Malaria is a disease that has affected the lives and livelihoods of human beings from early history to today. Although its pathogen and its transfer via mosquitoes was revealed around the turn of the twentieth century, efforts to treat malarial fevers go back much further. Notably, quinine (from the bark of the cinchona tree) appeared in therapeutics in the seventeenth century, and is still used as a curative measure for malaria in various forms, such as chloroquine. However, the emergence of chloroquine-resistant P. falciparum, a critical malaria parasite, has been of global concern since the 1960s, and created the need for new medicines. One of most effective treatments to arise was ACTs (artemisinin-based combination therapies), which are based on derivatives of artemisinin, an extract from the herbal plant Artemisia annua. In this book, Dana Dalrymple explores the modern history of global efforts to develop ACTs and their contributions to the elimination of the current economic and health threats of malaria.

After briefly summarizing the literature on the significance of malaria control in public health and economics in Chapter 1, the author moves to Chapter 2, where he provides a detailed story about how ATCs have been developed. Chinese scientists first noted the antimalarial qualities of Artemisia in 1971, but it had long been used as a traditional herbal remedy for various diseases. It wasn't until the last three decades that the plant (as a form of ATC) was extensively used as a treatment, especially in Africa. The author describes how China shared this vital knowledge with the western world, how research on ATCs has been conducted on a global scale through “global cooperation,” and how international organizations like WHO have played a role in subsidizing, commercializing, and distributing the treatments. Chapter 3 is devoted to explaining the complex technical processing of the plant to prepare ATCs, involving production of the Artemisia plant, extraction of artemisinin, the preparation of more effective derivatives, and their blend with an appropriate companion drug. Some parts of this chapter require scientific and technological knowledge for complete comprehension, but the main point through the chapter is that the process has been complicated by who produces, how each process is operated, and how costly it is. While economic issues with regard to processing are discussed chapter 3, the author investigates economic factors from a global perspective in chapter 4. In particular, he describes the challenge of balancing the supply and demand of ATCs over decades. Their supply has been affected by incorrect demand predictions for Artemisia, technological improvement of extractions, the introduction of competitors (i.e., new antimalarial drugs), and the level at which production has been subsidized. Demand has depended on the fluctuation of malaria prevalence, national policies of adopting ATCs, and international subsidy programs. The author also describes various aid programs for deploying antimalarial medicines in Africa, which have been provided by international organizations and developed countries. He particularly examines the programs of USAID (U.S. Agency for International Development), where the author worked for many years. At the end of the chapter, he concludes that the appropriate context for developing ATCs is global in nature.

Chapter 5 addresses policy issues. He argues that the threat of malaria is a public “bad” and so the control of malaria requires public action and utilization of public goods in a global context. He specifically suggests that we can achieve positive externalities through efficient resource allocation. Regarding ATCs, he suggests a more active role for public/private interactions at every stage of production, and more research on extraction and distribution. He emphasizes the importance of balancing supply and demand for ATC production through more systematic management. Shortly after discussing the externalities of malaria control in Chapter 6, the author provides concluding remarks. Interestingly, the subtitle of the concluding chapter is “The Wisdom of the Red Queen,” an allusion to Lewis Carroll's classic Through the Looking-Glass. The dictum of the Red Queen is, “If you want to get somewhere else, you must run at least twice as fast as that.” An adherent to this dictum, Dalrymple concludes that triumphing over malaria will require even more effort than is currently being expended.

This book is a nice modern history of combating malaria through the development of ATCs. It explores the history that many economists in the economic consequences and determinants of infectious diseases have probably missed so far. In the middle of the book, the author expresses a concern that an ATC-resistant malaria parasite could someday emerge, necessitating the development of another antimalarial medicine. He questions whether treatment or prevention is more significant (p. 145). This is another issue pertaining to the resource allocation discussed above. The author has a balanced point of view, calling for the involvedness of economists to study how best to balance this allocation, but we may be able to take a hint from our history, which has shown that many countries eradicated malaria mainly through prevention and protection efforts.