Transcription
Most of history has been decided by men in closed-door meetings. Chances are you can already see it in your head, right? The whiskey, the cigars, the big suits.
But I wanna talk to you about another meeting I've been obsessing over, and I've been obsessing because almost nobody has heard of this meeting. It didn't get a book. It didn't get a Senate hearing. It didn't get a Christopher Nolan movie. But way more people died in the wake of this meeting than after the Manhattan Project, up to 200 times more. And this meeting doesn't even have its own Wikipedia page.
The meeting I'm talking about was the eighth World Health Assembly. 150 delegates from almost every major country came together to do something monumental: eradicate malaria. Okay, now I get it, malaria is not the sexiest thing to talk about. The YouTube algorithm would much prefer if I were reviewing some new iPhone right now. And hell, maybe you would, too. But you wouldn't be alone.
See, in 1955, malaria was not sexy either. This entire meeting only got a tiny corner in the back pages of The New York Times, sandwiched between two menswear ads. But it's hard to understate just how insanely audacious this idea was. I mean, first of all, no one had ever eradicated a disease before. And second, malaria was then, and still is, arguably the deadliest thing ever. Not the deadliest disease, the deadliest thing.
According to one estimate, malaria has killed 5% of all people who have ever lived. Malaria and the mosquitoes that carried the parasite used to kill people in almost every single country in the world. Whether you lived in America or Sweden or England, if you were born before this meeting, malaria might have killed you, too. But you're here. Malaria didn't kill you. And that's in no small part because of these 150 men.
With billions of dollars, military-grade insecticides, and the world's greatest scientists, they decimated malaria in almost every single place in the world. Almost every single place. See, when these guys got together to save the world, they didn't decide to save the whole world. They decided to save a slightly different world, a world that didn't include Africa, south of the Sahara Desert.
Question one, why'd they call this meeting in the first place? I mean, nobody had ever eradicated a disease before, so what made these guys so confident they could start with the worst one? Answer: because they'd learned to destroy it. Question two, how do you destroy the deadliest thing in human history? Same way you destroy anything, US military.
Malaria used to be a huge problem in America, especially down South. The survival rates of children born in South Carolina were 16%. You had a 16% chance of living to 14. That's crazy. That's part of the reason Americans kidnapped and enslaved so many African people. White farmers didn't wanna work the mosquito-filled fields, so they enslaved human beings to do it for them.
Originally, colonial powers were enslaving indigenous peoples in the Americas to use as slave labor, but very quickly, we lose 95% of indigenous peoples in the Americas. So then indentured servants are brought over as well from Europe to work. Well, they're suffering the malaria and yellow fever burdens as well. African people seem to be able to withstand the yellow fever and malaria onslaught better.
If you look at a map of the US slave trade, then you look at a map of American malaria, you'll see pretty clearly they're the same map. Places that had more malaria had a much higher demand for slave labor. So the story of American malaria was a lot like the story of malaria everywhere else. It killed a lot of people, but it mostly killed poor people. It killed slaves, it killed laborers, and low-income families in the rural South.
By the early 1900s, there had been a few big malaria discoveries, but they hadn't helped much. Scientists had learned that malaria was a parasite, for instance. They'd also learned that malaria was carried by mosquito bites. But know thy enemy only goes so far if you have no idea how to kill thine enemy. So despite all of these discoveries, malaria was still one of the leading causes of death in America, until the war.
When the Americans fought the Japanese in the Pacific, they were winning on the battlefield, but getting slaughtered by the mosquitoes. When 30, 40, or 50 men out of 100 are knocked flat on their backs by malaria, the military situation is far worse than snafu. If a soldier was lucky, malaria was just two weeks of the worst flu he'd ever had. It starts with feeling drained, like extreme tiredness. After that, fever, I mean, high fever follows.
But the malaria parasite literally eats through your red blood cells. That's how it works. At any point, that flu could suddenly turn deadly. The same soldier who was just coughing and watching cartoons could suddenly go into malaria shock. His blood pressure would tank, and his circulatory system would just completely collapse. There were a million other ways he could die of malaria. He could run out of iron, his lungs could fill with water, or his spleen could just suddenly burst.
