The Fever: How Malaria Has Ruled Humankind for 500,000 Years (33 page)

Public enthusiasm for DDT had soured, too. The first off notes sounded a few years after DDT’s public launch, when the USDA admitted that the nation’s milk had been tainted with the toxin. It turned out that many creatures that had at first seemed impervious to DDT had actually absorbed and stored minuscule amounts of it in their fat tissues. So long as fat tissue keeps DDT in stasis, it’s a safe enough locale for the compound. But with a half-life of eight years, fat-ensconced DDT lasted long enough to persist throughout the food chain, and each creature that ate another received a full complement of its prey’s lifetime stores of DDT. Some creatures high on the food chain accrued dangerous concentrations of the stuff in their bodies.
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Robins, for example, had been eliminated entirely from a 185-acre plot at Michigan State University, thanks to DDT spraying against elm dark beetles and mosquitoes. The earthworms fed on the fallen leaves of the sprayed trees, and when robins ate the worms the following spring, they accumulated enough DDT to kill them, or to stymie reproduction for two years in those few who survived.
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Cows that fed on DDT-dusted crops stored the DDT in their fat tissue, and secreted it into the milk that scores of American children poured over their morning bowls of Cheerios.
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By 1955, the nation had been coated with so much DDT that the typical American diet delivered 184 micrograms of DDT—.0002 of a lethal dose—every day.
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That probably would have been unsettling enough. But that wasn’t all. As the cold war had heated up, so,
too, did American and Soviet testing of nuclear weapons, releasing invisible clouds of radioactive material into the stratosphere. By 1956,
Newsweek
magazine fretted, there was sufficient strontium 90 up there “to doom countless of the world’s children to inescapable and incurable cancer.” In 1959,
Consumer Reports
reported on a major study of strontium 90 concentrations in milk, and the film
On the Beach
terrorized mass audiences with its dark vision of a post–nuclear holocaust world.
¹³¹

Fears of DDT raining down upon the nation emulsified with larger fears of mass poisoning by secret, invisible toxins. Nobody knew if bioaccumulated DDT actually posed any threat to human health,
¹³²
but noting the dead birds rotting on their lawns, many Americans couldn’t help but wonder: Would humans be next? After the publication of the biologist Rachel Carson’s potent 1962 book,
Silent Spring
, which pointed out the folly of using widespread pesticides without a solid understanding of their health and environmental impacts, then-president Kennedy convened a committee that recommended, over the aggrieved howls of the chemicals companies, that the government phase out the use of their iconic DDT and other similar compounds.
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The United States’s five-year allocation for the global DDT blitz against malaria ran dry a few months later. Nobody asked for any more.

With the abrupt end of the U.S. contribution, funds to the WHO special account for the malaria-eradication program “stopped cold,” writes the historian James Webb.
¹³⁴
USAID formally withdrew from the program; UNICEF halved its malaria staff.
¹³⁵
For many countries, burdened by the expense and trouble of the campaign, this was just the excuse they needed. Soon some national governments were spending more on garbage collection.
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Malaria resurged.

From a low of 18 cases in 1963, malaria swept over Sri Lanka,
sickening more that 500,000 in 1969.
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Over roughly the same period the caseload in India zoomed from 50,000 to more than 1 million
¹³⁸
; in Central America, from 70,000 to nearly 120,000
¹³⁹
; in Afghanistan, from 2,300 to 20,000.
¹⁴⁰
A year after Europe was declared free of malaria in 1975, a two-year malaria epidemic roiled Turkey.
¹⁴¹

At their 1969 meeting, the World Health Assembly directed WHO to abandon the eradication effort.
¹⁴²
The “dramatic recrudescence” of malaria “will not be possible to stop” without new national commitments, nowhere to be seen.
¹⁴³
WHO dispatched teams to visit malaria programs around the world, advising them to switch from trying to eradicate malaria to learning to live with it.
¹⁴⁴
In 1974, PAHO jumped ship, too.
¹⁴⁵

