Members can sign in here.

About the Author

Bart Knols
Medical Entomologist (Dodewaard, Netherlands)

Bart G.J. Knols (1965) is the Managing Director of MalariaWorld, the world's first scientific and social network for malaria professionals. He is a malariologist with a Masters degree in Biology and a PhD in Medical Entomology from Wageningen University, the Netherlands. He also obtained an MBA degree from the Open University (UK) in 2006, for which he won the prestigious international ‘MBA Student of the Year 2007 Award’ as well as the Alumnus of the Year Award from the Open University. With 11 years of working experience in Africa he has managed large-scale research and vector control programmes on malaria for ministries, international or national research institutions. He has worked for the UN (IAEA) as a programme manager for three years, has served as a consultant for the World Health Organization, and is currently a Board Member of the UBS Optimus Foundation, the second largest charity in Switzerland. He has published over 130 peer-reviewed research articles, has written 16 book chapters, and has served as senior editor on a WHO/IAEA sponsored book on implementation research. In 2007 he co-edited a best-selling book titled 'Emerging Pests and Vector-Borne Diseases in Europe'. He received an Ig Nobel Prize (2006), an IAEA Special Service Award (2006), and in 2007 he became a laureate of the Eijkman medal (the highest award in the field of tropical medicine in the Netherlands). He has been a member of the Royal Dutch Academy of Arts and Sciences since 2004. Bart held an Assistant Professorship at Wageningen University until April '09 with projects across Africa. He currently directs K&S Consulting, a firm he founded in the beginning of 2007.

Post

War…Huh! What Is It Good For? Absolutely something!

Published 08th June 2010 - 29 comments - 12735 views -

For those of you that do not know the classic anti-war protest song by Edwin Starr that was released during the Vietnam war, have a look first.

 

 

It ain’t hard to be convinced that war is good for absolutely nothing. I agree. During my high school days I wore a peace sign button on my coat. And although it is gone now, I am still a pacifist. So if you got worried after reading this blog title, don’t. I am still on your side.

And like you read in the un-development MDGs, if we would half the arms transfers to the developing world by 2015, we’d all be much better off. All that money could be used in much better ways than for AK47s, bullets, and grenades.

But here’s a little ‘but’ for you.

Next time, when you sit out in the garden during a nice summer evening, and you apply the mosquito repellent DEET on your arms and legs, don’t forget to say ‘Thank you’. 

vietnamWhen you travel next to a malaria-endemic country and you take mefloquine (Lariam) as prophylaxis, don’t forget to say ‘Thank you’ every time you swallow a tablet.

Chloroquine is an anti-malaria drug that has saved millions of lives over the last five decades. It is still in use in many parts of the world, and continues to cure people. That’s millions of times ‘Thank you’. For the first seven years I lived in Africa I took chloroquine as a prevention against malaria. ‘Thank you’.

Sulphadoxine-pyrimethamine (Fansidar) is an anti-malaria drug that is being used by more and more African women during pregnancy (called intermittent preventive treatment, or IPTp). Thousands of infants are receiving the same drug to prevent malaria during their first year of life (IPTi). All of them should say ‘Thank you’.

If you ever bought yourself an insecticide-treated pair of trousers for hiking in tick or mosquito infested areas, don’t forget to say ‘Thank you’ every time you are out in the sticks.

The ‘Thank you’ is for: 

The United States Army.

I know I know. If the title did not upset you already, the ‘Thank you’ to the US army may have. Or perhaps I upset you twice in a row. I’m sorry.

But it was the US Army that wanted something to protect their troops against insect bites in thick tropical jungles. They screened thousands of chemicals as repellents against mosquitoes and discovered DEET, now used by more than 200 million people annually around the world. How many bites were prevented with this chemical over the last half Century? How many lives were saved as a result of it?

And it was the US Army that spurred research into medicinal chemistry during WWII that led to the development of chloroquine. When the allied forces were cut off from the quinine supply after Japan invaded Java in March 1942, where 90% of theus armyglobal production of quinine came from, they were forced to massively invest in research on synthetic anti-malaria drugs. Chloroquine came out of this research (after it was shelved by German scientists as being too toxic).

