children. So they are not able to break the cycle of infection just by focusing on pregnant women and children. So now there is a much larger album and a much bigger effort that they have to make and it will require a lot more money if elimination some people use the word in eradication but eradication, when youre talking about a disease that exists in the private, is a tricky word. Most of the paperwork and feel of malaria, especially cdc people who work on the ground and understand the disease will use the word elimination, try to reduce the number of infected people and the number of mosquitoes so that you dont reach the threshold of an outbreak. You need to have a certain number of each to reach a threshold that will break an outbreak. If you can get those numbers down malaria will still exist in the environment but it will be endemic and wont be constantly infecting people. Host somalia can be passed from person to person . Guest so malaria if i have other nics all over your not going to get it. If i wipe the sweat of my for it and shake your hand and youre not going to get it. It has to come to from you from a mosquito and has to be a mosquito that has had the parasites in its gut long enough for the exact to burst and send what i call may be parasites but i think of them in the lifecycle. Thats kind of its in the saliva, the mosquito bite you and within minutes today, those parasites get to your liver to avoid your immune system and then they stay and they reproduce in the feed on your liver cells. When they mature enough to bust out of your liver and they attack your blood cells and destroy blood cells and tell you become very sick antibody response with a high fever. The high fever is assigned your immune system is taken and has tried to reduce the number of parasites so that you know longer are sick enough with symptoms which is to the parasites in your blood. There they mature again and they become sexually distinct and to swim to the surface cells, the surface blood cells and they emit the chemical to attract a mosquito so that the mosquito, when you have malaria you are more attracted to mosquito. And pick up on the chemical and they bite you in they drink in these what are called adult versions of parasites. They are shape shifters. They are changing the shape and then they get into the mosquito and there they fuse, sexually fuse and they create a genetically unique set of offspring that are stick shape and to get into the saliva and the cycle continues. Host Karen Masterson, how did you get interested in this topic . Guest so i was a political reporter and i had covered congress for quite a while and i was interested in doing something else. I wanted to get back to science writing because i didnt an environmental reporter. I covered the environment, and to do that i decided that i wanted to research a scientist, because you can teach science to people if youre a narrative writer, a storyteller. So i was up at the National Archives looking for the world war ii records of Linus Pauling a twotime Nobel Prize Winner and i worked with archivists who helped me through the byzantine process of trying to find records. You go from one theres a whole room as large as this one is nothing but finding aids, and so its one binder after another that leads to another. You are tracking usually the contract of a that the scientist had with the federal government and so during World War TwoLinus Pauling had a contract number through caltech, and so i was trying to track that down had an archivist working with me, took three days. I had my call slips together. I knew my column numbers. I put it in and put it into the desk and an hour later i had my box. The box was labeled t. For people with the last name p. To open up and there was nothing in there about pauling. I had been there and ive never done. I tried to research. I had this box of records from box of records or more gorgeous i decided to start flipping through them, and they came across a memo that was written to the lead to Public Health official in the state of massachusetts. It was from a federal researcher who was the head of the National Research council and the letter asked if the federal researchers could come in and inspect patience at the boston psychopathic hospital with malaria so that trucks could be used against the infection no less than the worst outcome was a state. The War Department was experiencing the rent is casualties because of malaria and the War Department needed a drug in the Scientific Community was pitching in to help and with the also a Massachusetts State Hospital patients to become a part of this and he said just. So the boston psychopathic hospital was one of about a half a dozen who allowed these researchers to effect their patients with malaria for these drug tests. Host this is the the malaria project. How long did he go on, how many were infected, what were the results . Guest so it started, it really started in 1940 before the war, before the United States entered the war because scientists interested in the late would be the biggest problem of the War Department. This was before normative. This was before the battle of europe. This was when we were envisioning getting to hitler through his underbelly, through north africa but it took a while her strategists to get there but it would either be a part of it. We knew that it would contain japan. We would be in the South Pacific where malaria was everywhere. So a very clever scientist proposed this project. He said look the germans have come up with a project, a process, or try to find a truck for malaria, and we should model that here. They use their Drug Companies to come up with compounds, and then the federal researchers in fact patients with malaria and then test those drugs on them and we should do that here. But the actual project itself didnt start until the War Department would thought they had a problem and that was when the fall of bataan was likely because of malaria. And we were in guadalcanal on the verge of losing that island which was very important strategic island because of malaria. And the War Department opened the spigot. The leaders of the departments that were overseeing the health of the soldiers started attending these meetings were all the malaria all a just were and said we need you and we need to expand this program tenfold. We need 400 scientists working on this. All the Drug Companies and we did all the Drug Companies we can get involved in this. And so you saw this small project turned into the largest medical effort of the war. It was the number one medical priority of the war to find a cure for malaria. Host Mental Health patients . Guest right. So to understand why this was acceptable, you need to understand the history of malaria and syphilis. These