This book deals with the long struggle against malaria in sub-Saharan Africa, from the colonial period to the first decade of twenty-first century. Webb investigates how first European colonial powers and later the United States attempted to eradicate or control this terrible disease. Webb's work examines the struggle over more than a century in a huge territory inhabited by thousands of ethnic groups and more than fifty political entities. His task is an arduous one because malaria is a complex disease resulting from the combination of different factors: plasmodium species, Anopheles species, climate, water patterns, vegetation, human behavior, and political economy.

The chapter about European vulnerability is extremely interesting. Webb discusses the implementation of residential segregation in a failed effort to protect Europeans against malaria. The analysis of asymptomatic carriers of parasites underscores beliefs relating to African immunity despite medical publications denying this misconception. Colonization favored the spread of different species of Anopheles into new areas, such as the introduction of Anopheles nili into Cameroon. The author discusses the choice of splenic testing to estimate the rate of malaria rather than investigations by microscope, and shows the importance of malaria control in urban colonial and mining cities.

Webb might have studied the problem of health policy priorities for European colonial powers, African states, the World Health Organization, and non-profits such as the Bill and Melinda Gates Foundation, in order to better explain the aborted campaign of eradication and the problems of insecticides and chemoprophylaxis. He does thoroughly explore the British and Belgian former colonies, but spends less time on francophone Africa. Regarding the Kampala Conference, specialists in Africa refused to use the word ‘eradication’ because entomological knowledge about mosquitoes was lacking for huge territories, especially rural regions.

Immunity to malaria is not like that against smallpox or yellow fever; it is a fragile or ‘temporal’ immunity. Webb stresses medical concerns regarding the danger of treating entire populations with the potential risk of undermining acquired immunity. This book analyzes the problems of malarial drugs, as well as the fact that insecticides abandoned after the eradication campaign of the 1950s and the 1960s are now used, despite of the dangers posed to the environment. Malaria continues to present a serious challenge for biomedicine in tropical Africa and throughout the world, even as contemporary efforts focus on finding a vaccine.