The Fever: How Malaria Has Ruled Humankind for 500,000 Years (31 page)

The military had chosen to move forward with DDT despite its alarming toxicity profile, since the limited campaigns they were considering would never expose larger creatures to dangerously high doses—and even if they did, such collateral damage mattered little during the course of a war.
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By the time DDT came into much greater use, there was little interest in studying its impact on the environment and even less funding for such studies. With DDT fulfilling the long-held dreams of so many different sectors of society, the whole focus of entomology had shifted toward expanding and refining the use of pesticides, not fretting about their drawbacks or exploring possible alternatives.

Entomologists who studied non-pesticide-based methods—crop rotation, for example—were “ridiculed” by their peers as part of the “lunatic fringe,” as the historian John Perkins notes.
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And while the U.S. government required chemical companies to establish safe-use
guidelines for products such as medicines, there were no such requirements for pesticides, which could be marketed to the public with virtually no prior testing.
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Of course, regulatory laxity made sense in the years prior to 1945, when the entire U.S. production of all pesticides amounted to less than one hundred million pounds of materials that nobody had any interest in applying lavishly.
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But by 1951, U.S. manufacturers produced one hundred million pounds of benign-seeming, easy-to-use DDT alone.
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And so nobody paused much to ponder the bizarre reports of insects strangely immune to DDT. In 1948, government entomologists in Orlando, Florida, had noticed that a sample of houseflies collected around local dairies seemed strangely tolerant of DDT, withstanding the toxin for much longer than other flies.
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A WHO malariologist enjoying lunch at a country inn in Greece spied an
Anopheles
mosquito placidly reclining on a DDT-drenched wall.
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Within a few years of DDT’s arrival, reports of unnaturally tolerant flies and strangely oblivious mosquitoes popped up in Lebanon, Saudi Arabia, Egypt, El Salvador, and Greece.
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But when scientists from the U.S. public health service discussed the reports at a meeting of the National Malaria Society in December 1948, all agreed: those bugs were outliers, freaks, mutants.
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As a weapon to fight malaria, DDT was achingly simple. A small team of semi-skilled workers could spread the stuff in even the most forgotten and remote areas, without benefit of doctors, nurses, scientists, clinics, or schools. It was orders of magnitude more effective than older methods, its potency undeniable to the most skeptical scientist. Even the most lauded antimalarial programs of the past couldn’t compare to the fantastic results attained by DDT spraying.

But more than anything, DDT’s efficacy against malarial mosquitoes seemed universal. Less than two decades earlier, Hackett had pronounced malaria a “thousand different diseases”; here was the
best antimalaria method the world had ever seen, and amazingly it seemed to work
every where it was tried
, regardless of local variations in malaria epidemiology.

“This is the DDT era of malariology,” Russell proclaimed to an audience at the London School of Hygiene and Tropical Medicine in 1953, in one of a series of lectures published the following year under the bold title
Man’s Mastery of Malaria
. “For the first time,” Russell noted, “it is economically feasible for nations, however underdeveloped and whatever the climate, to banish malaria completely from their borders.”
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Regional public health agencies echoed Russell’s call. The entire American continent should be freed of malaria for all time, the Pan American Sanitary Conference decreed in 1954.
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So should the entire region of Asia, the Second Asian Malaria Conference agreed that same year.
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Russell wanted WHO to support eradicating malaria from the entire planet, too. But while WHO’s expert advisors agreed that DDT could dramatically depress malaria transmission, they were far from unanimous on the notion that it could effect a complete, planet-wide genocide on
Plasmodium
. Banishing malaria requires more than simply intensifying control efforts, just as sterilizing a kitchen floor requires more than simply better mopping. One must get down on hands and knees and target every last speck of dust, no matter how seemingly insignificant, from every crack and crevice. Eradication required a nearly impossible level of perfection.