are two diseases that worked against one another. So an austrian scientist was a psychiatrist and had surmised that when his patients hospital Health Patients came down with severe fever but sometimes they would be better off afterwards that their Mental Health problems would disappear. So he thought of something to do with the fever that could treat their Mental Health issues. And so he started infecting his patients with all kinds of migrants including tuberculosis. Get a german chairman frank in a pile of tuberculosis indicated to his patients to see figure get the fever high enough to cure them of their mental illness. These experiments spiraled out of control, but he thought that malaria might be a good candidate for treating these patients because certain types of malaria you can control with going to the that the pentagon in africa but the kind you picked up in africa europe. It is still over asia, south america but it used to be all over your. So if he used vivax molar to reduce a fever and allow the fever to go up high enough and they treat the fever with quinine, 30 of the time you could cure the patient of whats called euro syphilis. Its a syphilis that would infect a brain cells cause brain damage. These favors could kill a syphilis in these patients and they would walk away 100 pure. So this became a standard treatment. He won a nobel prize in 1927 for. This became a standard treatment for late stage syphilis, narrow syphilis. And theres only been a couple of decades since we figured out that malaria was caused by these parasites carried by mosquitoes saw this as an opportunity to study the parasites because you couldnt grow them in the petri dish. Dish. You could culture than the you can pass them around like you could with tuberculosis and should be migrants with other scientist and you could say the joint have an infected person. So the State Hospital iran was called malaria therapy had ample members of p. Per infected with malaria. So it was innocent first stage for malaria to come and study malaria, is going to the State Hospitals that were running the therapy for these patients and draw the blood instead of the parasites and it didnt take long for the dynamic to flip so that the Malaria Community was paying for the treatment of syphilis patients in State Hospitals so that they could use these patients to study them at also to test drugs on them. And when the war broke this was the state that these two fields were in. Psychiatrist warning these cannot to overstepped the bounds, to use only vivax which can be controlled by quinine. Quinine is not reliable treatment. And he warned them not to use mosquitoes for the infections because when you invite an infection by way of mosquito youre inviting every stage of the parasite into the body, not just the blood stage, which if i took blood from you and you had malaria and injected it into another patient the patient would just have that blood stage of malaria. And a few isolated the person and didnt let mosquitoes by that person it would never spread. It would never go its the on the liver stage so its not going to stay in your body and you will not walk away and have another outbreak of parasites and then pass it on. The field of malaria did not find these restrictions convenient. And so to study malaria you need to have the mosquitoes. You need to use more than just vivax parasites. You need to use all of the parasites that cause the given types of malaria, and when the war broke, germany and the United States develop these projects that used all phases of the parasites in all types of parasites to try to understand how to come up with a treatment. Host Karen Masterson, when you discovered that memo in that box accidentally, did you have any concept that it would grow into trenton . Guest you know, i didnt because i was again a reporter and i thought i was writing an article that outpitched to a magazine. I will wonder if id found another tuskegee experiment where men, black men in tuskegee, were not treated for their syphilis because they were not told they had. So the researchers could simply observe the life cycle of this disease which was arraigned is because there was a treatment for syphilis at that time. I thought i had Something Like that, but i spend enough time with researchers and i want a fellowship to go down to cdc and spent some time with researchers are there, especially with one man, bill collins who we been at it long enough to actually done some of that research on State Hospital patients. Because even after the war, State Hospital patients with late stage syphilis were so given malaria as a treatment so malaria all just malariologists could study their site and he was one of those people. He made me understand that this was a very nuanced project that there were many considerations that one needed to understand to put what went on during world war ii in the context. And once i spent time with him i realized there was no way i could write this in a magazine length piece, that it had to be a book. I had bookwriting friends who kept telling me you have a book year, you need to write this book. And i kept saying im not sure about this, give me some time. I continued my track up to the National Archives. I went through 500 box and found bits and pieces of the story, in a variety of different record groups. And once i saw the story, once i had the narrative in my mind i understood that i had a book. And so i found an agent and we got a publisher and i wrote it. Host is this written so that the layman can understand . Guest it is written for the layman to it is a narrative. I am a storyteller so i know that people like to read about other people. And so i chose three scientists really to focus on. My main scientist who i talk about cant talk about earlier hes a very interesting, he was a very interesting man, a very good man. He grew up a poor farm boy who didnt want to farm, and to to get out of farming he studied biology. He went to Indiana University and studied biology and you know, he said repeatedly totally by accident he tripped into malaria which i could identify with because it was totally by accident by me. He ended up getting a fellowship to go down and study the swamps in leesburg, georgia. He worked for the Rockefeller Foundation project. The only malaria station in the United States. It was run by samuel darling who was one of the leading thinkers on blair. What they were doing down there in south georgia in 1924 was trying to figure out what mosquitoes carry the malay because the malaria burden in the south was so tremendous that no one felt it would be any kind of Economic Growth in the Southern States with malaria. Because of this disease. So he went down into the swamps and had to kill a couple of snakes they came at