A reader writes:
I’ve been following you for about five years now. Am retiring next summer and setting off in May 26 for a ride to Bali. I currently live in Bolton so it was Bolton to Bali but I’m moving when I retire to Lincoln where my son is based in the RAF. So I’ve rebranded – Lincoln to Lombok! My question is about malaria. What’s needed in terms of protection. I’ve read that you’ve had malaria – not nice. What do I need to do in terms of pre trip purchase and on the road?
Thanks for the question! Firstly, don’t do what I did when I cycled to Africa: set off unprepared, realise I was in a malaria-endemic area, buy dodgy medication locally, and then catch malaria anyway. It isn’t pleasant!
Secondly, I am not a medical professional, the following advice should be considered anecdotal at best, I’m not responsible if you do end up catching malaria, etcetera etcetera.
Now. Assuming you’re in the UK and have access to NHS services, the obvious starting point would be to go and see your GP for a chat about your travel plans.
What they will probably do is look at the NHS website or similar to see if malaria-endemic areas and your planned route intersect, and advise on what medication to take for a given area. Malaria prevention in high-risk areas is usually achieved with prophylactic drugs, which means taking tablets before, during, and/or after your time at risk of exposure.
(As a bonus, you’ll also get other vaccination recommendations into the bargain, some of which may be available on the NHS; get your vaccination record updated and printed out to take with you; etc.)
Another way to source preventative medication for malaria is to go private. I’ve long used Nomad Travel (no affiliation) for pre-trip medical advice, vaccinations, and bespoke first aid kits. They have clinics in several major English cities.
Malaria medication is usually prescription-only in the UK, so that’s the reason for starting with a visit to a healthcare provider.
With malaria prophylactics, be aware that different medications are available, at different prices, with different dosage regimes, and with different side effects! Also know that the advice does change over time as strains become resistant to certain drugs. The World Health Organisation publishes some good data visualisations on this topic.
Depending on how long you’re planning to be on the road, you might also discuss with your GP or clinic the expiry dates of any medication that’s prescribed. You might need to plan what you’re going to take in advance, but then source the actual medication down the road.
Having said all that, the first line of defence against malaria remains avoiding getting bitten by carrier mosquitoes in the first place.
Data from malaria prevention projects around the world cites bednets as the single most effective method. Emulate this as a traveller. I’ve found it really useful to have a freestanding tent with a mesh inner that can be pitched indoors. On some trips I’ve also carried a Lifesystems lightweight travel mosquito net (again, no affiliation) that can be hung from whatever attachment is available.
Topical insect repellent can also be effective, but in heavily mosquito-ridden areas don’t expect anything other than high-strength DEET to have much of an effect. For what it’s worth, I tend to carry a bottle of Lifesystems 50% DEET spray for extreme situations, and make it last as long as I can. They used to do a 95% DEET product but it looks like it’s been discontinued. Treating clothes with permethrin can also help, but you probably won’t want to carry a bottle of it across Asia.
In short, the best advice I can give you is to do plenty of research from up-to-date, trusted sources, and then make a plan that works for you and your trip!
Don’t rely on hearsay (eg: this blog post), which may be long out of date as well as inherently subjective.
Hope that helps, and good luck with what I’m sure will be a fascinating and rewarding bicycle journey across Eurasia!
This is part of my “No Stupid Questions” series, in which readers write in with questions about cycle touring or bikepacking and I attempt to answer them. Check out more recent posts in the series or ask one of your own.
Something to add?