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Race for the cure. (Political Booknotes).

THE FEVER TRAIL: In Search of the Cure For Malaria by Mark Honigsbaum Farrar Straus Giroux, $25.00

IN THE LATE '90S, RELATIONS between African nations and American pharmaceutical companies were roiled by arguments that exclusive American patents on expensive AIDS drugs were leading to thousands of deaths in AIDS-plagued Third World nations that couldn't afford the treatments. Meanwhile, cheaper generic versions of the anti-viral drugs were being manufactured in Brazil and India. South Africa led the charge against the Americans by announcing it would ignore the patents and import the generics; the pharmaceutical firms cried foul and sued to retain rights to their intellectual property. In the end, humanitarianism won. The firms ceded their case after an international outcry, and President Bill Clinton gave AIDS-afflicted, impoverished countries the green light to import medications cheaply from wherever they could, regardless of the patent rules. It was an international public health emergency, after all.

The conflict between the drug companies and disease-ravaged Third World nations seemed to mark a new low by greedy American medical corporations, apparently indifferent to human suffering. But when it comes to the treatment of epidemic disease, the conflict between commerce and humanitarianism is nothing new. Some 150 years ago, a similar conflict over a critical treatment for an international scourge pitted Americans against the health needs of India, Africa, and Europe. But the last time around, the scourge was malaria, and the Americans seeking to keep a tight rein on their profitable treatment were South Americans in Bolivia, Peru, and Ecuador.

Variously known an "intermittent fever" or "ague," malaria had been endemic in the marshy, fenny lowlands of Europe and Africa for millennia. But soon after the colonization of America, the mosquito-borne malady made itself at home in swampy jungles and marshy plains all the way from Patagonia to New York City. The American role in the story begins in 1663, writes Mark Honigsbaum, a former chief reporter for London's The Observer, in his first book, The Fever Trail. That year, a tale began circulating in Europe about a Spanish Contessa who had been miraculously cured of an intermittent fever while in Lima, the capital of the Spanish Viceroyalty of Peru. A Jesuit missionary had reportedly given her an indigenous infusion made from something the Indians called quina quina, "bark of barks," or ayac cara, "bitter bark." Restored to perfect health, the Contessa de Chinchon returned to her native land, where she spread news of the "fever bark" far and wide.

Alas, writes Honigsbaum, the Contessa's story is more delicious than true. She died in Peru, never returning to her homeland, and may never have had malaria at all. And though the Jesuits did play a role in popularizing the indigenous fever-treatment during the 17th century, it's not entirely clear who first stumbled across this New World remedy for the Old World scourge of malaria. What is clear is that quinine, the active anti-malarial alkaloid in the bark of the South American cinchona tree soon became the only known treatment for the disease caused by the as-yet undiscovered Plasmodium falciparum parasite. It retained that singular status for more than two and a half centuries. And for the first 200 years it was used, the South American colonies and nations to which the tree was native retained exclusive control over the growth and harvest of quinine-tree bark.

The Fever Trail is an illuminating, profusely detailed, and confusingly organized yarn about the arduous European quest to end the South American quinine monopoly by transplanting cinchona and red calisaya trees, whose bark had an even higher concentration of quinine, to plantations in Europe, India, and Indonesia. There, the trees could supply European quinine needs, treat malaria-stricken populaces, and underwrite British and Dutch colonial ambitions.

The quest was stifled for centuries by the sheer difficulty of locating the trees in remote reaches of the Peruvian Andes--as well as in cloud forests and high mountains in Bolivia, Colombia, and Ecuador--and then transporting the delicate seedlings and seeds half way around the world on grueling voyages that could take three and a half months. International politics, wars, and the internal politics of botanical societies further complicated the picture. And the South Americans, much like modern American drug companies, worked hard to thwart the Europeans' incursion into their lucrative market. Bark cutters in Ecuador, Bolivia, and Peru all tried to thwart export of the seeds in order to maintain their monopoly--going so far as to poison seedlings' transport cases with arsenic or surreptitiously roasting seeds so they wouldn't germinate, as well as harassing and expelling European seed-seekers.

Honigsbaum is sympathetic to the South Americans, and dubs the European efforts to obtain cinchona and calisaya roja seeds "The Biggest Robbery in History." This seems eminently questionable, however, given that European claims of a humanitarian need for increased--and cheaper--quinine supplies were as real as Africa's need for cheap retroviral drugs. By the mid 19th century, the Bolivian cinchona and calisaya forests were overcut and poorly managed, and malaria remained a major, untreated scourge in India, Africa, and what is now Indonesia.

Honigsbaum's meandering narrative returns again and again to the three main players, all English, involved in the transfer of cinchona and calisaya trees into European hands. They include the well-connected botanist Sir Clements Markham, who secured cinchona seeds in Peru to develop a British fever-tree plantation in India, and Richard Spruce, an English botanist-explorer who trekked deep into Venezuela to secure seeds that would also germinate in India. But it was merchant Charles Ledger who outstripped them all.

Ledger sent his friend and longtime Indian guide, Manuel Incra Mamani, to acquire seeds from a particularly majestic old stand of calisaya rojos in Bolivia. Mamani waited five years for the right combination of rain and sun to gather the perfect seeds, and was eventually beaten and starved to death by his fellow Bolivians for helping a foreigner obtain their treasure. But those seeds turned out to be from plants that were the richest in quinine yet discovered, and the Dutch turned them into a plantation and quinine factory in Buitzenburg, Java, that became the best in the world.

Quinine retained its central status as an anti-malarial treatment until synthetic chloroquine and other advanced medications were introduced in the mid 20th century--medications which raised their own complex ownership issues. Chloroquine, for example, was first patented as Resochin by Nazi Herman Goering in 1934. Perhaps for this reason, Honigsbaum writes, German scientists at I.G. Farben exaggerated its toxicity, and it was not developed for general use until rediscovered by the company's American affiliate, Winthrop Stearns, a decade later.

Today, malaria has been largely eradicated from Europe, North America, and parts of Asia. But it remains a potent global health threat. It kills, according to the World Health Organization, between 1.5 and 2.7 million people per year of the 300 to 500 million it sickens. Half the victims are children in Sub-Saharan Africa. The search for a vaccine has yet to bear fruit and is unlikely to do so for several decades to come. Meanwhile, malaria has proved itself increasingly adept at resistance to quinine and every new drug scientists develop, and pharmaceutical firms are reluctant to invest in research to develop a product the First World scarcely needs and the Third World can hardly afford. And so the tension between profits and philanthropy that characterized early efforts to control ownership of the quinine tree remains central to the battle against malaria, even as the science has moved on.

GARANCE FRANKE-RUTA is a writer in Washington, D.C.
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Author:Franke-Ruta, Garance
Publication:Washington Monthly
Article Type:Book Review
Date:May 1, 2002
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