I grew up in Africa. We weren't as scared of Ebola, as we were, of good old Malaria.

It's also the gift that keeps on giving. Once you get it, it does a reunion tour, every now and then, for the rest of your life.

At the dinner table, we (expats) used to have a bowl of quinine tablets, set out like a condiment.

I really hope this works out, because, thanks to climate change, the lower 48 may get a chance to find something in common with our neighbors to the south.

Agreed with the other responses. The main reason there are lots of malaria deaths is often due to the lack of access to medication but for folks that do, it is similar to the flu stateside.

I was born and raised in Uganda and I'm shocked by this. Ebola was 100x more scary than malaria growing. At least way back before this recent vaccine. Get Ebola you are basically screwed, get malaria have a pill

To be fair on your part, as an 'expat' (I have a lot of qualms with this word, see https://www.theguardian.com/global-development-professionals... as a starter), its harder as your immune system didn't grow up with it and so when you get it, its much worse. Quinine in my head is a hard core malaria drug for the tough cases (well atleast in was 10-20 years back). But for folks born and raised it really was like the flu. When I go back these days though, I'm in the same boat and actually start a dosage of anti malarials a week before I arrive

Quinine is better as a prophylaxis rather than a treatment - i.e. for preventative or early-stage use, not once it's developed into a bad case. Low doses early (like in the tonic water of the late 1800s) could help prevent one from catching malaria while avoiding the nasty side effects of larger quinine doses needed for treating an advanced case.

Ah I see. I was only familiar with the latter advanced case usage

That's interesting and I hadn't thought about the difference in terms and how they were used before, thanks for the article to chew on.

Expat typically means emigrant, not immigrant.

Japanese working abroad are expats wherever they are.

And Russians are immigrants. It doesn't go by race, it's Haves vs Have Nots - the only two classes that really exist.

It's definitely more nuanced for sure. Factors that can play into it can include but aren't limited to race, social standing and class, country that you are living into etc. I agree there's a have vs have nots at play at times but I don't think you can discount race at play either.

As an example, I always found it interesting that when I moved to the US, I found the words use suddenly disappears despite there being lots of people that could fit that mold. Has anyone experienced otherwise? I'd be curious to know

> it's Haves vs Have Nots - the only two classes

Then what do you call it when the Haves trend light in skin tone and the Have Nots trend dark in skin tone?

I call it "fighting over bread crumbs when 0.01% take away the whole cake".

3/4 of Europe are have-nots in the expat:immigrant debate...

I might be confused. Is your argument that 3/4 of Europe being Have Nots negates racial inequity?

Malaria used to be common in the US until the 1950s or so. It was eradicated through extensive mosquito control and engineering efforts. Rich countries can cope; it's the developing world that's thoroughly boned, at least until industrial capabilities catch up.

I can't help being annoyed by how the West first exterminated malaria at home, and then, once they were safe, started worrying about the ecological consequences of doing the same in Africa.

I think it's a bit more complicated than that looking at the wiki article. It seems to have been very successful to begin with, but then the mosquitos became resistant to DDT and western countries have a climate advantage. Notably, they did try it in poorer countries too.

And a ton of kerosene. Spray it on all bodies of water and the larva can't breathe.

Malaria is why the first attempt at the Panama canal failed. Kerosene is partly why it became successful.

DDT was also used incorrectly. It was supposed to be sprayed on walls, so it was made to be persistent. Naturally farmers crop-dusted it on their fields, and that made it an environmental problem.

During cabin decompression, you put your oxygen mask on first, then help others.

I think the right analogy for the GP post is putting your oxygen mask on and then telling your seatmate they shouldn’t be flying due to climate change.

If all kids in your neighborhood get sick, including yours.

Do you first try to heal your kid or everyone at the same time?

> Malaria used to be common in the US until the 1950s or so.

I had no idea of that, as I suspect many given the time past if you wasn't around then. Did a little digging and nicely covered here: https://www.cdc.gov/malaria/about/history/index.html

Which makes me wonder - what the cost of malaria drugs are and how much would it cost to eradicate it. Equally have the true environmental and ecological aspects of eradication methods been analysed. I wasn't aware that mosquito's were pollinators until a while back, not that anything usurps Bee's, but many insects are pollinators and in some area's they may even be crucial as a species.

