They have been the difference between wars won and lost, and in some wars taken more lives than bullets, but the world is still grappling with the human enemy of parasites.
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Doctor Rowena Martin, a malaria researcher at the Australian National University, gave a public lecture at the Australian War Memorial on Sunday, focusing on war and malaria research sharing a close history.
“War and the development of anti-malarial drugs have pretty much gone hand in hand,” Dr Martin said. “Most of our key anti-malarial drugs have been developed in response to war and to protect soldiers at war.”
Dr Martin was joined by Professor Nick Smith of James Cook University, who specialises in cell molecular biology, and who explained the significance of parasites and infectious disease in times of war.
“War creates the perfect conditions for disease,” he said, noting fleas and lice carrying typhus are also problems.
“People are crowded together, they’re not in the best physical condition … so they’re susceptible to infection [and] there’s more chance of infection. Also a lot of wars are fought in tropical areas and there are a lot of very dangerous parasites there.”
Professor Smith said there was anecdotal evidence of how seriously malaria affected the war effort in the Asia-Pacific region during World War II.
“Roughly for every troop in action there was one out of action actually sick with malaria and another one who was recovering,” he said. “Vietnam was even worse; the Americans lost far more to malaria than they did to the Viet Cong.”
At the ANU, Dr Martin is one of several people researching malaria as time ticks away to come up with new treatments as drug-resistant strains of the infectious disease – which kills up to a million people a year – start to spread. Malaria is transmitted by insects, the tsetse fly (mosquito) in particular.
"It first came about in west Cambodia on the border with Thailand and that resistance has steadily got worse as it spread and is now knocking on the door of India – this is the same situation we’ve gone through again and again," she said.
"This is how Chloroquine-resistant malaria got into Africa and this is how parasites resistant to other drugs got into Africa.
"It’s history repeating itself – we’ve been here before, we had no plan B before and people gave up – deaths spiralled up and malaria re-invaded its old territories."
The resistance has been put down to, among other things, misusing anti-malarial drugs and lower quality and dosage counterfeit drugs.
Dr Martin is leading a team looking into using current drugs differently to ward off the spread.
"We can re-evaluate and re-optimise drug-dose regimens to make them active again ... this could be a key strategy that we use to deal with multi-drug-resistant malaria while we wait for the new drugs to be ready to deploy."
