The Vast Malarial Microclimate

I'm not much interested in pediatrics, per se, since my days of being a pediatric textbook case are long behind me, and I hope never to have to be involved with the stuff again, but a blogger called Neonatal Doc has a thought-provoking post up called Malaria that discusses an interesting resource allocation problem. Neonatal Doc notes in passing that the money used in keeping one extremely premature (26 weeks' gestation) baby alive, if reallocated differently, could prevent countless deaths in Africa from malaria, by providing insecticide-laced mosquito nets and medical treatment for infected people.

A lot of ND's commenters seem to miss the point -- he's not arguing that the money should be diverted, or even that it will be, he's just noting in passing that in this case, where you stand often (as always) depends on where you sit.

I quite liked the article, and the comments were informative, although rather tangential and oftentimes missing ND's point entirely. However, I can't completely give ND a pass (and I left a comment at his blog about this) for the first half of the very first sentence in his post, which was: Malaria is one of those diseases that has practically no significance in America, to which my response is simultaneously

...right now... and
...yet.

There was a malaria outbreak in Bytown (Ottawa) in 1832 amongst workers on the Rideau Canal. This outbreak was apparently partially from a strain of infected mosquitoes that came with British engineers from the tropics, and partially from a native strain. According to this Encarta article, the last major North American outbreak of malaria occurred in the 1880s. Improved sanitation, swamp drainage, and the increasing use of pesticides put paid to it.

However...I've been watching what has been happening with insect-borne and emerging diseases in this area. Due to climate change, the ranges of various insects are moving northward. Species that once couldn't survive the cold winters here are now thriving. Combine that with ubiquitous and fast overseas travel from around the world, and is it really so farfetched to think that we could begin to see malaria in this area somewhere soon? Already there has been a localised outbreak in Palm Beach County, Florida.

Yes, it could happen here, probably in much the same manner as SARS. I am not a doctor (nor do I play one on tv), and I'm not an epidemiologist (even a barefoot one), but I think it's probably safe to assume that the native strain of malaria is eradicated, and I wouldn't want to speculate on the chances of reintroducing or re-evolving a plasmodium parasite that can live in our native mosquitoes (I think that's more The Reveres' line of work), but I also don't think it's completely unrealistic to think we might see a reappearance of malaria in North American temperate zones in our lifetimes, either.

Unfortunately, there are so many other pressing problems that it's unlikely we'll see some kind of plan put in place to deal with the contingency if and when it arises.