Paul Russell and Fred Soper were devastated. Russell avoided the subject altogether, remembers Andrew Spielman, “withdrawing from contact with students and faculty” at Harvard. Soper pretended it hadn’t happened. When he wrote his memoirs, he made “no significant mention” whatsoever of the campaign he’d helped inspire.
¹⁴⁶

Between 1957 and 1967, the war against
Plasmodium
cost $1.4 billion or about $9 billion in 2009 dollars.
147 148
To this day, malariolo gists and historians disagree over whether it was worth it. The optimists point out that, in just over a dozen years, malaria had been lifted from the shoulders of 32 percent of the human population, which is no small thing. And the first baby steps toward a public health infrastructure had been taken in some of the most remote corners of the planet. The maps that malaria-eradication teams created, for example, had proven crucial to the success of WHO’s smallpox-eradication campaign, doubtlessly a high point for global public health.
¹⁴⁹

Where some see incremental progress, others see what WHO’s Tibor Lepes described as “one of the greatest mistakes ever made in public health.”
¹⁵⁰
Malaria had been eradicated from just eighteen
countries in the world, all of them either prosperous, socialist, or island nations.
¹⁵¹
That left some two billion souls still burdened with malaria.

And the malaria that stalked them was in almost every way more vicious and harder to control than it had been before the eradication effort.
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Our best and cheapest weapons—chloroquine and DDT—had been rendered toothless. By the early 1960s,
Plasmodium falciparum
parasites resistant to chloroquine distributed in table salt had emerged in Colombia, Brazil, Venezuela, and Thailand.
¹⁵³
Chloroquine-resistant
P. falciparum
arrived in Kenya and Tanzania by 1978, and spread throughout the continent within a decade.
¹⁵⁴
Around the globe, thirty-eight species of
Anopheles
mosquitoes had developed resistance to either DDT or its cousin compound dieldrin.
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Worse, the shallow reservoir of public attention and political will to fight malaria had been spent. In 1979, WHO announced its triumphal success in wiping smallpox off the face of the earth,
¹⁵⁶
and reoriented the organization away from attacking specific diseases and toward a commitment to providing basic health care to the masses instead.
¹⁵⁷
The worldwide malaria-eradication campaign faded away to a soon-forgotten footnote. Not even WHO, which stopped using precise measures of malaria, even bothered seriously tracking the disease anymore.
¹⁵⁸

Some experts blamed the failure of the campaign on pesticide-heavy agriculture, which sped up insecticide resistance. Two Columbia University public health experts, for example, called malaria’s post-campaign resurgence in India a “social cost” of growing high-yield crops.
¹⁵⁹
Others blamed WHO for its lack of sensible leadership, particularly in the years after U.S. funding dried up. “All logic went out the window,” complains Spielman.
¹⁶⁰
Thanks to the skyrocketing price of oil, upon which its production depended, DDT’s price had spiked near the end.
¹⁶¹
What if it hadn’t? Russell blamed people in general. “Resistant strains of
Homo sapiens
” were the problem, he wrote, “impatient bureaucrats” and “deans of schools of public health,” with their trendy ideas about social medicine.
¹⁶²

If nothing else, the failure of the spray-gun war showed the folly of treating malaria as a single disease with a single solution. For when the war fell apart, there were a thousand different reasons why.
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In many places today, the spray teams, surveillance workers, and microscopists first put to work on eradicating malaria continue to go through the motions, shadows of the long-dead program. Properly controlling malaria, as opposed to attempting to exterminate it, requires different kinds of workers with different skills, but in many places government leaders feared the political fallout from firing so many eradication workers. So they continue to spray, a little, and collect blood slides, at least a few. But with minimal financing and less oversight, there’s no sensible purpose to it.

