During the Pacific War of 1942–1945, malaria transmitted by mosquitoes caused more American and Allied casualties than Japanese weapons for much of the campaign. At Guadalcanal in 1942, malaria rates among American troops exceeded those of combat casualties. The disease shaped strategy, prolonged campaigns, and killed or incapacitated tens of thousands of soldiers in New Guinea, the Philippines, and throughout the Pacific theatre. The Allied response included the mass production of Atabrine (quinacrine) as a replacement for quinine.

The Pacific War's mosquito-driven misery produced a distinct strand of war literature focused on environmental and biological suffering rather than conventional combat. Norman Mailer's The Naked and the Dead (1948) depicts soldiers debilitated by disease and insects in the Pacific jungle. James Dickey, who flew bombing missions over Japan, wrote poetry haunted by the tropical warfare experience. The mosquito as killer — invisible, indiscriminate, and omnipresent — became a literary figure for the dehumanising randomness of modern warfare.