General MacArthur's quote: "This is going to be a very long war. For every division I have fighting, I have one on leave and one in the hospital with malaria." So the military needed a solution, and they needed it desperately, and to find that solution, they had to find the greatest mind in malaria: Fred Soper.
He was a tall, corn-fed Kansas boy from a little salt mining town about an hour north of Wichita. Before Soper, everyone thought that fighting malaria was about fighting the parasite inside of the body, medications like quinine. Fred Soper thought that that was all boring, boring nerd shit. He knew that the best way to fight malaria was not to fight parasites, it was to fight mosquitoes. So Fred Soper became the best goddamn mosquito killer there'd ever been.
See, Soper had cut his teeth down in Brazil, where he basically wrote the book on killing mosquitoes. They'd called him into Rio after one of the most dangerous mosquito species had accidentally found its way into Brazil. Soper carved the country's entire northeast region into a grid, where he sent troops town to town, door to door, clearing mosquitoes. He made them check every cistern, climb along every roof gutter. After they'd check a house, he'd make them go back later and check it again. That's the kind of guy Fred Soper was.
So it was no surprise that the military loved him. But the military knew that Soper's ideas weren't nearly enough on their own. The military didn't have time to go door to door killing bugs. I mean, remember, this was going on at the same time as the Manhattan Project. The American military wasn't exactly thinking small. They wanted the atomic bomb, but for mosquitoes.
This is the story of a miraculous white powder that is helping to win the war. Its name is dichlorodiphenyltrichloroethane. DDT comes out of the malaria project in the United States that was given the same scope and secrecy as the Manhattan Project. Once they knew it worked, the US government went to chemical factories around the country. They told them to stop making whatever the hell it was they were making and start making DDT.
So by the early '40s, the US had their plan. They had Fred Soper's playbook for killing mosquitoes, and the world's best artillery to do it in DDT. So they boarded up planes with sprayers, scientists, and as much DDT as they could fit, and sent it all off to the Pacific. Turned out to be a great fucking plan. By 1945, they'd basically beaten malaria in the Pacific Theater. Disease rates fell 70% in Japan, 83% in Burma, so it wasn't surprising when the war very quickly started to turn in America's favor.
So back home, the rest of the government started getting excited, too. I mean, if they could clear malaria from military bases in the middle of the Pacific Ocean, why the hell couldn't they clear it in America? So that's what they did. They went back home and followed the same playbook. They took Fred Soper's best students and gave them as much DDT as money could buy, and in just a few years, the US government sprayed six and a half million homes, drained millions of acres of swamp, and completely eradicated malaria in the country.
That was the first time any country had eradicated malaria or any disease on that kind of scale, I mean, in a place where it had been killing tens of thousands of people. In the war against malaria and disease, this was the first sign that we could do the impossible. Everyone was incredibly excited. Could you imagine being the Americans? Could you imagine being Fred Soper? You just defeated the deadliest thing in human history. You must feel like God.
It was no surprise, then, that Fred Soper wanted to go bigger. His ambitions were way beyond America. He wanted to eradicate malaria in every corner of the world: Africa, Asia, South America. I mean, he was ready to kill mosquitoes in the North Pole if he could find them. So what does the little Kansas boy do? He starts playing politics, specifically in the World Health Organization.
When the previous World Health Organization director general stepped down, Soper helped install a new director general, a Brazilian named Marcelino Candau, who was much more sympathetic to Soper's mission to eradicate malaria. People are enthusiastic. When you think of the national character in the '50s, like, we can do anything. You know, build the tallest building, make the biggest bridges, build the world's largest road network.
So in 1955, when the World Health Organization met for their annual meeting in Mexico City, the schedule was Fred Soper's. The subject was his dream: a global crusade against malaria. They called it the Global Malaria Eradication Program. I mean, everyone was fired up. All the delegates in their best summer suits, the Mexico City sun. I mean, they were about to save the goddamn world.
But there was a hiccup. Should Africa be included in the plan? Nominally, they were asking a question about difficulty. Would it be possible to eradicate malaria in Africa, or would it be too large and too rural to get all the DDT sprayers there? But these weren't the only questions they were asking. There was subtext there.
