Piero Sepulcri (1899-1980) and malaria eradication in Veneto

Piero Sepulcri may be considered the antimalaria pioneer in the Italian region of Veneto during the 20th century. Through his activity with the Regional Antimalarial Institute he made a major contribution to one of the most important successes of medicine in the 20th century: malaria eradication in Italy. His writings on the activity of the Antimalarial Institute display the phases of eradication. In the first period antimalarial drugs were used to cure infected patients and as prophylaxis against infection. In the second period, eradication of vectors permitted the lack of transmission and consequent eradication of malarial disease. The history of malaria eradication in Italy is of the utmost importance because it established a series of steps to be taken against any transmittable disease that could return and spread once again in Italy or elsewhere. Keywords: malaria, anopheles, prophylaxis, treatment, history, Veneto.

Sedimentary record of polycyclic aromatic hydrocarbons and DDTs in Dianchi Lake, an urban lake in Southwest China

Unique time trends of polycyclic aromatic hydrocarbons (PAHs) and dichlorodiphenyltrichloroethanes (DDTs) were found in a dated sediment core from Dianchi Lake (DC), an urban lake in Southwest China. The temporal trend of PAHs in DC was not only different from those in China's coastline and remote lakes of China, but also different from those in more developed countries. Identification of sources suggested that PAHs in DC originated primarily from domestic combustion of coal and biomass. However, a change of source from low- and moderate-temperature combustion to high-temperature combustion processes was observed. Different from those in China's coastline and some developed countries, the temporal trend of DDTs in DC mirrored the historical usage of DDTs in China, with erosion of soils and surface runoff from its drainage area the most likely routes of DDT introduction to the lake. Rapid urbanization and industrialization in its catchment, effective interception of point-source pollution, and changes in sources of energy during the last few decades have significantly influenced the vertical profiles of PAHs in DC.

The first large-scale use of synthetic insecticide for malaria control in tropical Africa: lessons from Liberia, 1945-1962

In 1945, a United States Public Health Service team in Monrovia, Liberia, began the use of synthetic insecticides for indoor residual spraying (IRS) and as a larvicide, with the goal of controlling malaria in the Liberian capital. In the early 1950s, the project was "scaled up" to reach the surrounding areas, and in 1953, the World Health Organization (WHO) launched an antimalaria program in the upcountry region of Central Province, Liberia. It was initially based solely upon IRS, as it was one of a series of pilot projects whose goal was to determine the feasibility of malaria eradication in tropical Africa. The malaria control project in Monrovia constituted the first large-scale use of synthetic insecticide to combat malaria in tropical Africa, and the WHO pilot project in Central Province was one of a first cluster of projects initiated to explore the efficacy of IRS in a variety of African ecological zones. These projects encountered a spate of difficulties that foreshadowed the general retreat from malaria eradication efforts across tropical Africa by the mid-1960s.

North American osprey populations and contaminants: historic and contemporary perspectives