A whisper of suspicions streamed from the expert advisors’ reports, issued in 1951 and 1954. Think of all the mud-walled huts across Asia, they said. Would they absorb sufficient quantities of DDT? Wouldn’t some mosquitoes escape unscathed, parasites hatching in their guts? What about all the people who slept outside, they asked, or those whom mosquitoes bit out of doors? Untouched by DDT, they’d remain silent carriers and purveyors of the parasite. Very few health programs around the world could even
control
malaria effectively. How many, suffering “critical shortages” of personnel,
would be able to muster the organizational finesse to ferret out every last remaining parasite?
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But WHO was a fledgling organization, and it didn’t have the luxury of abiding by the cautious consensus of its scientific advisors. In 1955 Russell spoke at a meeting of the political body that governed WHO, the World Health Assembly, telling the lawyers, unionists, and other political appointees there that WHO would be left in the dust if it didn’t get on board, fast. Whatever WHO decided to do, he announced, a campaign for worldwide malaria eradication was already under way.”
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Russell exaggerated. A wide range of countries had started using DDT to control malaria, but only a select few had announced their ambition to extinguish it altogether, and few of those had actually embarked on a purposeful eradication campaign.
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Nevertheless, the assembly took heed of the esteemed malariologist’s word, and instructed WHO to take the initiative in Russell’s de facto global surge toward eradication. “There is . . . no other logical choice,” the assembly’s director-general said.
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Experts estimated at the time that turning DDT projects into a truly global effort would cost at least $500 million. WHO established a special malaria-eradication account to start collecting funds to do the job. After a year, aside from a UNICEF donation of $10 million, the account held a grand total of $63,000, from Germany, Taiwan, and Brunei. PAHO, which had trailblazed the agencies’ calls for eradication, allocated only $193,000.
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That left the bold plan just $489,000,000 short.

By 1956, Paul Russell had met with the International Development Advisory Board, a State Department committee comprised of movie producers, newspaper moguls, and business leaders, and convinced them that the eradication scheme was not only relatively straightforward and scientifically urgent, but politically expedient as well.

The IDAB had been tasked with figuring out how to counter the
Soviet Union’s magnanimous foreign aid programs in developing countries. Containing the spread of communism—and its acolytes’ disinterest in buying American goods—had become a central political and economic preoccupation in Washington, and the State Department feared that the Soviet programs were winning hearts and minds and spreading the communist credo.
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According to Russell, bankrolling WHO’s global malaria-eradication program was not only an “excellent investment” (since the wiping out of malaria would lead to economic development, greater land cultivation, cheaper exports, stronger demand for American products, and ultimately the end of poverty), but also, politically speaking, an “outstanding opportunity.” Particularly in regions key in the fight against communism—Southeast Asia and the eastern Mediterranean—the biannual arrival of door-to-door DDT spray teams would provide “concrete evidence of the interest of the U.S. in the well being of the populations concerned,” effectively neutralizing the Soviets’ nefarious charm offensive.
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The advisory board agreed, and issued its plea for funding for the eradication scheme in a 1956 report. Malaria’s demise could be had in just a handful of years, the board wrote. Zap houses with DDT twice a year for four years, surveil the area for another four years to ensure that no remnant malaria lingered, and extinguish those cases that did, and malaria would be kaput. After that, “normal health department activities can be depended upon,” the board reported, “to deal with occasional introduced cases just as they now remain on guard against smallpox, cholera, and other diseases.”
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There were several glitches to the plan, as WHO had outlined. The IDAB acknowledged few. Sure, the deepest jungles of the Amazon and the remote mountain villages of Asia might not be fully accessible to spray teams, as WHO fretted, but these malarious pockets did not pose a “significant threat,” the IDAB report said. “No doubt malaria can and will be eradicated in these areas in due time.” Nor did its report make much of the problem of mud walls or the fact that many people didn’t live in fixed homes sprayable by
DDT teams. There was a “sufficient range of alternative techniques” to deal with such eventualities, the IDAB noted blithely.
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WHO had been making noises, too, about the difficulty of prosecuting malaria’s eradication in places such as tropical Africa, which lacked roads, trained personnel, and other necessary infrastructure. “The most we may be able to do” in tropical Africa, the WHO director-general bemoaned, “is to ensure that everyone who has an attack of malaria can go and pick up some tablets.”
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With tropical Africa figuring relatively little in cold war machinations, Russell and IDAB recommended simply dropping the continent from the campaign altogether. Africa carried such little political weight in those days that they didn’t even bother nodding toward the irony of continuing to call the campaign a “global” one, even while excluding a whole continent. Not to mention the danger of leaving untouched a giant reservoir of some of the most virulent malaria parasites in the world.