Africa had always had this fraught and lethal relationship with the Western world, and the center of that relationship had always been malaria. It started like this. In the 1400s, Europeans desperately wanted to get into Africa. They wanted to steal resources, land, people. But malaria was like this force field keeping Europeans out of the interior. Every single time Europe tried to send a mission into Africa, they got beaten back by the continent's particularly lethal strain of malaria. The Tuckey Congo Expedition, for example, lost 75% of its men. The Mungo Park party lost two-thirds. When the British tried to station soldiers in Sierra Leone, half of them were dead by the end of the year.
So for years, Europeans exclusively operated from Africa's coast. The slave trade, for example, had to be operated from the shoreline. The Europeans can't go into the interior and capture slaves because they die, they just die. This was the paradox. Inside of Africa, malaria was this incredibly deadly force, but it was also keeping this other extremely deadly force, Europeans, out of the continent.
Until the 1870s. That's when Europe started mass producing this bitter white powder called quinine. At the time, quinine was the only thing that could keep you from getting malaria. The story of how they started mass producing quinine is its own epic about alpacas and the Bolivian police, but for now, just know that quinine used to be too expensive for Europeans to launch any real assault inside Africa. But then they found a new better version of the quinine tree, started mass producing it, and then the price of quinine fell 94%.
Then they had all the quinine they needed, so faster than anyone knew what was happening, European ships were loaded up with quinine, and they were suddenly slaughtering their way through the interior. Countless people died from European guns. The Belgians alone killed as many as 10 million people in the Congo. That was half the country's population.
And as far as malaria goes, Europeans didn't just find a continent full of malaria. In some cases, they created the malaria epidemics. Take Swaziland, for instance. Before the British arrived, Swazis typically lived at higher altitudes where mosquitoes were less common. That's how they kept themselves safe from malaria. But the British forcibly moved Swazi people from the highlands into the lowlands, where they made them farm. This turned malaria from a seasonal annoyance to a nonstop epidemic.
I mean, for me, this is the crazy irony. The Europeans got a cure for malaria, quinine, and then they used that cure to make malaria much, much worse for other people. And then, in Mexico City, the rich countries were deciding Africa's fate again. So when they asked, "Should Africa be included in the plan?" They were asking whether they should invest money to save the people they just conquered and murdered.
A lot of rich countries like England and America argued that it would be too difficult to eradicate malaria in Africa, and on this specific point, they weren't completely wrong. Eradicating malaria in Africa would have been difficult. I'll grant you that. Africa was much larger and much more rural than somewhere like the Southern US. But there were a lot of reasons to believe it was possible.
DDT, for example, had already shown really good success in certain African countries like Mauritius. Now, Mauritius is an island, which made it easier, but it had the same type of mosquitoes and a similar topography as other parts of Africa, and DDT spraying had basically eradicated malaria there. And besides, wasn't the whole point of this meeting to do a difficult thing?
The few African delegates that were in Mexico City tried to fight back, but it didn't matter. In the end, they called a vote on whether Africa should be included in the plan, and the rich countries just overwhelmed the poor countries. So when everyone walked out of Mexico City, the entire world had all the funding they needed to fight malaria, except for Africa. Africa was left to die.
A lot of people died. Hundreds of thousands of African people died of malaria in the year after the Mexico City conference, and most of them were children. Hundreds of thousands more died the year after that, and the year after that, and the year after that. But then the tides started to change. It started with a sexy young senator named JFK.
In the Senate, JFK became known as one of the most powerful advocates for poor people and poor nations. He tried raising the minimum wage. He tried getting the French out of Vietnam. And a few years after that Mexico City meeting, he pushed forward $100 million of new funding for the malaria eradication effort, just about a billion dollars today. And this new funding was one of the many reasons why the US and the World Health Organization were able to start ramping up pilot programs in Africa.
There were at least 24 well-funded campaigns in 21 different African countries. And for the most part, they worked miraculously well. Don't get me wrong, I mean, there were plenty of difficulties. It can be hard to get sprayers to rural places, and there were a thousand implementation issues. But on the grand scale, almost everywhere the DDT sprayers showed up, malaria rates started plummeting. Zanzibar and Swaziland, for example, got their case counts down to basically zero.