Osprey (Pandion haliaetus) populations were adversely affected by DDT and perhaps other contaminants in the United States and elsewhere. Reduced productivity, eggshell thinning, and high DDE concentrations in eggs were the signs associated with declining osprey populations in the 1950s, 1960s, and 1970s. The species was one of the first studied on a large scale to bring contaminant issues into focus. Although few quantitative population data were available prior to the 1960s, many osprey populations in North America were studied during the 1960s and 1970s with much learned about basic life history and biology. This article reviews the historical and current effects of contaminants on regional osprey populations. Breeding populations in many regions of North America showed post-DDT-era (1972) population increases of varying magnitudes, with many populations now appearing to stabilize at much higher numbers than initially reported in the 1970s and 1980s. However, the magnitude of regional population increases in the United States between 1981 (first Nationwide Survey, ∼8,000 pairs), when some recovery had already occurred, 1994 (second survey, ∼14,200), and 2001 (third survey, ∼16,000-19,000), or any other years, is likely not a simple response to the release from earlier contaminant effects, but a response to multi-factorial effects. This indirect "contaminant effects" measurement comparing changes (i.e., recovery) in post-DDT-era population numbers over time is probably confounded by changing human attitudes toward birds of prey (shooting, destroying nests, etc.), changing habitats, changing fish populations, and perhaps competition from other species. The species' adaptation to newly created reservoirs and its increasing use of artificial nesting structures (power poles, nesting platforms, cell towers, channel markers, offshore duck blinds, etc.) are two important factors. The timing of the initial use of artificial nesting structures, which replaced declining numbers of suitable trees at many locations, varied regionally (much later in the western United States and Mexico). Because of the increasing use of artificial nesting structures, there may be more ospreys nesting in North America now than ever before. Now, with the impact of most legacy organic contaminants (DDT, other organochlorine [OC] pesticides, polychlorinated biphenyls [PCB], polychlorinated dibenzo-p-dioxins [PCDD], polychlorinated dibenzofurans (PCDF]) greatly reduced or eliminated, and some osprey populations showing evidence of stabilizing, the species was proposed as a Worldwide Sentinel Species for evaluating emerging contaminants. Several emerging contaminants are already being studied, such as polybrominated diphenyl ethers (PBDE) and perfluorinated acids and sulfonate compounds (PFC). The many advantages for continued contaminant investigations using the osprey include a good understanding of its biology and ecology, its known distribution and abundance, and its ability to habituate to humans and their activities, which permits nesting in some of the potentially most contaminated environments. It is a top predator in most ecosystems, and its nests are relatively easy to locate and study with little researcher impact on reproductive success.

[How was endemic malaria eradicated?: community-based action in postwar Hikone]

Immediately after World War II, malaria became one of the major infectious disease threats in Japan. The prevalence of malaria was high in all regions in the summer of 1946. In most prefectures, the prevalence decreased with time thereafter and virtually no epidemics occurred after 1947. Shiga Prefecture, however, was an exception to this pattern. The epidemics in the prefecture occurred repeatedly until 1949, and the prevalence rapidly decreased in 1950. While the epidemics in most prefectures were caused by "imported malaria," those in Shiga Prefecture were caused by "indigenous malaria." This paper focuses on the eradication campaign of "endemic" malaria in Hikone City, Shiga prefecture after WWII. The city government began the campaign in April 1949. They established a malaria research institute for developing and implementing plans. The widespread spraying of insecticides such as DDT was implemented throughout the city and the moat around Hikone Castle was filled in, in order to reduce the mosquito population. Residents also cooperated extensively with programs for sanitation and health education. As a result of these efforts, malaria was completely eliminated in the city within six years. Malaria is still a life-threatening illness for many people in tropical areas of the world. Hikone's postwar experience could provide important lessons for malaria control programs in many places.

"God bless General Péron": DDT and the endgame of malaria eradication in Argentina in the 1940s

This article explores the politics of malaria eradication in Argentina during the first government of Juan D. Perón. The article develops the theme of historical convergence to understand the rapid mobilization and success of the climactic battle against malaria in Northwest Argentina. The nearly complete eradication of malaria in Argentina resulted from a combination of three factors. First, Carlos Alvarado, the director of Argentina's Malaria Service, had already developed a solid but flexible organizational base that allowed a dramatic change in control strategy. Second, an infusion of new technologies, especially DDT but also motor vehicles, was instrumental. Lastly, a radical reorientation of national public health policy in the 1940s, under the direction of Perón and his health minister, Ramón Carrillo, encouraged eradication. These figures embraced and refashioned long-standing organicist ideologies that hitched the strength of the nation-state to the health and vigor of its ordinary citizens. This ideological orientation was reflected in bold, populist political strategies that showcased swift, massive, and expensive public health campaigns, including malaria eradication. In the conclusion, the article explores the ambiguous connections between malaria eradication and an ecological perspective on the disease.

