Global Eradication of Malaria Program

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The Global Eradication of Malaria Program (in German about the program to eradicate malaria worldwide ) was a health project that was coordinated by the World Health Organization (WHO). The declared goal was to eradicate malaria in all countries of the world. The program essentially covered the period from 1955 to 1970, with a total of around 50 countries participating. The strategy was to drastically reduce the number of new infections with the help of DDT . The remaining malaria sufferers should then be treated with medication until the disease completely disappears. In some of the participating countries, malaria could be permanently eradicated in this way, in others only short-term successes or failure were achieved.

prehistory

In the United States, the National Eradication Program was carried out from 1947 with the aim of eradicating malaria. Five years later, malaria had virtually disappeared from the United States and the program was discontinued. As was later the case with the Global Eradication of Malaria Program , the interiors of the houses were sprayed with DDT.

Fight against malaria in Sardinia

The main features of the strategy to eradicate malaria worldwide are attributed to Fred Soper . It was tested on a large scale in Sardinia between 1947 and 1951 , the number of malaria cases there was reduced from 75,000 (1946) to 9 (1951) by the end of the project. In contrast to later campaigns, attempts were made in Sardinia to eradicate the locally most important malaria vector, Anopheles labranchiae , but this did not succeed.

In 1953, Marcolino Gomes Candau was elected Director General of the WHO, he would hold this office throughout the malaria eradication program. In the 1930s, Candau had worked with Soper in the fight against the Anopheles gambiae introduced into Brazil from Africa . The strategy was adopted in 1954 by the Pan American Health Organization (PAHO) for the American continent. The WHO adopted it at its 8th General Assembly, which took place in May 1955 in Mexico City.

strategy

The strategy of the Global Eradication of Malaria Program had four phases. First, it required in each participating state an approximately one to two years of planning and preparation phase ( preparatory phase ). The states had to carry out the malaria control largely on their own. During the preparation, among other things, they had to secure the financing for the entire expected project duration. In addition, the predominant types of Plasmodia , their carriers and the degree of contamination had to be determined. Personnel had to be recruited and trained, equipment obtained, preliminary tests carried out and a schedule drawn up.

In the attack phase (translated as attack , eradication or active phase , malaria campaign ), the malaria-transmitting mosquitoes should be combated by spraying the apartment walls with DDT or Dieldrin . It was not necessary to exterminate the malaria mosquitoes ( Anopheles ), it just had to be prevented that they transmitted the pathogen from malaria patients to healthy people. Therefore, they used their habit of resting after a stab on the next wall and sprayed the inner walls of the houses and huts in an area with DDT ( Indoor Residual Spraying ) solution . When the mosquitoes settled on the wall, they ingested a lethal dose of DDT. Since DDT remained effective on the walls for about half a year, the spraying action only had to be carried out twice a year. In countries where malaria occurred only during certain times of the year, one treatment per year was sufficient. 1-2 g of DDT were required for one square meter of wall surface. It has been calculated that if about 80% of apartment walls in an area could be treated with DDT for three to four years, malaria transmission rates would drop dramatically. Experience has shown that it takes about three years for a malaria infection to heal. If new infections are largely prevented during this time through the use of insecticides, the number of malaria cases will drop to a medically manageable level. The WHO was already aware of cases of DDT resistance in Anopheles in 1953 . The use of insecticides should therefore be restricted to the attack phase in order to minimize the risk of resistance building up. At the same time, the reservoir of pathogens in the sick person's body should be decimated with the help of chloroquine and other malaria drugs.

During the subsequent period of consolidation ( consolidation phase ), the emphasis of the program was broadcast remaining herd on the treatment of the remaining malaria patients with medication and culling. If not a single case of malaria occurs within three years of consolidation , the fourth phase has been reached.

In the maintenance phase ( maintenance phase ), the region in question was free of malaria. Only the re-import of malaria from other regions had to be prevented; every new case of malaria had to be treated immediately. The controls necessary for this had to be maintained for years until the disease disappeared worldwide.

If the malaria flared up again during the consolidation or maintenance phase , the program would re-enter the attack phase .

financing

In the USA, Senators Hubert H. Humphrey and John F. Kennedy campaigned for the project. They achieved that in 1958, the United States provided $ 23 million each for the next five years, a huge amount for the time. Between 1955 and 1970, the United States spent about $ 1 billion on malaria control worldwide. In 1960 alone, all donor countries around the world made over $ 100 million available for the Global Eradication of Malaria Program . The states affected by malaria also raised large sums of money to combat malaria. In India, the malaria eradication program accounted for 35% of the total health budget in the mid-1960s.

execution

Traces of the fight against malaria in Italy

An eyewitness who participated in the fight against malaria in Jamaica in the early 1960s reports:

“We all had three- gallon portable sprayers . We usually used a water-dispersible formulation, i.e. powder that had to be stirred into water. Then the tank was pressurized. The group leader had informed the affected households a few days in advance. They had been instructed to remove the pictures from the walls and move the furniture away. Groceries and eating utensils should be brought out of the house. The man with the syringe sprayed the walls with up and down movements, at a predetermined speed and according to a predetermined pattern. You started at a certain point and sprayed the walls and ceiling, then went out and sprayed under the overhang as well. A man could spray DDT ten to twelve houses a day this way. They used about 200 mg of DDT per square foot (about 2 g per square meter) which is not much, but you could see where it had already been sprayed. When the walls dried, a residue remained, something like lime. It smelled a little like chlorine, like swimming pool water. People were told to wait half an hour for the walls to dry. Then they could go back to their homes. "

Results

During the course of the program, malaria disappeared from Taiwan, large parts of the Caribbean, the Balkans, parts of North Africa, Northern Australia and large parts of the South Pacific. In Holland, Italy, Poland, Hungary, Portugal, Spain, Bulgaria, Romania and Yugoslavia, malaria was permanently eradicated by the end of the 1960s. Similar successes have been achieved in Pakistan, Ceylon (= Sri Lanka), Paraguay, Venezuela, Mexico and Central America. In Indonesia, Afghanistan, Haiti, and Nicaragua, malaria eradication programs have had little effect. The extermination thus succeeded mainly in the countries of the temperate climatic zones and on islands, but not in the continental areas of the tropics.