him but he studied the larva, the mosquito larva to see if certain chemicals would kill them. That was his introduction to malaria and he became because of going down as a College Student he became one of the countries few malaria experts. So the Rockefeller Foundation and the u. S. Public Health Service called on him every summer in between his studies, because he decided that from biology is going to go into medical school. So he had many years in university and every summer he would go and work on malaria in the south. And through that became an expert and was one of the leading thinkers and most innovative thinkers on malaria when the world went to war. Host whats your job here at Johns Hopkins . I teach. So i teach writing courses i teach writing courses for science students and i have one course that is specifically geared toward Public Health students. So i asked them the ones in the workshop, and i send them out to the city of baltimore where they have to find stories and have to actually get on the ground and work with communities. A lot of them will look at hiv. A lot of them will look at heroin addiction, because baltimore is the heroin capital of the country. They come up with a Public Health topic that they want to explore and then have to get on the ground and they have to find a store. Then they bring it back to the class and workshop it and to help them. Help them develop their ideas into a store with an arc so in the future they want to tell stories about their research and the work that they do theyll have the skills to do it. Host have you had malaria . Guest no, i did not. When i was sitting next to bill collins down to cdc when i was on the fellowship, we would chop the heads off mosquitoes that have been infected, so the mosquitoes would pickup malaria from the monkey house, so they were cycling their lives of these parasites and they bring mosquitoes to the monkey house where the racist monkeys were infected with malaria and then he would bring them back to wil collins at left put them in incubators for that week to 10 days, sometimes two weeks for the parasites to use, develop exact and exact a burst with these parasites. Then we would catch them just after the parasites were in the saliva, put them under a magnifying machine, chop off the heads and i would and ahead to build a new look under a microscope for parasites. While we were doing that one day, an infected mosquito flew off, and i was like bill we have a problem here. There is an infected mosquito in the room. He looked up and he was such a color for, interesting, funny mean. He looked up and he said gosh, i hate to see that and then he went back down on his microscope. I didnt understand this community malaria and i didnt understand the parasites yet because i had really launched into the different species and try to understand what the big differences between them. So i just tried it because i didnt want malaria. I tracked its flight pattern and i tried it and i slapped the life out of. I went home and i said i was in a room with an infected mosquito but i couldve contracted malaria, but it was not until five years later when i really started studying the monkey malaria because its more important to the project that i realized the kind of monkey malaria that we were working with could not jump the species. So he was just kind of having fun with me because i didnt understand that it was not going to infected, that there was a mosquitoes in the lab was not a big deal but i did note that the time. So no i have never had malaria. I traveled with a friend who came down with malaria when i was in africa. We were told when we got to the clinic that we got her there just in time, because she was showing early signs of cerebral malaria which can kill you. The drug that was used to treat her was the one product that came out of this malaria project. It was the wonder drug of the project found which we actually in need of stealing from the germans. Host still in use today . Guest it is still in use today, yes. Most of the drugs used today were created during this project. So when a drug becomes ineffectual because of resistance, scientists at walter reed will go back to the drug war, go back to the series of 14,000 compounds that were made during the war and will pull another one off the shelf and study it. They were maybe a dozen that showed promise, but when the war ended there was no more Research Money to develop them. So walter reed scientists have come back, taking them off the shelf, developed them, made them into different analogs and then headed them off to pharmaceutical conference to develop and use again in these programs overseas. So those have become ineffectual because of resistance and start over again pictures that have a good use today except for a chinese herb that we learned about from the chinese thats one drug that didnt come from this project. Host and finally, how has your friends life changed since she got malaria . Are the limitations of what she can to . Guest no. Shes fully recovered. Host doesnt say whether . Guest this is african malaria. It does not have a liver stage which is why it is not a type of malaria that can survive well in northern climates. It will not hide in the liver and then come out when the mosquitoes. That malaria is called vivax and that you find in asia and find in south america. There are tiny bits of vivax in africa but theres another whole reason why you dont see much of it there. It has to do with a blood mutation that makes most africans completely immune to it. You have an intense infection but when it clears it is gone and it doesnt come back. Host a little bit from Karen Masterson the malaria project is the name of the book. Booktv is on location at Johns Hopkins university. Booktv is on facebook. Like us to get publishing news schedule updates, behind the scenes pictures and video. Author information and to talk directly with authors turn for life program. Facebook. Com booktv. In 2008 i got a call from dexter was a very well known war correspondent, and he was a very good friend and would Work Together very expensively extensively in iraq and afghanistan. He called me up and he said hey man, and he talked to everyone with the exact same time whether its the taliban, become his girlfriend, doesnt matter. He doesnt matter. Because the company says hey man, ive got a great assignment. He said, well its on the talibanization of pakistan. And i remember my husband who was not yet my husband was sitting next to me and he just rolled his eyes and hes like you are not going to be the taliban. I didnt answer. Said dexter went to pakistan, and he spent months trying to line up access. And the thing about south asia and the thing about pashto culture, its a tribal culture is when they bite you