Parachuting cats and crushed eggs the controversy over the use of DDT to control malaria

The use of DDT to control malaria has been a contentious practice for decades. This controversy centers on concerns over the ecological harm caused by DDT relative to the gains in public health from its use to prevent malaria. Given the World Health Organization's recent policy decisions concerning the use of DDT to control malaria, it is worth reviewing the historical context of DDT use. Ecological concerns focused on evidence that DDT ingestion by predatory birds resulted in eggs with shells so thin they were crushed by adult birds. In addition, DDT spraying to control malaria allegedly resulted in cats being poisoned in some areas, which led to increased rodent populations and, in turn, the parachuting of cats into the highlands of the island of Borneo to kill the rodents, a story that influenced the decision to ban DDT spraying. I focus on this story with the intention of grounding the current debate on lessons from the past.

Parasites and progress: ethical decision-making and the Santee-Cooper Malaria study, 1944-1949

As part of a mid-1940s malaria research program, U.S. Public Health Service researchers working in South Carolina chose to withhold treatment from a group of subjects while testing the efficacy of a new insecticide. Research during World War II had generated new tools to fight malaria, including the insecticide DDT and the medication chloroquine. The choices made about how to conduct research in one of the last pockets of endemic malaria in the United States reveal much about prevailing attitudes and assumptions with regard to malaria control. We describe this research and explore the ethical choices inherent in the tension between environmentally based interventions and the individual health needs of the population living within the study domain. The singular focus on the mosquito and its lifecycle led some researchers to view the humans in their study area as little more than parasite reservoirs, an attitude fueled by the frustrating disappearance of malaria just when the scientists were on the verge of establishing the efficacy of a powerful new agent in the fight against malaria. This analysis of their choices has relevance to broader questions in public health ethics.

"The horizon opened up very greatly": Leland O. Howard and the transition to chemical insecticides in the United States, 1894-1927

The transition to synthetic chemicals as a popular method of insect control in the United States was one of the most critical developments in the history of American agriculture. Historians of agriculture have effectively identified the rise and charted the dominance of early chemical insecticides as they came to define commercial agriculture between the emergence of Paris green in the 1870s and the popularity of DDT in the 1940s and beyond. Less understood, however, are the underlying mechanics of this transition. this article thus takes up the basic question of how farmers and entomologists who were once dedicated to an impressively wide range of insect control options ultimately settled on the promise of a chemically driven approach to managing destructive insects. Central to this investigation is an emphasis on the bureaucratic maneuverings of Leland O. Howard, who headed the Bureau of Entomology from 1894 to 1927. Like most entomologists of his era, Howard was theoretically interested in pursuing a wide variety of control methods--biological, chemical, and cultural included. In the end, however, he employed several tactics to streamline the government's efforts to almost exclusively support arsenic and lead-based chemical insecticides as the most commercially viable form of insect control. While Howard in no way "caused" the national turn to chemicals, this article charts the pivotal role he played in fostering that outcome.

Dichlorodiphenyltrichloroethane usage in the former Soviet Union

DDT (Dichlorodiphenyltrichloroethane), an organochlorine pesticide (OCP), is one of 12 persistent organic pollutants (POPs) that is being proposed for elimination or control under the Stockholm Convention on POPs. This paper presents historical DDT usage in the Former Soviet Union (FSU) from different sources. Although the data from different sources do not agree with each other, the data clearly show that the usage of DDT in the FSU were intensive in the 1950s and 1960s, and the use of DDT continued until early 1990s although DDT was officially banned in 1969/1970 by the FSU government. Two estimations (high and low) are made for the historical annual DDT usage in the FSU. The total DDT usage in the FSU from 1946 and 1990 was 520 kt for the high estimation and 250 kt for the low estimation. Gridded DDT usage inventories in the FSU on a 1 degree longitude by 1 degree latitude grid system are created by using the gridded distribution of cropland density for the FSU, and show that DDT usage varied considerably across the FSU. Most DDT was applied in southern regions of the FSU where agricultural activity was greatest, such as in Moldova and Ukraine followed by the Northern Caucasus region of Russia and the Central Asian republics.

