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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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What DDT could not do, however, was eradicate malaria entirely. How could you effectively spray eighty per cent of homes in the Amazonian jungle, where communities are spread over hundreds of thousands of highly treacherous acres? Sub-Saharan Africa, the most malarious place on earth, presented such a daunting logistical challenge that the eradication campaign never really got under way there. And, even in countries that seemed highly amenable to spraying, problems arose. "The rich had houses that they didn't want to be sprayed, and they were giving bribes," says Socrates Litsios, who was a scientist with the W.H.O. for many years and is now a historian of the period. "The inspectors would try to double their spraying in the morning so they wouldn't have to carry around the heavy tanks all day, and as a result houses in the afternoon would get less coverage. And there were many instances of corruption with insecticides, because they were worth so much on the black market. People would apply diluted sprays even when they knew they were worthless." Typical of the logistical difficulties is what happened to the campaign in Malaysia. In Malaysian villages, the roofs of the houses were a thatch of palm fronds called atap. They were expensive to construct, and usually lasted five years. But within two years of DDT spraying the roofs started to fall down. As it happened, the atap is eaten by caterpillar larvae, which in turn are normally kept in check by parasitic wasps. But the DDT repelled the wasps, leaving the larvae free to devour the atap. "Then the Malaysians started to complain about bedbugs, and it turns out what normally happens is that ants like to eat bedbug larvae," McWilson Warren said. "But the ants were being killed by the DDT and the bedbugs weren't-they were pretty resistant to it. So now you had a bedbug problem." He went on, "The DDT spray teams would go into villages, and no one would be at home and the doors would be locked and you couldn't spray the house. And, understand, for that campaign to work almost every house had to be sprayed. You had to have eighty-per-cent coverage. I remember there was a malaria meeting in '62. in Saigon, and the Malaysians were saying that they could not eradicate malaria. It was not possible. And everyone was arguing with them, and they were saying, 'Look, it's not going to work.' And if Malaysia couldn't do it-and Malaysia was one of the most sophisticated places in the region-who could?"

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At the same time, in certain areas DDT began to lose its potency. DDT kills by attacking a mosquito's nervous system, affecting the nerve cells so that they keep firing and the insect goes into a spasm, lurching, shuddering, and twitching before it dies. But in every population of mosquitoes there are a handful with a random genetic mutation that renders DDT nontoxic-that prevents it from binding to nerve endings. When mass spraying starts, those genetic outliers are too rare to matter. But, as time goes on, they are the only mosquitoes still breeding, and entire new generations of insects become resistant. In Greece, in the late nineteen-forties, for example, a malariologist noticed Anopheles sacharovi mosquitoes flying around a room that had been sprayed with DDT. In time, resistance began to emerge in areas where spraying was heaviest. To the malaria warriors, it was a shock. "Why should they have known?" Janet Hemingway, an expert in DDT resistance at the University of Wales in Cardiff, says. "It was the first synthetic insecticide. They just assumed that it would keep on working, and that the insects couldn't do much about it." Soper and the malariologist Paul Russell, who was his great ally, responded by pushing for an all-out war on malaria. We had to use DDT, they argued, or lose it. If countries, due to lack of funds, have to proceed slowly, resistance is almost certain to appear and eradication will become economically impossible," Russell wrote in a 1956 report. "TIME IS OF THE ESSENCE because DDT resistance has appeared in six or seven years." But, with the administrative and logistical problems posed by the goal of eighty-per-cent coverage, that deadline proved impossible to meet.

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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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