Paul Russell, the main architect of the Malaria Eradication Program, had promised the Eisenhower Administration that the DDT-spray teams would extend a hand of friendship to wavering Cold War allies, revive the entrepreneurial spirit of populations made dull and sickly by malaria, open up huge areas of fertile land for cultivation, pro-mote economic development, end poverty, and spur demand for American products. But the global DDT campaign turned out to be one of the most famous and costly failures in the history of public health. Although by 1970 the disease was eradicated in eighteen countries, most were already controlling it relatively effectively before the program began. Where malaria had been an unmanageable problem, the DDT program had little effect. After retreating for a few years, the malarious mosquitoes returned, now resistant to the chemical, and in some places killed more people than before. Third World poverty did not abate.

This paragraph comes from an excellent essay by Helen Epstein in the March issue of Harper’s.*

What I love about the piece—actually a book review of Sonia Shah’s “The Fever: How Malaria has ruled Humankind for 500,000 years”—is the way it shows the historical roots of a struggle still raging in public health assistance today.

As early as the 1920s, a group of researchers from the League of Nations put forth the theory that to fight malaria you also had to fight the social and economic conditions that caused it to flourish. Their recommended program of “rural uplift” called for swamp drainage, economic development, better housing, education, and health care in malaria-stricken areas. According to Epstein, this strategy had a steady string of successes, slowly eradicating malaria where it was tried in Italy, Borneo and the American South.

But scientists from the Rockefeller Foundation thought that mass-production of powerful insecticides (DDT) would be the silver bullet that would wipe out the disease, without having to improve people’s basic living conditions.

Recent anti-malaria campaigns like that of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, are similarly “predicated on the optimistic notion that fighting malaria is easy;” that if we can just distribute enough insecticide treated bednets, malaria will become a thing of the past. But Epstein’s main takeaway is that malaria is ultimately a political problem as much as a medical one, and “local politics, rather than the charity of outsiders, determines how successfully it can be controlled."

*The link is, unfortunately, gated. But if you are a student or professor, check to see if your university has electronic access to Harper’s- NYU does.

From Aid to Equality

Malaria, past and present