Organochlorine contaminants in human adipose tissues from China: mass balance approach for estimating historical Chinese exposure to DDTs

Concentrations of persistent organochlorines (OCs), such as DDTs, hexachlorocyclohexanes (HCHs), hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs), and chlordane compounds (CHLs) were determined in 34 human adipose tissues collected from Guizhou Province, southern China, during 2002. DDT was the predominant contaminant among OCs analyzed; concentrations ranged from 420 to 20 000 ng/g on a lipid wt basis (average +/- sd: 5700 +/- 4100 ng/g). Concentrations of DDTs and the ratio of p,p'-DDT/ sigmaDDT in humans in China were significantly higher than those reported for developed countries. DDT levels in humans in Guizhou Province were comparable to those from Shanghai City, implying the presence of significant sources of DDTs in inland and coastal areas in China. Age-dependent accumulation of HCH concentration was found in this study, possibly because of the considerable reduction in average dairy intake (ADI) of HCHs by Chinese during the recent two decades. On the basis of the information of the ADI rates, half-lives, and body burdens of DDTs, the magnitude of historical DDT exposures by Chinese was estimated. This suggested that approximately 80% of DDTs deposited in Chinese adipose tissues was accumulated before the 1990s. The monitoring of OC levels and epidemiological studies are needed in China to understand the status of contamination and the risks to humans.

Malaria films: Motion pictures as a public health tool

I offer a historical examination of a group of malaria motion pictures, a subset of a larger genre of public health films. The majority of these more than 100 films were produced or coproduced by American and British agencies or production companies since 1940. The material is divided into 5 chronological periods, which include World War II, the postcolonial or DDT era (1946-1961), and the past 2 decades. The films themselves, I argue, represent a unique record of preventive measures, clinical techniques, and sociocultural biases, all within the context of a history of one of the greatest continuing challenges in public health. The malaria films, as a group, represent a large body of work that has not yet been brought together or analyzed as historical sources.

The dynamic performances of DDTs in the environment and Japanese exposure to them: a historical perspective after the ban

The fugacity model for evaluating DDTs dynamic performances in the environment was combined with the dietary exposure evaluation model, including the contribution of imported food, to develop the macroscopic mathematical model relating DDTs in the environment with the health risks of the reference Japanese. The model validity was examined by comparing the simulated DDTs concentrations in environmental media, various kinds of food, and dietary intake with those observed. Numerical simulations were done for the past half and future of one century to evaluate the effect of the DDTs usage prohibition in 1970 in Japan. The major results obtained under the limits considered are as follows. The DDTs concentrations in environmental media, various kinds of foods, and the dietary intake showed the steady exponential decrease after the DDTs usage prohibition in 1970. The DDE/DDTs ratio is larger in the higher position in an ecological system, and increased steadily with time. The critical exposure of DDTs occurred through animal product intake until 1960; after 1990 marine product intake caused the most exposure. The estimated DDTs intake was evaluated to be less than the PTDI and RfD. The annual excess cancer induction risk due to the annual dietary intake of DDTs was the largest at the level of (0.5 - 2.0) x 10(-6) (1/yr) in the early 1970s. The effect of the DDT usage prohibition on dietary exposure reduction was expected to appear after about 20 years. The life-span excess cancer induction risk was conservatively estimated to be larger than 10(-5) (1/lifespan) for the reference Japanese who were born before 1970. The DDTs usage prohibition in 1970 was effective to reduce the life-span cancer risk under the 10(-5) level.

Marine organic pollution history in the Changjiang Estuary and Zhejiang coastal area--HCHs and DDTs stratigraphical records

The variations of concentrations of hexachloro-cyclohexane (HCHs), dichloro diphenyl trichloroethane (DDTs) in surface sediments from the Changjiang Estuary and Zhejiang coastal area suggests that although there is a substantial decrease of these persistent trace compounds since the last two decades, they still presented in recent surface sediments. Their concentration levels in suspended matter are still quite high. In dated sedimentary cores, the DDTs and HCHs concentration peaks appeared in 1960s to 1980s, which approximately corresponded to their production and usage history.

