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Fred Soper and the Global Malaria Eradication Programme

Journal of Public Health Policy, 2002 by Gladwell, Malcolm

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In 1963, the money from Congress ran out. Countries that had been told they could wipe out malaria in four years-and had diverted much of their health budgets to that effort-grew disillusioned as the years dragged on and eradication never materialized. Soon, they put their money back into areas that seemed equally pressing, like maternal and child health. Spraying programs were scaled back. In those countries where the disease had not been completely eliminated, malaria rates began to inch upward. In 1969, the World Health Organization formally abandoned global eradication, and in the ensuing years it proved impossible to muster any great enthusiasm from donors to fund antimalaria efforts. The W.H.O. now recommends that countries treat the disease largely through the health-care system-through elimination of the parasite-but many antimalarial drugs are no longer effective. In the past thirty years, there have been outbreaks in India, Sri Lanka, Brazil, and South Korea, among other places. "Our troubles with mosquitoes are getting worse," Spielman concludes in "Mosquito," "making more people sick and claiming more lives, millions of lives, every year."

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For Soper, the unravelling of his dream was pure torture. In 1959, he toured Asia to check on the eradication campaigns of Thailand, the Philippines, Ceylon, and India, and came back appalled at what he had seen. Again and again, he found, countries were executing his strategy improperly. They weren't spraying for long enough. They didn't realize that unless malaria was ground into submission it would come roaring back. But what could he do? He had prevailed against gambiae in Brazil in the nineteen-thirties because he had been in charge; he had worked with the country's dictator to make it illegal to prevent an inspector from entering a house, and illegal to prevent the inspector from treating any open container of water. Jesse Hobbs tells of running into Soper one day in Trinidad, after driving all day in an open jeep through the tropical heat. Soper drove up in a car and asked Hobbs to get in; Hobbs demurred, gesturing at his sweaty shirt. "Son," Soper responded, "we used to go out in a day like this in Brazil and if we found a sector chief whose shirt was not wet we'd fire him." Killing mosquitoes, Soper always said, was not a matter of knowledge and academic understanding; it was a matter of administration and discipline. "He used to say that if you have a democracy you can't have eradication," Litsios says. "When Soper was looking for a job at Johns Hopkins-this would have been '46-he told a friend that 'they turned me down because they said I was a fascist.'" Johns Hopkins was right, of course: he was a fascist-a disease fascist-because he believed a malaria warrior had to be. But now roofs were falling down in Malaysia, and inspectors were taking bribes, and local health officials did not understand the basic principles of eradication-and his critics had the audacity to blame his ideas, rather than their own weakness.

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Fred Soper and the Global Malaria Eradication Programme

Journal of Public Health Policy, 2002 by Gladwell, Malcolm

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