In many of the participating states, after the initial successes, money and medical staff were withdrawn from the anti-malaria campaigns too early and used elsewhere. As a result, new cases of malaria could not be adequately treated or went undetected. In the meantime, DDT resistance had emerged in various species of the anopheles mosquito. The necessary replacement of DDT by other pesticides was mostly neglected, as these would have been 4 to 10 times more expensive. In addition, the cause of malaria, the plasmodia , had become partially resistant to the most widely used drug chloroquine .

The WHO assessed the prospects of success as positive in 1958, but in 1961 the first doubts about the feasibility were expressed. In the mid-1960s it became apparent that the ambitious goal of eradicating malaria could not be achieved. The WHO officially discontinued the program in 1972 as a failure.

Course in individual states

India

The Indian malaria control program National Malaria Control Program (NMCP) was incorporated in 1953 and renamed the National Malaria Eradication Program (NMEP) in 1958 . While the number of annual new malaria infections in 1953 was estimated at 75 million cases and 800,000 people died of malaria, in 1966 only 108,400 new infections were counted, and there was not a single death from malaria. Then the number of diseases rose again. In addition to the emergence of DDT resistance in various Anopheles species and chloroquine resistance in Plasmodia, errors in the planning and implementation of control programs, various reasons are given for the failure of malaria eradication in India. In India, malaria was originally prevalent in rural areas, but the number of malaria cases in cities rose sharply in the second half of the 1960s. Here Anopheles stephensi was the carrier who could hardly be combated by spraying the inner walls. As part of the Green Revolution , irrigation systems were set up which offered the malaria mosquitoes new breeding grounds. In the 1960s, the industrialization of India was driven forward, migrant workers moved from one large construction site to the next, dragging the disease back into previously malaria-free regions. India joined the Non-Aligned Movement , whereupon the US stopped financial support for malaria control in India in 1965. The conflict with Pakistan ( Second Indo-Pakistani War , Bangladesh War ) meant that malaria was no longer the top priority. During the oil crisis , all petroleum products and, as a result, DDT became more expensive. Half a million new cases were counted in 1970, and in 1977 30 million people in India again contracted malaria.

Ceylon / Sri Lanka

In Sri Lanka dominates vivax malaria , epidemics usually occur in dry years. When the monsoon rains fail, the island's rivers dry up, leaving small pools behind. In these there is a mass multiplication of the most important malaria vector Anopheles culicifacies .

In 1948 Ceylon had 2.8 million cases of malaria and the government decided to use DDT to combat it. As early as 1954, the number of malaria cases was so low that the campaign was discontinued. Malaria flared up again in 1956 after a period of drought. As a result, the mosquito control with DDT was resumed, from 1959 onwards as part of the Global Eradication of Malaria Program . By 1963, the number of malaria cases in Ceylon had dropped to 17 cases. It was concluded that the disease was now defeated and the spraying of DDT stopped. One year later (1964) there were already 150 cases of malaria and by 1969 the number increased to 2.5 million cases annually. By resuming the spray program, the number of cases of illness could be reduced again to 150,000 by 1972. Despite continuing massive DDT use, around 400,000 cases were counted again in 1975. The epidemic could not be contained until 1976 when DDT was replaced by malathion .

Individual evidence

  1. ^ A b c Malcolm Gladwell : Fred Soper and the Global Malaria Eradication Program , Journal of Public Health Policy, 2002.
  2. ↑ David Kinkela: DDT and the American century , The University of North Carolina Press, Chapel Hill., 2011
  3. ^ DA Warrell: Infectious Diseases , VCH, 1990, ISBN 3-527-15304-7 .
  4. ↑ a b c d e Oaks, Mitchell, Pearson, Carpenter (Eds.): Malaria: Obstacles and Opportunities , NATIONAL ACADEMY PRESS, 1991.
  5. ^ Robert S. Desowitz: The history of Malaria ( Memento of January 20, 2007 in the Internet Archive ).
  6. ↑ Centers for Disease Control and Prevention: The History of Malaria, an Ancient Disease - Eradication Efforts Worldwide: Success and Failure (1955-1978) .
  7. ↑ a b Christian Simon : DDT - cultural history of a chemical compound , Christoph Merian Verlag, Basel, 1999, ISBN 3-85616-114-7 .
  8. ↑ a b V. P. Sharma: DDT: The fallen angel (PDF; 74 kB), Current Science, 2003.
  9. ↑ Georganne Chapin, Robert Wasserstrom: Agricultural production and malaria resurgence in Central America and India , Nature 293, 17 Sep. 1981, pp. 181-185 according to archive link ( Memento from June 15, 2007 in the Internet Archive ).
  10. ^ Gisela Peters: Malaria in Sri Lanka , dissertation at the University of Mainz, 1982.
  11. ↑ G. Gramiccia, PF Beales: The recent history of malaria control and eradication , 1988, in Wernsdorfer, McGregor (Ed.): Malaria: Principles and Practice of Malariology , Chap. 45, according to archive link ( memento of March 3, 2007 in the Internet Archive ).
  12. ^ Gordon Harrison: Mosquitoes, malaria, and man: A history of the hostilities since 1880 , (1978) according to Archivlink ( Memento of March 3, 2007 in the Internet Archive ).