And it was the US Army that, following resistance to chloroquine, developed Fansidar to protect its troops during the Vietnam war.

And it was (and still is) the US Army that invested heavily in the development of insecticide-treated clothing to protect troops.

I’m on thin ice here, but dare I say that more lives were saved by these products and drugs than the casualties suffered during the wars in which these were developed? In all likelihood: Yes.

So what’s going on here?

First, it shows that innovation is spurred by the need for change. And change is directly dependent on a ‘sense of urgency’. When the allied forces lost access to quinine during WWII, it created a massive sense of urgency. In some of the Pacific battlefields more lives were lost to malaria than to bullets. General McArthur reported back to President Roosevelt: ‘Of every three soldiers, one is in bed with malaria, the second one recovering from it, and the third barely fit enough to fight’. If the allied forces were to win the war, they needed a new anti-malaria drug. A year later they had one in production (in the form of Atabrine, also first discovered by the Germans).

Second, the DoD (Department of Defence) has never been short of cash. Well-endowed laboratories, recruitment of top scientists, and ample resources fuelled successful discovery of new drugs and anti-mosquito products.

Third, the US Army is not interested in science that is not of direct relevance to its forces. So the research is directly geared towards immediate benefits in terms of prevention of disease or cure of it.

Fourth: rigour. Only the US Army would screen tens of thousands of chemicals for activity against mosquitoes or parasites.

War is good for nothing. But the war machine has delivered public health benefits that cannot be underestimated. Millions of people around the world owe their lives to it.

 

Further reading:

Bwire, R. (1999). Bugs in armor: A tale of malaria and soldiering. iUniverse.com. 187 pp.

Slater, LB (2009). War and disease: Biomedical research on malaria in the twentieth Century. Rutgers University Press. 249 pp. 


Category: Health | Tags: malaria, war, drugs, public health,


Comments

  • Ian Sullivan on 08th June 2010:

    Nice post - war always spares on scientific development in virtually all fields (although I’m not going to write a post thanking for atomic and nuclear development-  “when you turn on a light say “thanks” - hhhmmm).

    Interesting paradox that the deisre to destroy leads (ofen inadvertantly) to advancing causes that save lives…


  • Bart Knols on 08th June 2010:

    @Ian. And you know what? Research in the field of nuclear technologies did not only lead up to the Manhattan project that resulted in the A-bomb, but also spurred research that gave us cancer therapy…

    Indeed, something very bad that yields something very good. Perhaps we need research institutes that have the same discipline, drive and resources as the US Army, so we can do away with the war part and only keep the good stuff…


  • Bart Knols on 08th June 2010:

    @Ian. And before I forget: Some of the major malaria initiatives currently underway are led by military personnel. The best example is Rear Admiral Timothy Ziemer, who heads the US President’s Malaria Initiative, a 1.2 bn $ five year programme. See: http://www.fightingmalaria.gov/about/bio_ziemer.html


  • Giedre Steikunaite on 08th June 2010:

    Great post Bart, you pacifist! wink

    Funny, but the US actually benefited from probably every single war they went to. WW2 was obviously the best deal they ever got. And let’s not forget the goods that came out of Silicon Valley, CA.

    What do you think, Bart, if there were no Army, would all that good stuff have been done by civilian scientists? I mean, given the extraordinary circumstances of war and the situation of troops in the field, and also the money the armed forces have.


  • Bart Knols on 09th June 2010:

    @Giedre. Thanks for kind words. I am not aware of a link between Silicon Valley and a US war, can you enlighten me?

    Regarding your question, I honestly think: No. It would not have been done. Sadly enough, the US wars have given the global population more drugs and tools than any other scientific endeavour.

    Perhaps the situation may change now that well-endowed charities like the Gates Foundation are pumping in billions in global public health. Whether these projects will have the same rigour to come up with products remains to be seen. Military discipline is certainly very much different from my own experiences in academic environments (where output in terms of products is only secondary to outputs in terms of academic papers in top scientific journals, see: http://development.thinkaboutit.eu/think3/post/can_science_cripple_development

    Let me know about Silicon Valley, pls.


  • Iris Cecilia Gonzales on 09th June 2010:

    Bart,

    Very informative. Palawan in the Philippines comes to mind. It’s a malaria infected area. Thanks for this.