Nor did the IDAB report mention the possibility that the DDT campaign could actually cause more malaria deaths. Nobody disputed that DDT would depress malaria to begin with. But freed from chronic exposure, local people would quickly shed their acquired immunities. And then if, for any reason—lack of funds, lack of roads, lack of popular support—malaria returned, they’d be especially vulnerable. More people could die. A less-than-perfect eradication campaign, in other words, could end up being much deadlier than no eradication campaign at all.

The one glitch the IDAB report did acknowledge was the growing hordes of mosquitoes that could withstand DDT and its cousin compounds. The outliers who’d once seemed so odd had started breaking out onto the front pages. “Mosquitoes Developing an Armor Against DDT,”
The New York Times
headlined in 1952.
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Three years later, the paper was warning: DDT “in danger of losing the war” against malarial mosquitoes.
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DDT-impervious mosquitoes were even turning up in places where mosquitoes had never been purposely targeted. In El Salvador, Greece, Lebanon, Iran, Saudi
Arabia, Indonesia, and Nigeria, DDT-spiked runoff from treated cotton and rice fields formed puddles in which mosquito larvae squirmed, emerging out of the water fully formed and entirely unmoved by the toxin.
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A few DDT-resistant mosquitoes here and there didn’t make much difference in the campaign. DDT’s neurotoxic effect depended upon its ability to bind to insects’ nerve cells, so an insect with even very subtly altered nerve cells—a single amino acid out of whack, for example—could avoid DDT’s worst effects. Even in places that had never seen DDT, there were likely a few such mutant individuals flitting around.
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This was tolerable, though, for ending malaria transmission didn’t require that every last mosquito perish. Indeed, on Sardinia, Soper’s $11 million DDT blitz hadn’t exterminated the entire mosquito population: it had simply depressed it long enough for malaria transmission to become impossible.
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But if DDT-resistant mosquitoes came to dominate a population of mosquitoes before malaria was fully exterminated, eradicating malaria with DDT would indeed become impossible. This had already happened in a little-known test project run by malariologists in Panama. They’d been spraying riverside villages with DDT and supplying antimalarial drugs to disrupt malaria, but after they logged an initial decline in malaria, cases started to climb again, as DDT-resistant mosquitoes took up the malarial cause after their susceptible cohorts died out.
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What this meant is that the eradication campaign would have to kill sufficient numbers of mosquitoes, and quickly enough—in less than six years, Russell figured,
before
large numbers of the mosquitoes became inured to the toxin—to make malaria transmission untenable. The DDT had to come on fast and heavy. “If countries, due to lack of funds, have to proceed slowly, resistance is almost certain to appear and eradication will become economically impossible,” the IDAB wrote. “TIME IS OF THE ESSENCE” (emphasis in original).
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•    •    •

The political appeal of the campaign proved irresistible. One by one, the State Department, Congress, and President Eisenhower got on board. In 1958, in legislation introduced by then-senators John F. Kennedy and Hubert Humphrey, the U.S. Congress allocated $100 million for a five-year worldwide malaria-eradication program (and, in the same act, extended the Marshall Plan).
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In his State of the Union address, President Eisenhower touted the program as a “great work of humanity” that would put the Soviets to shame.
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It was “a Christmas gift directly to more than a billion people,”
The New York Times
enthused.
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