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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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Fred Soper ran up against the great moral of the late twentieth century-that even the best-intentioned efforts have perverse consequences, that benefits are inevitably offset by risks. This was the lesson of "Silent Spring," and it was the lesson, too, that malariologists would take from the experience with global eradication.

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DDT, Spielman argues, ought to be used as selectively as possible, to quell major outbreaks. "They should have had a strong rule against spraying the same villages again and again," he says. "But that went against their doctrine. They wanted eighty-per-cent coverage. They wanted eight out of ten houses year after year after year, and that's a sure formula for resistance." Soper and Russell once argued about whether, in addition to house spraying, malaria fighters should continue to drain swamps. Russell said yes; Soper said no, that it would be an unnecessary distraction. Russell was right: it made no sense to use only one weapon against malaria. Spielman points out that malaria transmission in sub-Saharan Africa is powerfully affected by the fact that so many people live in mud huts. The walls of that kind of house need to be constantly replastered, and to do that villagers dig mud holes around their huts. But a mud hole is a prime breeding spot for gambiae. If economic aid were directed at helping villagers build houses out of brick, Spielman argues, malaria could be dealt a blow. Similarly, the Princeton University malariologist Burron Singer says that since the forties it has been well known that mosquito larvae that hatch in rice fields-a major breeding site in southeast Asia-can be killed if the water level in the fields is intermittently drained, a practice that has the additional effect of raising rice yields. Are these perfect measures? No. But, under the right circumstances, they are sustainable. In a speech Soper presented on eradication, he quoted Louis Pasteur: "It is within the power of man to rid himself of every parasitic disease." The key phrase, for Soper, was "within the power." Soper believed that the responsibility of the public-health professional was to make an obligation out of what was possible. He never understood that concessions had to be made to what was practical. "This is the fundamental difference between those of us in public health who have an epidemiological perspective, and people, like Soper, with more of a medical approach," Spielman says. "We deal with populations over time, populations of individuals. They deal with individuals at a moment in time. Their best outcome is total elimination of the condition in the shortest possible period. Our first goal is to cause no outbreaks, no epidemics, to manage, to contain the infection." Bringing the absolutist attitudes of medicine to a malarious village, Spielman says, "is a good way to do a bad thing." The Fred Soper that we needed, in retrospect, was a man of more modest ambitions.

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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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