So in 1960, the world was looking bright. We had proven that we could beat, or at least control, malaria in every part of the world. And then we all lived happily ever after, right? Right? Right? Right? Not everyone was so excited about helping Africa, specifically a guy down in Louisiana, a congressman named Otto Passman.
Passman chaired the House Subcommittee on Foreign Aid, and despite his job title, he hated foreign aid. Now, I am not saying that Otto Passman was a bad guy. I am not saying that. But he was a hardline segregationist. He did get successfully sued for sexual discrimination, and he was later accused of taking bribes from a South Korean businessman. Also, he married his secretary right after his wife died. But I am not saying that he was a bad guy.
JFK and Otto Passman constantly fought over foreign aid, and they really came to blows in 1963. JFK proposed a budget that earmarked $4.9 billion for foreign aid, and importantly to our story, that budget included all of the funding necessary to renew the successful malaria programs that were going on in Africa. But even though it wasn't that much money, Otto Passman did everything he could to stop the bill. And in response, JFK did everything he could to pass the bill. He even, and this is true, tried to take Otto Passman on a nighttime cruise down the Potomac River to convince him.
But none of it worked. Some congressmen thought aid was frivolous. Others thought that it was stupid to send money to Africa when none of those countries were at risk of going communist. In the end, Otto Passman took a massive bite out of the foreign aid budget Kennedy had asked for and cut more than a third of the funding for Africa. And with all this funding gone, all of those pilots, those shining programs that were actually controlling malaria in Africa, where the WHO was actually about to fulfill its promise for global malaria eradication, they fell apart. First, the US pulled millions of dollars in funding from the World Health Organization, and then the pilot programs in Africa started shutting down one by one by one. And of course...
"Our nation is bereaved. The whole world is poorer because of his loss." And that became the world in Africa for the next 40 years, countless people dying of a disease we knew how to prevent.
Okay, so George W. Bush. Talk about a duality, right? So on one hand, you have the Iraq War. 500,000 innocent civilians dead. If you trust other people, it's more like a million. On the other hand, you have this campaign in Africa. In 2005, Bush launched the President's Malaria Initiative, the PMI. "As a compassionate nation, we are called to spread awareness about malaria." It was this massive program to fight malaria in Sub-Saharan Africa, and this was on top of PEPFAR, which he launched in 2003 to fight HIV/AIDS.
Researchers at Imperial College London estimated that in its first 12 years, Bush's PMI saved around 940,000 lives, most of them kids under five. That is almost a million people. George W. Bush. So I said, uh, why don't we work together to eradicate malaria in parts of Africa? And for all the Republican talk about how ineffective the government is, the PMI was insanely efficient. The whole program cost about $5 billion, which comes out to about $5,000 per life saved.
Now, bear with me on the math here, but charity evaluators like GiveWell, their whole job is figuring out the cheapest way to save a kid's life. They will tell you that the world's most effective charities right now can prevent a child from dying for about four or $5,000. That would make the PMI one of the best charities or one of the most effective uses of money ever.
Now, why the hell did he do this? Seriously, why did George W. Bush spend so much money trying to save African children? I actually want you to guess. I think it'll be fun. So take three seconds. I'll wait. You come up with a guess. Okay, you got one? It's probably wrong. He read Roots. If you don't know, it's a book about a young Gambian kid named Kunta Kinte who gets sold into American slavery. They made it into this big TV show. It was a really big deal at one point.
But George W. Bush, and this is all according to his autobiography, he wrote this, he was so transfixed by the book that he went to The Gambia, and he was so transfixed by The Gambia that he started surrounding himself with other evangelical Christians who deeply cared about Africa. The most notable one was a chief speech writer named Michael Gerson, this incredibly religious conservative who said this line, "What definition of pro-life does not include saving millions of people from preventable disease and death?" I mean, you cannot make this shit up.