  • Inge on 09th June 2010:

    ‘Thank you’.
    ‘Thank you’ Bart for a wonderful story.

    I am a pacifist too but still wondering how to make the world realize that malaria is a war worth fighting now. There is already a battlefield where some 3000 people lose their lives everyday despite all our efforts to tackle the disease.  So much for the sense of urgency and the need for change.

    As far as my army knowledge goes (close to zero; always been a pacifist) I could imagine that it is about strategy and implementation, a.o. That doesn’t sound bad in the fight against malaria. I welcome any applied innovation today. Let’s not wait until tomorrow.

    If it were 3000 american soldiers dying every day of malaria what would the US army do?


  • Jan Marcinek on 09th June 2010:

    Nice post. A saw series The Pacific from the creators of “Band of Brothers” telling the intertwined stories of three Marines during America’s battle with the Japanese in the Pacific during World War II.
    I remembered it while reading your article.


  • Bart Knols on 09th June 2010:

    @Iris. Thanks. I just read a gripping story yesterday about Mindanao and malaria in WWII. It had to do with smuggling of quinine tree seeds by allied forces (which succeeded) and were taken to Costa Rica. Unfortunately the trees were only big enough for harvesting after the war ended…

    @Inge. These are highly valid observations, thank you. The sense of urgency when it gets to malaria in the developing world is indeed not high enough. Half-hearted control measures are in place, where military discipline and precision could in all likelihood end the scourge. The point goes back to the issue of chronicity. As long as children die every day, we forget (see: http://development.thinkaboutit.eu/think3/post/malaria_when_sudden_beats_chronic)

    As for your last comment: If the US Army would suffer the loss of 3000 troops every day, believe me, the world would look different!

    In his 1946 book, Paul Russell describes the ingredients for successful malaria elimination:

    - Law
    - Persuasion
    - Organization
    - Training
    - Supply
    - Technical operation

    Follow this, and you can go a long, long way in combatting malaria… This then goes back to my arguments about Fred Soper (http://development.thinkaboutit.eu/think3/post/the_man_who_saved_brasil)


  • Bart Knols on 09th June 2010:

    @Jan - thanks. Much appreciated.


  • Giedre Steikunaite on 09th June 2010:

    “Major reforms in the US were brought by warfare.” My US professor at uni.

    During WW2, California became one of the main areas for the military, it was basically the Pacific front. Shipbuilding, aircraft, Navy, Marines, Army, all the defense industries were there. Much of CA’s prosperity in the 1950s and 1960s was built on federal money, especially military. Naturally, because such a big war machine was deployed there, so was scientific research. This was the start. Then later, after the end of the Cold War, all these defense industries collapsed, as federal money was stopped being poured in. This left lots of smart people and high-tech infrastructure in CA. Turning to this high-tech industry was one of the ways in which CA rebuilt itself in 1990s after the recession which was partly caused by the end of the Cold War. Computing, high-tech, Silicon Valley were the causes and products of the long love affair between CA and the military. Garrison State, they call it.

    “Thank you”. wink


  • Bart Knols on 09th June 2010:

    @Giedre - many thanks for this info. I wasn’t aware of this string of events fuelled by the US ware efforts.


  • Giedre Steikunaite on 09th June 2010:

    Bart, I’m glad I can be helpful. California is as much the Golden State as it is the Garrison State. It’s been like this since it was taken from Mexico. But it is still America’s America… smile


  • Roger on 09th June 2010:

    Bart

    Would you write a similar post about the benefit derived from Nazi or Japanese “science and medical research” during WWII?

    On the ethics of such research see http://bit.ly/bSkgOZ

    ~r


  • Bart Knols on 09th June 2010:

    @Roger. Many thanks for bringing this up - it’s an interesting point.

    Having read the article, the experiments performed by the Nazis fall way outside the scope of the above discussion. The products and drugs that culminated from research on mosquitoes and malaria is very distant from the 4 types of research performed on Jews by the Nazi doctors.

    I do know, however, that the Nazis also experimented with malaria, but need to look this up.

    As to the ethics of using the information that came out of these experiments I tend to agree with the author (see conclusion section 7).


