The Long Struggle is a concise, informed history of malaria as a leading cause of death in sub-Saharan Africa and of the attempts to control the disease. Webb calls his work historical epidemiology. It clarifies the most salient and important medical developments while charting a clear and comprehensible path through what might otherwise appear as a bewildering forest of Latinate species names, insecticide acronyms, and complex drug regimens. An accessible 170-page narrative of malaria and malaria control for all of sub-Saharan Africa is a genuine coup.On the one hand, this book is a straightforward chronological narrative, ranging from the early colonial experimentation with environmental engineering and drug treatment to the consequences of the World Health Organization’s interventions, the postwar dichlorodiphenyltrichloroethane (ddt) spraying, the phenomenal successes resulting from the use of chloroquine in the 1960s, and finally the impact of the Gates Foundation and the public distribution of mosquito nets. On the other hand, Webb’s history is far from simple, an attempt to navigate a volatile tectonics of ever-shifting and interconnected local variables with economic, political, environmental, and biological overtones. In addition, Webb considers the consequences of decolonization, the Cold War, economic and environmental change, population growth, and urbanization for malaria infections and malaria-control programs.Webb’s presentation ensures that none of the relevant factors and conditions fails to register. His analysis even attempts to account for the racially motivated residential segregation of the colonial era, local African responses to malaria, and the relationship between sub-Saharan Africa’s vulnerability to malaria and its vulnerability to other diseases, like hiv/aids. Embedded in Webb’s narrative are the unavoidable but sometimes jarring movements between diverse locations, variables, and categories of analysis that continually demonstrate the degree of complexity involved.Webb, however, does not acknowledge all of the complexities equally. While moving among the different registers of the malaria story, he maintains an oddly remote geopolitical neutrality. He levels strong criticism at African states but not so much at forces outside Africa. Hence, colonialism, Cold War−era neocolonialism, World Bank structural adjustment, U.S. neoliberalism, and modern science receive nearly a free pass in his analysis. Webb does not even mention the colonial and postcolonial tendency to represent African bodies and environments as if they were diseased, or the freewheeling medical experiments made possible by vastly unequal power relations. Colonial and postcolonial science and scientists—which have received considerable censure in the works of other historians and, admirably, in some of Webb’s other work—come across as surprisingly homogenous, humane, nonpolitical, and mutually cooperative in this book.Webb evinces an unfortunate, passive tendency to apportion considerable blame on African malfeasance, as, for instance, when he reports that African importation of cheap cereals favored urban populations at the expense of local farmers without mentioning the extent to which the global north subsidized food dumping (115). Another example is his complaint that the phenomenal mineral wealth of Africa was not effectively applied to public health—“most industrial profits fled Africa” (146)—as if this assertion were adequate to explain the economics of the situation. The rapacious strategies of the multinational corporations that promoted, and continue to promote, this “fleeing” of African wealth from local people and governments is completely neglected in his study. Scholarship that fails to appreciate the ramifications of the vast disparities in power between Africans and outsiders throughout history lacks a key set of explanatory rubrics.Despite the meager consideration of colonial and neocolonial power relations in his analysis, the medical history at the center of Webb’s study is compelling. The seemingly inevitable collapse of every control program eventually resulted in resurgent vulnerabilities for generations of people. Webb successfully demonstrates the extent to which Africans lost whatever immunities to malaria they might have gained with the introduction of even semi-successful control programs. Within dynamic political, economic, and environmental African contexts, the rise and fall of control programs left previously immune generations more, not less, vulnerable.Added to this problem is the ability of malaria pathogens and mosquito species to develop resistance to a particular drug and then to lose it when that drug is no longer in use. As a result, in the context of shifting geopolitical and natural variables, malaria eradication begins to look like an unachievable goal. Webb, however, is hardly opposed to medical interventions. In full recognition that complete eradication is a fantasy, sustained to promote governmental and nongovernmental support for public-health programs, Webb argues nonetheless for local and national disease management as well as palliative measures and general health-improvement strategies—a smart and humane conclusion to his detailed research of the subject.
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Jan 1, 2024
Sara Moussavi 
Open Access