After all the 1950's approach was basic killing of the mosquito's and whilst that may of been a solution for one area like the US, I'm not sure that approach would be taken as much today and for Africa, certainly as I mentioned, the whole pollinator aspect of mosquito's may make for a more fragile ecosystem that removal of a species would be more impaction than the gains.

I always found it fascinating that malaria has been around so long that a genetic mutation evolved in some that makes them immune to it.

Afaik mosquitoes don’t really contribute ecologically. They are just nuisance.

I recall a town in Texas decided to wipe out the local bat population due to fear of rabies. The next year they had a major scourge of mosquitoes. Turns out bats mostly eat mosquitoes. They let the bats resettle the area.

Bats eat tons of mosquitoes. Some outfits encourage and help people set up bat friendly enclosures to deal with local mosquito problems.

There's IIRC a single-digit number of mosquito species carrying malaria and a slightly higher number of mosquito species targeting humans - as compared to hundreds of species of mosquito. Kill the carriers off and they just get replaced by some other specie of mosquito.

Lets face it, if the same Malaria mortality rate happened in the West, we wouldn't (and historically didn't) wait for vaccines - we'd pave over an entire ecosystem if we had to. We'd do the same even if we had the same death rate as the group that got vaccinated.

Well bats certainly haven’t caused us any major global health problems recently...

While the bat origin of Covid 19 is plausible, it hasn't been conclusively demonstrated. The gain of function lab leak is just as plausible, and equally unproven -- due to the Chinese dictatorship's suspicious lack of transparency and cooperation.

Lab escape is still bat origin, just potentially with a human assist (or human mistake with an unaltered virus.)

Sure, and they’re a large viral reservoir, but I’d hope we don’t think that’s a good reason to eradicate them. They don’t typically come into our homes the way mosquitos do; we go to theirs.

They are the food for birds. Not sure how big that chunk is. Also mosquito's larvae is a water predator, might be an important ecological niche in water reservoirs.

Malaria has killed so many people I don't really care if wiping them out starts a trophic cascade, it would probably still kill fewer people than malaria. If we had to give up condors and bees, I'd still think it a fair trade.

With the bees will go lots of foods that depend on them for pollination. Bees are very essential for agriculture.

Actually very few of our foods, and none of our staple crops rely significantly on insects for pollination. Grapes for instance, can use insects but don't have significant problems in their absence.

Bees are just another legacy producer ripe for disruption. With recent Progress in AI and Drone technology the question isn’t if Bees get replaced by autonomous Nanobots but when.

I remember when I was a kid the EMP trucks went around to keep the nano swarms down, but most of us got bot-lung anyway.

Even rogue nanoswarms are less worrisome than mosquitos as a vector.

It used to be common in southern Europe as well and was an absolute scourge in SEA until the 20th century.

Not just Southern Europe. Oliver Cromwell (English ruler in 1600s) died of malaria.

Malaria in North America and England is covered pretty well in Mann’s 1493. There are a couple kinds of malaria, one more resistant to cold than the other.

No doubt the indigenous Americans had it bad, to put it mildly, but reading the accounts of early colonization efforts in that book, I mean, damn. Wave after wave of colonists, each losing 50+% in the first year (and it’s not like the survivors stopped dying then). For years on end, across multiple colonies. Mostly to disease.

That's awesome trivia!

> Once you get it, it does a reunion tour, every now and then, for the rest of your life.

Maybe only certain strains of malaria do that? I had malaria many years ago. It was a very unpleasant experience, but I recovered in a couple of weeks with no lingering effects.

Growing up in India, malaria was common. But I don't recall anyone living in terror of it. Mosquito nets, mosquito repellent incense, repellent cream, turning the ceiling fan on to full speed were common countermeasures we employed at bedtime.

From my understanding, the vivax variety can bury into the liver and come back out in the future, whereas the falciparum type, which seems to have faster and deadlier results if untreated, once it is treated, is no longer in the body.

Or at least I hope so. I lived in Tanzania for a few years and I got malaria (I think falciparum) a few times. The first time it was the worst headache I've ever experienced. By the third or fourth time, I barely noticed that I had it and yet it was at maybe 5x or more the concentration it was when I first contracted it.