The PMI spent 20 years rolling out all these incredible and life-saving tools. Bed nets, for example. Really simple. If you sleep under a net, you can't get bit by a mosquito, and if you don't get bit by a mosquito, you can't get malaria. These nets cost about $2 each, and they can cut a village's malaria rate by about 50%. Then there are other tools, like seasonal malaria chemoprevention. It's a very fancy name for a very simple idea. You give kids under five an anti-malarial pill during the rainy season, which is when the mosquitoes are at their worst, and the pill, despite only costing around $6 per kid, can reduce a child's chance of dying by around 80%.
"Every life matters to the American people. Every life is precious." And they kept saving hundreds of thousands of lives long after Bush left office: under Obama, under Biden, and even under the first Trump administration. But if you're picking up on the pattern here, or if you've been watching the news, you'll know that this success did not last.
"It's absolutely obscene, dangerous, bad, very costly. I mean, virtually every investment made is a con job." Last year, Trump paused the PMI completely. Then he proposed a new budget that cut the PMI in half. "You have an uncomplicated malaria, it's becoming a severe malaria. And then after that, there is death." A few weeks ago, he signed a new, new budget that seemed to restore the PMI's funding. A lot of people doubt they'll be able to do anything with the money without any USAID staff or infrastructure. You know, it's not clear on the how. Yeah, you, you remember that USAID is closed.
At the same time, the EU has also majorly pulled back its malaria funding. It's actually the European countries that have cut back by between 15 and 50%. And at the same time the world is doing less, the problem is getting much, much worse. Now, malaria cases are at their highest point in decades. And this is for a lot of reasons, like climate change, for example. Mosquitoes do better in warmer environments, so as the world is getting hotter, mosquitoes are carrying malaria into places that used to be too cold for the disease, like Nepal, for example.
So it seems from all this research and from everyone that I've spoken to, that we're at this incredible inflection point. We can either do nothing and watch this problem get much, much worse, or we could do something. I feel like the same thing always happens whenever I hear stories like this. Maybe it does for you, but it definitely does for me. The problems just feel so big that I, I just shut down, right? Like, okay, someone tells me that a child dies every minute from malaria, and, and that's just, it's the worst thing I've ever heard. Like, I wanna go think about literally anything else, and, and so I do. I stop thinking about it.
But malaria is a special kind of problem because we know exactly how to solve it. And a lot of problems aren't like this. I mean, Alzheimer's, for example, right? We have a lot of treatments to manage symptoms, but all we can do is just keep researching, keep funding trials, and hope for the best. I mean, we don't know how to solve it. Malaria isn't like that. We know how to prevent malaria. We know how to treat malaria. We know how to keep kids and pregnant women from dying of malaria. And we have known all of this since 1955, and we have only gotten smarter in the years since then. Malaria is preventable, it's treatable. We've got the tools, we just need the money.
Here's another way that malaria is special. By a lot of calculations, spending money to prevent people from dying of malaria is one of, if not the most cost-effective way to save a human life. But say you want to solve the whole problem, right? I mean, there's something really sexy about eradicating an entire disease. And that's the last piece of good news. Leading authorities agree that with enough money we have the ability to completely eradicate malaria.
Okay, I will end with a little confession. This research process was not my first time hearing about malaria. I found out about it in high school, and it just always from then seemed so crazy to me that a kid could die of some arcane disease just because he was born in the wrong place. Right? And I was born in the right place. Like, I was born in New Jersey. And so I… Okay, so when I was 16, I was working the front desk at a massage parlor in New Jersey. I was making minimum wage, $10 an hour, and I'm not kidding, I was donating 10% of that money to buy malaria nets.
So I guess, um, I'll end with an invitation. I worked with a nonprofit called Giving What We Can to make a very simple webpage. First, it has a bunch of cool links to read more about malaria and also to fact-check literally everything that I have said. And second, it includes a list of the most cost-effective charities evaluated by places like GiveWell, where you could contribute to ending this thing. I mean, most of the time problems are, like, way too big, um, or way too complicated or too far away, or they depend on, like, a million other people need to vote a certain way, or some president or senator needs to do something. B- but this one isn't like that at all. I mean, this problem has just been sitting there for decades, waiting for enough people to give a shit. Thank you for watching.