Nothing but Nets: The History of Insecticide-Treated Nets in Africa, 1980s-Present
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Insecticide-treated bed nets (ITNs) have become a main pillar of global malaria control in the twenty-first century, distributed by the millions annually across Africa and the global South. Understood as ‘evidence-based,’ biomedical tools and one of the most cost-effective global health interventions, ITNs are a main target for health and development aid. This dissertation tracks the history of ITNs since 1980 to see how and why the technology became the centerpiece of malaria control efforts in Africa. Doing so, it reveals how conditions of resource scarcity and the politics of structural adjustment shaped the construction of ITNs as biomedical objects, the translation of experimental findings into evidence-based malaria control policy, and the implementation of evidence-based policy in practice. The identity of ITNs as biomedical tools was by no means obvious or pre-determined, nor did that identity alone lead to the tool’s widespread adoption as an evidence-based intervention for malaria control in Africa. By following the biography of ITNs through the initial production of scientific knowledge, the consolidation of ITNs as universally applicable biomedical tools, the incorporation of ITNs into malaria control policy, and the implementation of ITN policy in public health practice, this study examines the relationship between local contingencies of knowledge and technology, and the formulation and mobilization of supposedly ‘universal’ scientific knowledge in global health. In tracking these biographical ‘moments’ both on a transnational scale and in Kenya, this study also elucidates the impact African, and specifically Kenyan, populations and landscapes have had on the production and application of ITNs as biomedical, evidence-based technologies. In this case, Africans were not marginal or passive in the making of evidence-based global health; rather, they were centrally involved in the endeavor, actively reshaping and redefining ITNs to address biological and economic vulnerabilities during and following structural adjustment.