When chloroquine-resistant
P. falciparum
arrived in Chepo, Panama’s Kuna village, the eradication-era workers put in their ghostly appearances: a lone, sporadically paid guy from the country’s Vector Control Agency, perhaps, and the occasional sprayman with a canister of insecticide making a few rounds. It’s a tepid response that makes little sense given malaria’s changing epidemiology or Panama’s limited budget. In 1996, Panama collapsed its antimalarial service into the general Health Department, as per WHO’s advice. The government has only nineteen cents per capita to spend to tackle malaria. Now when the disease breaks out, they just flex a tired old muscle. The people get bitten, the sprayers head out. The mosquitoes come back. It starts over again.
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After the ignominious failure of the 1950s-era DDT blitz, malaria disappeared from the headlines. Books on the topic went out of print. Scientists stopped studying the disease; educators stopped teaching it. So completely did malaria vanish from the public mind that many people in the West grew up thinking that there was, literally, no more malaria in this world.

Take Lance Laifer, a hedge-fund manager turned antimalaria organizer. He knew nothing of malaria until he happened to catch a television program on it in 2005. “I didn’t know it still existed,” he later told
The Wall Street Journal
. “I didn’t know it was still killing people. I thought it was eradicated a long time ago. I was just flabbergasted.”
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In fact, over the course of Laifer’s lifetime, the problem of malaria had worsened considerably, especially in Africa.

Although the planet’s malarial heartland, sub-Saharan Africa, was excluded from the global malaria-eradication program of the 1950s and 1960s, eradicationists hadn’t given up on the continent altogether. In 1960, WHO decided to launch what it called a “pre-eradication”
campaign in Africa, a series of demonstration projects and studies that would lead to a viable eradication strategy for the continent. The plan, WHO said, would eradicate malaria from Africa by 1979.
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Eradication projects commenced in Liberia, Cameroon, Uganda, and, most extensively, in Nigeria. But it couldn’t be done. Even in Nigeria, after six years of near-perfect coverage with proven-effective chemicals, malaria hung on. The evidence appeared irrefutable. Even with the best, most effective tools—and no matter how much money was spent—malaria parasites would always find succor on the African savannah, a stronghold from which to perennially infect and reinfect the rest of the continent.

With eradication off the table, public health experts had little else to recommend to fight
Plasmodium
. The fractious dissolution of the global eradication program had left the antimalaria community underfinanced and roiled with misgivings. The prospects of even reducing malaria seemed challenging, given how compromised both DDT and chloroquine, the two cheapest and most effective antimalaria weapons, had become. Chloroquine-resistant parasites and DDT-resistant mosquitoes, grizzled survivors of the eradication era, lurked across the continent. And DDT in particular had become anathema. The United States banned it in 1972 (by then the chemical industry had moved on to more lucrative and often more toxic insecticides) and geared up to push for an international ban as well. When that happened in 2000, many African governments censored DDT, too, despite a last-minute exclusion for its use against public health threats. Few public health leaders stuck their neck out for the internationally despised chemical.
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That’s not to say there was nothing that could be done about malaria in Africa. Even without DDT and chloroquine, there were many possible strategies and tools that could tame the scourge, from leveling roads and providing electricity and safe water, to improving housing and installing mosquito-proof window screening, strengthening healthcare systems and heightening public awareness. Mosquito
habitats could be minimized, managed, and avoided. Simply paying local clinicians more money, or beefing up a local health clinic, could have helped lighten the malarial burden, as the health policy expert Anne Mills has pointed out.

There wasn’t much interest on the part of international antimalaria financiers in any of this, however. The world’s biggest funder of aggressive attacks against disease, the United States, had all but written off the notion of helping African countries with anything. “It is highly unlikely that most African countries will obtain external assistance or investment on anything approaching the scale required for sustained economic development,” a CIA report noted in 1965. Nevertheless, as one National Security Council staffer put it at the time, “substantial increases in U.S. foreign assistance expenditures [to Africa] are not envisaged.”
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