The amazing journey of the struggle against a thousand-year-old disease

There are people who collect stamps, cava badges or Star Wars figures. There are collectors of books and records, coins or objects related to the cinema. And then there is Quique Bassat. This doctor hoards one that is probably one of the largest collections of elements related to malaria, a disease that killed 435,000 people in 2017 and that affects 219 million people affected.

This pediatrician dedicated to the investigation of infectious diseases in countries with few resources is the bearer of a position that requires a certain intellectual quotient simply to memorize it: ICREA research professor and coordinator of the Malaria program of the Institute of Global Health of Barcelona (ISGlobal), center drove for “la Caixa”.

One day, without any extortion or coercion, Dr. Bassat confessed that he cultivated this hobby in line with his position. The extensive journey of this disease that humanity aspires to eradicate begins 1,500 years ago and leads to the present and we have decided to summarize it on this website. Through a selection of photographs from the collection of this Barcelona malariologist we know, for example, that traditional Chinese medicine already made use of the Artemisia annua plant that the Andean Indians knew the properties of the bark of the cinchona tree against recurrent fevers. In these two natural remedies is the basis of two of the main pharmacological treatments against malaria: quinine, which for a long time was the only existing treatment, and artemisinin, a powerful antimalarial for which Tu Youyou was recognized with the Nobel Prize. Medicine in 2015

The photographic tour of the sample is sprinkled with curiosities: for almost 400 years the remedy against malaria was obtained by crushing the bark of the cinchona tree until a powder with therapeutic properties was obtained. It was not until 1820 when French pharmacists Pierre Pelletier and Joseph Caventou succeeded in isolating quinine, the active ingredient in cinchona bark, in the laboratory. Later, to their scientific feat, they added another of humanitarian character: neither of them chose to patent their discovery, with what was left free for its use. Malaria is today a disease of the poor mainly: 70% of the cases in the world of this disease are Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda, and Tanzania.

Well, known is the story of how the bitter taste of quinine led to inventing various concoctions with which to make the most pleasant drink. This is how the tonic waters and the gin-tonics were born (although anyone who tries to prevent or treat malaria with one or the other has it complicated and risks some predictable secondary effect). It is also that the origin of tonics and wines quinados that were offered as a kind of restorative panacea for children and adults could become ” fat as pigs “.

Especially interesting is the close relationship between malaria and wars. As if it were a third army with its own interests, parasites of the genus Plasmodium, causing malaria, have played a leading role in the war of American secession and in the two world races, among others. In specific places and situations, malaria caused as many casualties as the battles themselves, reaching the point of leaving both sides technically opposed to combat. Hence, the finding of a new treatment came to have a range almost equivalent to that of a new weapon. In a situation of blockade due to medical losses, the army that managed to defeat malaria could gain a decisive advantage over its enemy.

In Spain and Italy, eliminating this disease became a matter of State. During the civil war, there was a rebound of cases that placed malaria among the leading causes of death

This situation occurred in a very particular way during the Second World War, when the island of Java, which concentrated much of the world production of cinchona, fell into the hands of the Japanese, who cut off the supply to the allied powers. In this way, an unfortunate period in the human being ended up becoming a small golden age for the fight against malaria, with the generalization of the use of mepacrine and the development of chloroquine and the first synthetic quinine.

Something similar happened in the Vietnam War, although with a new contender on the board: the parasites resistant to the known treatments. From that warlike confrontation with a branch of the arms race, two advances emerged, one for each block. The United States, through its military research institute Walter Reed, developed mefloquine. At the same time, in the Communist bloc, China put the scientific Tu Youyou in charge of an army dedicated to research. After diving into the legacy of traditional medicine and analyzing more than 2,000 plant extracts, they managed to develop artemisinin.

Before finishing the tour, the monograph on malaria treatment stops in Spain and Italy, where eliminating this disease became a state issue during the 20th century. As a result of the civil war, Spain suffered a rebound of cases that placed malaria as the eleventh cause of death in the country in 1941. Fortunately, 20 years later the last indigenous cases were declared. Italy, on the other hand, came to set up a state company to produce antimalarials in formulations so diverse that they even included chocolate bars with quinine. The malaria-free country certification did not arrive until 1970.

The last station serves to remind you that the trip is not over yet. Malaria is still one of the main enemies of global health. Climate change and the expansion of the parasites resistant to the treatments that we know make it necessary to continue developing tools to control and, if possible, eradicate the disease. In the meantime and while developing his scientific work, Quique Bassat promises to continue cultivating his somewhat geeky hobby of which, at the moment, we have already extracted these stories and that will lead, before the end of the year, to a small exhibition in the Faculty of Medicine of the University of Barcelona.

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