  • John McConnell on 09th June 2010:

    Good post Bart. Sorry to be a pedant, but I suspect General McArthur reported back to President Roosevelt.


  • Bart Knols on 09th June 2010:

    @John. Of course John, you’re right. I’ll change the article immediately. Thanks for picking up this error.


  • Serge Christiaans on 09th June 2010:

    Thank you, Bart, for this extremely valuable post and for being a pathfinder for the eradication mission.

    Ethics and science aside, If the military taught us one thing it is how to plan and execute large scale operations involving an enormous amount of people and material. The logistics behind a war is not only very complex, but also crucial to victory, whatever side you’re on.

    Since the US got such a great deal out of WW2 (Accepting only the USD as currency on the global oil market created a never ending demand for the US currency, which is still boosting the US economy to a huge extent) they simply could afford the research. And we all suspect that this research would not have been done without this very large and rich victory driven community we call the US Army. Their contributions to science demand respect.

    As to the solution to malaria, everybody agrees that we should not wait until tomorrow. But what are we doing? What have we really achieved the past decades? We’ve created an enormous amount of reports, research papers and books. But still, 1 child every 30 seconds… Need I say more?

    So why is it quiet around the topic of malaria ERADICATION? We study the enemy, know the threat, know it’s location. We demand victory, but we do not create a task force to destroy the enemy. Why?

    Because the planning and execution of such a large scale operation can only be done the military way? Because the logistics experience required can only be gained during large military operations? Because the required discipline can only be found in the military?

    Let’s create a commercial company which holds all this knowledge and eradicate malaria for once and for all.


  • Bart Knols on 10th June 2010:

    @Serge. Thanks for your interesting contribution to this discussion.

    It is indeed true that with elimination as the endgoal that complexity goes up. It is no longer a bit of this and that (nets, drugs, a bit of indoor spraying) but a well-orchastrated definitive campaign that requires (yes I use the word) military precision.

    That’s why I feel that the staging of such a campaign by voluntary community members with minimal training will be difficult, if not impossible. We don’t ask civilians to stage a war for us, we have highly trained military troops to do so. Don’t get me wrong: You can’t do it without community consent, but you can do it without their involvement.

    As mentioned in the blog ‘The Man who Saved Brazil’, this army can be made up of young, well-trained people who are now on the street, unemployed. After 45 comments in that blog, I have not seen a single argument why this cannot be done.

    And indeed, we know the enemy, know where it breeds and rests, where it feeds, where it hides. We have good tools to combat them right at the source with a biological and environmentally benign insecticide (Bti). It is not a matter of tools and lack of know-how, it is a lack of strategy.

    Not a single person working in the field of malaria today has been involved in the elimination campaigns of the past. So we need to start learning the tricks of the game once more. But unlike our predecessors, we have a huge advantage: technology, specifically ICT. This will make the logistics of elimination campaigns an order of magnitude easier compared to the ‘old’ days.

    Now’s the time to start…


  • Elsje Fourie on 10th June 2010:

    Very nice post, Bart.  It’s interesting how even the most worrying political developments often have a silver lining.  Your post also reminded me of the role that war played in advancing women’s rights in Europe and the US…when men were out of the country, fighting World Wars I and II, women were often left to run businesses, factories, etc - and thereby got used to a level of independence (financial and otherwise) that they never again completely relinquished.


  • Bart Knols on 10th June 2010:

    @Elsje. Woow, I wasn’t aware of this effect, but very interesting indeed…


  • Clare Herbert on 11th June 2010:

    I wasn’t quite sure where you were going with this post, but as always, you pulled it off. Interesting reading.


  • Bart Knols on 11th June 2010:

    @Clare. Well, if I would have started the blog with ‘Say ‘Thank you’ to the US Army’ I would have missed the surprise effect… I guess one learns from reading many excellent blogs on TH!NK3.


  • Marit on 14th June 2010:

    Thanks for this interesting post Bart!

    It seems to me that both urgency and capacity were the 2 major driving forces behind the success of the US army.
    This makes me wonder if the threat of tropical diseases coming closer to the richer, Western societies (due to potential climate change and globalisation) would be the necessary trigger for them to put much more effort in the development of eradication strategies.