Technology and malaria control, 1930-1960: the career of Rockefeller Foundation engineer Frederick W. Knipe

Frederick W. Knipe was a malaria-control engineer with the Rockefeller Foundation, serving in Bulgaria, Albania, India, Mexico, Italy, and the United States. There were two phases to his career: from 1930 to 1943 he focused on drainage works that reduced or eliminated mosquito habitat, and from 1944 to 1960 he supervised DDT spraying programs. His appointments to the WHO Expert Committee on Insecticides, 1948-55, demonstrate that his contributions to malaria-control were highly regarded by his peers.

The disappearance of Dutch malaria and the Rockefeller Foundation

Sixty years ago Professor Nico Swellengrebel wrote his famous book 'Malaria in the Netherlands' (Swellengrebel and de Buck, 1938). At that time tertian malaria was still endemic, with its epidemic ups and downs. Malaria disappeared as recently as 1960 and the Rockefeller Foundation (RF) contributed substantially to this effect. The Rockefeller Archives proved a valuable source of anecdotal information, which puts the scientific publications of the Dutch malariologists in a more vivid perspective. Following the course of history, first the already existing links with the RF are explained along with some peculiarities of tertian malaria in the Dutch temperate climate. The emergence of a new epidemic during the war years and the implication of new tools and principles for control as advocated by the RF are described. The subsequent shriveling of the vector population and the disappearance of malaria are presented, along with some details about the reluctance of WHO to declare the Netherlands malaria-free. Finally, recent unrest about possible return of malaria is put into perspective.

Malaria eradication: the Taiwan experience

In November 1965, the World Health Organization (WHO) certified Taiwan as an area where malaria had been eradicated. Malaria eradication in Taiwan resulted from government initiatives and involvement, careful planning and organization, the development of basic health structure and community support, as well as the cooperation and assistance of international agencies. The Japanese colonial government of Taiwan had contributed to the antimalarial efforts through the establishment of a rudimentary health infrastructure and introduction of measures to combat malaria and other diseases during their occupation of the island from 1895 to 1945. The Chinese government regained control of the island after Japan's surrender in 1945, and with the support of the Rockefeller Foundation, established a research institute to investigate the malaria problem. Political instability in 1949, however, caused the Foundation to end its support. After the Nationalist government moved to Taiwan, it continued antimalarial efforts which received the support of WHO and other international agencies. While Taiwan followed closely WHO's guidelines and plan of attack, the development of the program illustrates the importance of local factors in shaping its actual implementation and eventual success. Malaria eradication in Taiwan went through the following phases: preparatory (1946-1951); attack (1952-1957); consolidation (1958-1964); and maintenance (after 1965).

Epidemiology in the strategies for malaria control

A rapid overview is presented of the evolution of the main orientations of malaria control, since the discovery of mosquito transmission. Stated control objectives appear to have oscillated between expectations to eradicate the vector, or at least the disease, and more modest approaches to minimise the effects of the infection. High optimism was raised when a new control measure, or new combination of existing measures, appeared to be highly effective and was expected to have universal applicability. The implementation of large scale campaigns eventually found the limits of applicability of the proposed strategy and the exaggerated expectations soon gave way to disillusion and, eventually, to a revival of research. The longest and most impacting period of exaggerated expectations was the global malaria eradication campaign of the 1950s and 1960s, which completely disregarded the study of local epidemiology, considering that all it was needed was to know if an area was "malarious" or not. Research was practically abandoned and, even when reinstated after the recognised failure of the campaign, it has retained an almost exclusive orientation towards the development of control tools, drugs or eventually vaccines. One of the earliest victims of the eradication campaign was the study of epidemic malaria and its determinants in different epidemic prone areas. In spite of an extremely long period of disillusion, lasting for almost two decades, the reality of the malaria problem led WHO and member countries to agree on a global strategy of control, aiming at a realistic use of existing tools, to at least reduce or prevent mortality. An essential element of this strategy is the prevention or control of malaria epidemics and the selective use of vector control, both of which have to be based on a solid knowledge of local epidemiology, the study of which has to rejoin the path abandoned fifty years ago.

