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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 Super's big idea came to be known as the Global Malaria Eradication Programme. In the early nineteen-fifties, Soper had been instrumental in getting the Brazilian malariologist Marcolino Candau-whom he had hired during the anu-gambiae campaign of the nineteen-thirties-elected as director-general of the World Health Organization, and, in 1955, with Candau's help, Soper pushed through a program calling on all member nations to begin a rigorous assault on any malaria within their borders. Congress was lobbied, and John Kennedy, then a senator, became an enthusiastic backer. Beginning in 1958, the United States government pledged the equivalent of billions in today's dollars for malaria eradication-one of the biggest commitments that a single country has ever made to international health. The appeal of the eradication strategy was its precision. The idea was not to kill every Anopheles mosquito in a given area, as Soper had done with gambiae in Brazil. That was unnecessary. The idea was to use DDT to kill only those mosquitoes which were directly connected to the spread of malaria-only those which had just picked up the malaria parasite from an infected person and were about to fly off and infect someone else. When DDT is used for this purpose, Spielman writes in "Mosquito," "it is applied close to where people sleep, on the inside walls of houses. After biting, the mosquitoes generally fly to the nearest vertical surface and remain standing there for about an hour, anus down, while they drain the water from their gut contents and excrete it in a copious, pink-tinged stream. If the surfaces the mosquitoes repair to are coated by a poison that is soluble in the wax that covers all insects' bodies, the mosquitoes will acquire a lethal dose." Soper pointed out that people who get malaria, and survive, generally clear their bodies of the parasite after three years. If you could use spraying to create a hiatus during which minimal transmission occurred-and during which anyone carrying the parasite had a chance to defeat it-you could potentially eradicate malaria. You could stop spraying and welcome the mosquitoes back, because there would be no more malaria around for them to transmit. Soper was under no illusions about how difficult this task would be. But, according to his calculations, it was technically possible, if he and his team achieved eighty-percent coverage-if they sprayed eight out of every ten houses in infected areas.

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Beginning in the late fifties, DDT was shipped out by the ton. Training institutes were opened. In India alone, a hundred and fifty thousand people were hired. By 1960, sixty-six nations had signed up. "What we all had was a handheld pressure sprayer of three-gallon capacity," Jesse Hobbs, who helped run the eradication effort in Jamaica in the early sixties, recalls. "Generally, we used a formulation that was water wettable, meaning you had powder you mixed with water. Then you pressurized the tank. The squad chief would usually have notified the household some days before. The instructions were to take the pictures off the wall, pull everything away from the wall. Take the food and eating utensils out of the house. The spray man would spray with an up-and-down movement-at a certain speed, according to a pattern. You started at a certain point and sprayed the walls and ceiling, then went outside to spray the eaves of the roof. A spray man could cover ten to twelve houses a day. You were using about two hundred milligrams per square foot of DDT, which isn't very much, and it was formulated in a way that you could see where you sprayed. When it dried, it left a deposit, like chalk. It had a bit of a chlorine smell. It's not perfume. It's kind of like swimming-pool water. People were told to wait half an hour for the spray to dry, then they could go back." The results were dramatic. In Taiwan, much of the Caribbean, the Balkans, parts of northern Africa, the northern region of Australia, and a large swath of the South Pacific, malaria was eliminated. Sri Lanka saw its cases drop to about a dozen every year. In India, where malaria infected an estimated seventy-five million and killed eight hundred thousand every year, fatalities had dropped to zero by the early sixties. Between 1945 and 1965, DDT saved millions-even tens of millions-of lives around the world, perhaps more than any other man-made drug or chemical before or since.

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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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