    What’s your thought on this? Do we (the ones with actual capacity) need more urgency to win the war against malaria?


  • Bart Knols on 14th June 2010:

    @Marit. Thanks for comment.

    There is no doubt that the threat of tropical diseases for the developed world has led to much higher investments in research. A great example is the West Nile virus. Before it invaded New York in 1999 nobody cared and it was merely a problem of the ‘other’ world.

    But after the USA was flooded by the virus massive amounts of funding became available for research. By now thousands of articles have been published and a vaccine is being developed. This will, ultimately, benefit the poor of the planet.

    The same is happening with the Chikungunya virus, also of African origin. But again, this is a threat directly on our own soil.

    So you’re absolutely right: we need a higher sense of urgency on this side for problems on the other side.

    There is so much to learn from the American mosquito abatement districts (see: http://development.thinkaboutit.eu/think3/post/when_a_killer_disease_strikes_what_do_you_do1) so a simple transfer of knowledge would already be a good thing….


  • Jan Peter Verhave on 18th June 2010:

    Dear Bart, The introduction of Atebrine in the US and its forces abroad did not go smoothly at all. The famous medical science writer Paul de Kruif (roving editor of Reader’s Digest) had already written enthusiastically about this drug as a replacement for quinine in the southern malarious States (Georgia) (RD August 1938). When the US joined the War he wrote “Enter Atabrine-exit malaria” (RD Dec. 1942). It caused a flood of critical remarks by US medical officials and journals, “entirely erroneous”, “misinformation, potentially dangerous to civilian health and the war effort”, reasoning that the superiority to quinine was not proven and with one drug malaria cannot be eradicated &&. Two years of “necessary” additional research followed, with the military in malarious areas meanwhile unprotected. Fortunately, some medical generals did not care about the opposition at home and had their personnel swallow the yellow pills. Finally, in 1944 the National Research Council approved of its use. Paul wrote “Atabrine fully vindicated: Malaria, scourge of mankind, CAN be licked (RD Dec. 1944). This part of the story is lacking in Slater’s “War and Disease”.
    Jan Peter Verhave
    P.S. I write a biography of Paul. Any info on him is welcome!


  • Bart Knols on 18th June 2010:

    @Jan Peter. Thanks very much for this additional insight. It is very interesting to note how individuals’ perceptions get snowed under by the going ‘groupthink’.

    I am currently reading ‘The excellent powder: The political and scientific history of DDT’ which appeared in April this year. It irradiates the same: how few people with well-meant intentions get snowed under by public perception and political games, leading to completely the wrong decisions. I will write about that soon here.

    Many thanks for your comment, much appreciated.


  • Daniel on 28th June 2010:

    Great post smile The role of the military in the history of innovations is under debate, but without doubt armed conflicts speed up all kinds of developments. And as you say - armies in war do not operate under a budget, so they can simply do what needs to be done.

    But this one: “I’m on thin ice here, but dare I say that more lives were saved by these products and drugs than the casualties suffered during the wars in which these were developed? In all likelihood: Yes.”

    I would say NO! The developing world would not be underdeveloped today if it wasn’t for western armies, including the US Army. Would people die from malaria today if there was no colonialism and no hot conflicts in the cold war? Don’t think so.


  • Bart Knols on 29th June 2010:

    @Daniel. It is hard to find figures to back up my statement (hence the ‘thin ice’), but consider the following: chloroquine (a direct result of WWII) has been in use for 55 years. Although no longer effective in Africa, it has been used there for at least 4 decades. Hundreds of millions of malaria cases were treated successfully with this drug…

    The story is similar for Fansidar, an outcome of the Vietnam war. Again, hundreds of millions of lives saved.

    200 million people use DEET as a mosquito repellent every year, also in 2010. Five decades of use must have prevented hundreds of millions of cases…

    So the odds way up.

    Malaria with or without colonialism wouldn’t have made a vast difference (unless you can give me examples I remain unaware of), nor does the cold-war conflict bring examples to mind. I stand to be corrected here…


Post your comment

  • Remember my personal information

    Notify me of follow-up comments?

    --- Let's see if you are human ---

    A human creature that practices the art of "blogging" is called a... Add a questionmark to your answer. (8 character(s) required)