The malaria cauldron of Southeast Asia: conflicting strategies of contiguous nation states

The past half-century or so has witnessed dramatic failures but also some successes in control of malaria in the world at large. South and Southeast Asia have had their share of both outcomes, a scenario that reflects many variables in control programs: technology, management strategy, human and financial resources. However, at least equally culpable have been major wars and minor conflicts, economic growth and stagnation, inequity of opportunity, urbanisation, deforestation, changing transport and communications. The history of malaria is thus an integral part of the broader political and economic evolution of the region, as well as the story of the wisdom and unwisdom of malaria specialists. In positive reflection on the latter, systematic organisational effort using standard tools of trade has seen the gradual elimination of major malaria foci from central plain regions of a number of nations in this large region, with residual foci at forested border areas. In many cases there is good evidence of sustainability of elimination in defined areas but the differing success stories reflect in part conflicting strategies in neighboring nation states. On the other hand, physical conflicts, population migration, inequitable economic change, border instability and many other socio-economic variables can be clearly seen to undermine the most ingenuous strategies. Undoubtedly the single most important negative ingredient is the rise and spread of multi-drug resistant falciparum malaria that has its epicenter in Southeast Asia, from which it threatens the world in insidious fashion. Containment of this phenomenon has been the focus of attention for 30 years, more particularly the past decade, and represents the greatest challenge at this time in predicting the continuing impact of malaria globally on human history. So too does the compelling necessity to link malaria control with macro and micro economic planning. This challenge impinges on the sovereignty of individual nations in this region, for they exist in contiguity, so that successful applications of technology require collaborative political determination.

Malaria control in East Africa: the Kampala Conference and the Pare-Taveta Scheme: a meeting of common and high ground

The 1950 Malaria Conference in Equatorial Africa, held in Kampala, Uganda, has been remembered primarily for its decision to control malaria '...by modern methods as soon as feasible, whatever the original degree of endemicity, and without awaiting the outcome of further experiments.' This decision was far from conclusive and, indeed, reflects only one side of the argument which brought two groups of malariologists into direct opposition on the wisdom of malaria control in equatorial Africa, using modern methods such as DDT. Through an examination of the unpublished verbatim transcript of the Kampala Conference, we are able to document the 'furious debates' which took place at Kampala in 1950. We highlight, in particular, the adamant concerns expressed by some of the delegates that intervention in areas of high malaria transmission might lead to a loss of naturally acquired immunity which, in turn, could give rise to a resurgence of malaria, should the control strategies fail to be sustained. As we show, this concern had been expressed by a number of malariologists working in East Africa in the first half of the twentieth century, but it was only with the advent of DDT, as a residual insecticide, that the implications of wide-spread control, in the absence of any knowledge of the long-term consequences, became a serious possibility. While the Kampala Conference gave the 'go ahead' to control malaria in Africa without awaiting the outcome of 'further experiments', a number of participants insisted that a field trial should be set up to evaluate the impact of malaria on areas of high transmission both before and after spraying: to this end, a field trial in Pare-Taveta was carried out in 1954-59. In this paper we look at the Kampala Conference for its scientific debates and the Pare-Taveta Scheme for its field applications. In the final part of the paper, we address a number of questions raised at Kampala which have, once more, become contentious issues, following the recent successful trials of ITBNs. We believe that an understanding of the historical foundations of these issues should provide an important component of the new WHO campaign to Roll Back Malaria.