I have had both falciparum and vivax (different years), confirmed by lab tests. The treatment was exactly the same in both cases. While one of them was quite debilitating, the other felt like an ordinary flu. I forgot which is which. In both cases, I was prescribed a month's worth of medication to get rid of the plasmodium from the liver.

I don't live in a malaria-prone locality anymore, but when I did, the people did not consider it a deadly disease. I think access to medical facilities and good nutrition are the key factors why some populations consider it a deadly disease, and other populations don't.

That's my experience as well - I had it 17 years ago, was very ill for weeks, but recovered and haven't had any problems since (but am no longer exposed to risk of new infections). However, it used to be that in the US you could donate blood if you had seen a doctor and been symptom-free for 3 years. It's now a lifetime ban. So perhaps there's new evidence it's not so simple?

Edit: Or there just aren't many donors who have had malaria, so they err on the side of safety.

That's my understanding as well; there are multiple malaria (plasmodium) species, and their effects vary. Some are a one-time infection, and some come back periodically.

I never got it, so I don't know.

The way it was explained to me, is that it's a parasitic disease, and the parasites would embed eggs in tissues, with the possibility of the eggs (or whatever they are -spores?) being re-released in the future.

I grow up in Africa too, Sudan to be specific. During my early childhood years, I contracted malaria more than 5 times. It was really a very regular disease -- that an typhoid. It was only during college have I learned how devastating and seriously dangerous those diseases are: just to put things in perspective, a doctor once told my friend, after he checked his lab results (and be mused of it), they either have malaria or typhoid.

I'm interested to read more about the possibilities that in africa we contracted so many diseases that explains the rather shocking covid mortality rate. It could be because of mean age too.

I dont know what part of Africa you grew up in, but growing up in Nigeria, no one was scared of Malaria.

It is treated pretty much the same way Americans treat getting the Flu

I was born in Nigeria. I barely remember it, but what I can remember, is being constantly told how bad it was. It's entirely possible that my parents had an unreasoning fear of it. When we are kids, they are our source of Truth.

I also remember my sister getting caught in one of those 'squito swarms, near the Delta. That was freaking awful.

Uganda was a bit worse; but we also had other things to be scared of.

I should also mention that Ebola wasn't actually around (that we knew of), when I was a kid, but we hasd some fun diseases. The parasitic ones (like Elephantitis and Belhartzia) were pretty difficult to look at.

Well then, nice to meet a fellow Nigerian :) Ebola is a recent thing AFAIK, so it would make sense that no one was freaking out about it when you were a kid.

To be fair, it does sound like you were in rural Nigeria, so my Malaria experience is likely different from yours

Someone pointed out that us Europeans were probably a lot more sensitive to this than others, who had been around it, all their lives. Also, my mother was the prime vector for my information, and she might have been a bit freaked out by all the fun ways Africa has to kill people.

But I'm still here. I seem to have survived.

My African friends would run around barefoot over the most God-awful crap, and were some of the healthiest people I've ever known.

200000 kids under 5 don't die of the flu every year.

Malaria is a massive drain on the lives, well being and economies of central Africa. An effective malaria vaccine would be huge.

And from the perspective of most africans a lot more relevant than the Corona vaccine.

I wish the rest of the world would realize that Africa first and foremost benefits from this new Malaria vaccine.

I think it's common knowledge that malaria primarily affects Africa, but you're right that it's particularly devastating to a couple dozen mostly very poor countries.

The fact that malaria is so common in those areas is almost certainly a significant contributing factor to the intractable poverty in those areas.

It's hard to be productive when you are sick all the time and/or caring for someone sick.

I think the point was mostly that comparing the case/fatality numbers of covid19 - a truly global pandemic - with those of malaria has to factor in the size of the population being exposed.

Sure, Malaria is unlikely to spread like covid or it would have done so a long time ago, but the absolute numbers don't tell the whole story about how bad each disease is.

Actually malaria used to be in much larger areas of the world, including the United States. But the population was much smaller at that time.

It's a good point about absolute numbers versus population relative numbers.

Siberia used to be a giant malaria hotspot, and then it was suddenly gone at the onset of 20th century, and first semblances of effective treatment.

Some say climate change killed it, some say the extinction of a mosquito species carrying it, some better nutrition, some say quinine.