A Photographic (and Geek) Journey through the History of Malaria Treatment

Quinine preparation used for malaria control and elimination in Italy. Photo: Quique Bassat (ISGlobal).

[This article has been published originally in Spanish in El País. El Planeta Futuro]

Some people collect stamps, champagne capsules or Star Wars figures. There are collectors of books and music records, coins or cinema objects. And then, there is Quique Bassat. This paediatrician and researcher on infectious diseases in low-income countries holds a position that requires a certain IQ to remember: ICREA Research Professor and coordinator of the Malaria Programme at ISGlobal.

Through a selection of photographs from Quique Bassat's collection, the malariatreatment.isglobal.org website is a fabulous journey that starts over 1,500 years ago and leads us to our times

One day, without any coercing or extortion, Bassat confessed to members of ISGlobal’s Communication Department that he nurtured a passion in line with his affiliation: collecting books, photographs, and objects related to the history of malaria treatment. Among the consequences of such confession, we can count this post and, above all, the malariatreatment.isglobal.org website, a fabulous journey that starts over 1,500 years ago and leads us to our times. Through a selection of selected photographs from this Catalan malariologist’s collection, we learn for example that Chinese traditional medicine already used the Artemisia annua plant (sweet wormwood) and that Andean natives knew of the curing properties of the Cinchona tree bark against recurrent fevers. These natural remedies contained the basis for the two main antimalarial drugs: quinine, which was the only available treatment during many years, and artemisinin, a powerful antimalarial for which Tu Youyou won the Nobel Prize in 2015.

The photographic trip proposed by malariatreatment.isglobal.org is peppered with curiosities: during almost 400 years, the remedy against malaria was obtained by crushing the Cinchona tree bark into a powder with therapeutic properties. It was only in 1820 that the Frenchmen Pierre Pelletier and Joseph Caventou managed to isolate quinine, the active ingredient, in their laboratory. To their scientific exploit, they added a humanitarian one: they did not patent their discovery, leaving it free to use.

Recipient for storing quinine hydrochloride made by Pelletier, Delondre and Levaillant. Photo: Quique Bassat.
 

The story of how the bitter taste of quinine led to the invention of different beverages is better known. This is how tonic waters and gin tonics were born (although preventing or treating malaria with these drinks is certainly tricky and likely associated with foreseeable side effects!) This is also the origin of tonics and quinine wines, which were advertised as a sort of miraculous restorative that made children and adults “fat as pigs”.

The close connection between malaria and wars is particularly interesting. As if it were a third army with its own agenda, the malaria-causing Plasmodium parasites played a key role in wars such as the American Civil War and both World Wars. In certain moments and places, malaria caused as many casualties as the battles themselves, sometimes leaving both opposing sides technically hors de combat. Hence, the discovery of a new treatment was almost equivalent to developing a new war weapon. In a blocked situation, the army capable of defeating malaria would have a definite advantage over its enemy.

The close connection between malaria and wars is particularly interesting. As if it were a third army with its own agenda, the malaria-causing Plasmodium parasites played a key role in wars such as the American Civil War and both World Wars.

This situation was particularly true during the Second World War when Java Island, where most of the world’s quinine was produced, fell in the hands of the Japanese army, who blocked the supply to the Allied forces. This is how a dark period in humanity became a small golden era for the fight against malaria, with the generalised use of mepacrine and the development of chloroquine and the first synthetic quinine.

Warning for soldiers to follow their treatment with Atebrin.
 

Something similar occurred during the Vietnam War, but with a new contender on board: parasites resistant to available treatments. From that conflict and the consequent arms race, two breakthroughs emerged, one by each opponent. The US, through the Walter Reed Army Institute of Research, developed mefloquine. In turn, China and the communist block put scientist Tu Youyou in charge of a research army. After plunging into the legacy of traditional medicine and analysing over 2,000 plant extracts, they finally developed artemisinin.

Before ending the journey, the monographic of malaria treatments makes a stopover in Spain and Italy, where malaria elimination became an affair of state during the 20th century

Before ending the journey, the monographic of malaria treatments makes a stopover in Spain and Italy, where malaria elimination became an affair of state during the 20th century. As result of the Civil war, Spain suffered an upturn in malaria cases, placing the disease as the 11th cause of death in the country in 1941. Fortunately, twenty year later the last autochthonous cases were reported. In turn, Italy went as far as creating a state-owned company to produce antimalarial formulations as diverse as chocolate bars with quinine. Its certification as malaria-free country arrived only in 1970.

The last stop reminds us that the journey has not ended. Today, malaria remains a major global health enemy. Climate change and the spread of parasites resistant to existing drugs push us to keep developing tools to control and, if possible, eradicate the disease. Meanwhile, and at the same time that he pursues his scientific career, Quique Bassat promises to keep nurturing his somewhat geek hobby, from which we have already learned these stories and that will give place to a small exhibition in the Faculty of Medicine (University of Barcelona) before the end of this year.

Read the complete story in malariatreatment.isglobal.org