Resurgence of malaria in Bombay (Mumbai) in the 1990s: a historical perspective

Bombay has achieved extraordinary success in controlling its malaria problem for nearly six decades by relying primarily on legislative measures and non-insecticidal methods of mosquito abatement. In 1992, however, malaria reemerged in Bombay with a vengeance. During 1992-1997, the city witnessed a manifold increase in the number of malaria cases diagnosed and treated by the public health system. The large number of malaria patients treated by private practitioners was not recorded by the municipal malaria surveillance system during this period. In 1995, at the peak of the resurgence, public health officials of the Municipal Corporation of Greater Bombay (MCGB) confirmed that 170 persons in the city had died due to malaria. The crisis was unprecedented in Bombay's modern public health history. In response to intense criticism from the media, the city's public health officials attributed the resurgence to the global phenomenon of mosquito-vector resistance to insecticides, and Plasmodium resistance to antimalarial chemoprophylaxis and treatment. Local scientists who investigated the problem offered no support to this explanation. So what might explain the resurgence? What factors led the problem to reach an epidemic level in a matter of two or three years? In addressing the above principal questions, this paper adopts a historical perspective and argues that in the resurgence of malaria in Bombay in the 1990s, there is an element of the 'presence of the past'. In many ways the present public health crisis in Bombay resembles the health scenario that characterized the city at the turn of the 19th century. It is possible to draw parallels between the early public health history of malaria control in Bombay, which was punctuated by events that followed the bubonic plague epidemic of 1896, and the present-day malaria epidemic punctuated by the threat of a plague epidemic in 1994. As such, the paper covers a long period, of almost 100 years. This time-depth is used to illustrate how malaria control programs in Bombay and in other parts of India have evolved through a combination of local historical forces and political expediencies in the context of technological developments. The boom in construction activities in Bombay following the liberalization of the Indian economy in 1991, and the local politics affecting administrative practices of the MCGB, are discussed as crucial factors in the crystallization of the present-day malaria resurgence in Bombay. The paper concludes by arguing that malaria in urban India is a serious problem that cannot be neglected. In the case of Bombay, the solution to the crisis can be found, in part, by reexamining the historical and political issues that have determined the nature and magnitude of the problem over the last century.

Dealing with malaria in the last 60 years. A personal experience

Dealing with malaria in the last 60 years is seen by the author in the perspective of his own experience. His malaria work, which began in 1941, covered the study of the habits of the mosquitoes dwelling in the savanna country of Eastern Colombia and the effect on malaria transmission of the newly introduced DDT residual spraying. The success of the campaign he later directed in Sarawak and Brunei contributed to the launching by WHO of its global malaria eradication campaign. Further successful work in Uganda showed the possibility of effective control and even eradication in highland country but left unsolved the problem of how to interrupt transmission of holoendemic malaria in Africa. The author's work with WHO in the Middle East showed to what extent social and economic conditions could influence the course of a malaria campaign. This was also the experience in America, both in Colombia in the author's early work and later in Mexico during an evaluation of the national malaria programme. Development of insecticide resistance was also encountered in his career and the refractoriness of the European vectors was also observed in his work as a malariologist.

Anopheles (malaria) eradication in Cyprus

The island of Cyprus was suffering for many years from malaria fever. It was only in 1946 when a well organised Anopheles eradication campaign started. For this purpose the Anopheles Eradication Service was formed. Until 1949 this Service worked on Mosquito Eradication. An official announcement about the success of this Campaign was made on January 10th, 1950.

The dawn of DDT and its experimental use by the Rockefeller Foundation in Mexico, 1943-1952

The Rockefeller Foundation played an important early role in promoting the use of DDT for malaria control. During World War II the Foundation helped test DDT in the United States. North Africa and Italy. From 1945 to 1952 the Foundation carried out an experimental anti-malaria program in Mexico as part of its global mission to diffuse knowledge of how to control malaria-bearing mosquitoes with DDT.

'No other logical choice': global malaria eradication and the politics of international health in the post-war era

In 1955 the Eighth World Health Assembly voted to initiate a program for the global eradication of malaria. The global eradication of malaria represented a remarkable leap of faith. Many health authorities, both within and outside the Assembly, viewed eradication as at best fool hardy, and at worst, potentially disastrous. To understand why the World Health Assembly went ahead with a Global Eradication strategy, despite these concerns, it is necessary to examine the politics of international health and development in the post-war era. This political context shaped decisions about the adoption of DDT as a primary tool in the fight against malaria, as well as the adoption of the Malaria Eradication Program. It is equally important to understand how the advocates of an eradication strategy shaped arguments and developed support for their cause in the years leading up to the Eighth World Health Assembly meeting.

The role of chemotherapy in early malaria control and eradication programmes in Thailand

The use of synthetic antimalarial compounds played a secondary role to the use of residual insecticides in post World War II antimalarial control and eradication campaigns. The discovery of chloroquine-resistant malaria in South East Asia and South America prompted an intensification of antimosquito measures, rather than a thorough investigation of resistance. It was the failure of the antimosquito measures which primarily called a halt to malaria eradication and a return to control. A focus on the role of synthetic antimalarials in Thailand thus aims to provide a complementary view to those histories being constructed around the antimosquito measures.

The meanings of control and eradication of malaria in the Andes

For centuries Peruvians distinguished malaria from other conditions with different names in Spanish and in the native languages because it was a frequent occurrence in the coast and in the jungle located in the west and east of the Andean highlands. Frequency in different local contexts generated different meanings of malaria that appear more clearly when studying the campaigns of control and eradication of the 20th century. These meanings played an important role in the divisions and tensions that cross race, national integrity, and regional identity in this Andean country. This work deals with the medical and social dimensions of malaria's control and eradication efforts and the ways in which they codified geographical and racial distinctions within peru. Because malaria does not develop in the highlands, Andean migrants to the coast and the jungle regions are particularly susceptible. Some doctors associated the disease with Andean people, even contending that it was an indication of "Indians" weakness. Finally, this article analyses the spread and containment of malaria in light of the world eradication campaign initiated in the late 1950s and with regard to mass migration, urbanization, and other 20th-century phenomena.

Cognition and the global Malaria Eradication Programme

When making a decision involves the analysis of complex cause-effect relationships, experts are normally consulted to describe the best options available. The global Malaria Eradication Programme relied upon the advice of a small group of experienced malariologists; their counsel directed the most ambitious endeavour in the history of the World Health Organisation. In this essay 1 week to show how that group behaved with a single purpose and ultimately grew to be greater than the sum of its parts because of the control of knowledge. Each member of this epistemic community was willing to battle against malaria as soon as possible--forsaking research, traditional tools, and risking disastrous epidemics--because they believed that residual insecticides could progressively eradicate a disease that killed millions and sapped the lives of countless more. Alternative methods were ridiculed; and the epistemic community used their individual prestige to insert the DDT gospel into the technical forums of the WHO, and the power (and money) forums of the USA. Particular knowledge structures of the post-war decade nurtured a technical solution to malaria, and we shall explore how the WHO and the epistemic community could grow within this environment so compatible to their praxes.

Commentary: malaria control in the 1990s

In May 1955 the Eighth World Health Assembly adopted a Global Malaria Eradication Campaign based on the widespread use of DDT against mosquitos and of antimalarial drugs to treat malaria and to eliminate the parasite in humans. As a result of the Campaign, malaria was eradicated by 1967 from all developed countries where the disease was endemic and large areas of tropical Asia and Latin America were freed from the risk of infection. The Malaria Eradication Campaign was only launched in three countries of tropical Africa since it was not considered feasible in the others. Despite these achievements, improvements in the malaria situation could not be maintained indefinitely by time-limited, highly prescriptive and centralized programmes. Also, vector resistance to DDT and of malaria parasites to chloroquine, a safe and affordable drug, began to affect programme activities. A global Malaria Control Strategy was endorsed by a Ministerial Conference on Malaria Control in 1992 and confirmed by the World Health Assembly in 1993. This strategy differs considerably from the approach used in the eradication era. It is rooted in the primary health care approach and calls for flexible, decentralized programmes, based on disease rather than parasite control, using the rational and selective use of tools to combat malaria. The implementation of the Global Strategy is beginning to have an impact in several countries, such as Brazil, China, Solomon Islands, Philippines, Vanuatu, Viet Nam and Thailand. The lesson from these areas is clear: malaria is being controlled using the tools that are currently available. The challenge is now to apply these tools among vulnerable individuals and groups experiencing high levels of morbidity and mortality, particularly in sub-Saharan Africa, for which long-term investments are required.