The Fever Read online

  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.”57

  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 1954.58 So should the entire region of Asia, the Second Asian Malaria Conference agreed that same year.59

  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?60

  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.”61

  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.62 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.63

  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 $193,000.64

  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.65

  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.66

  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.”67

  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.68

  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.”69 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 mosqu
itoes 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 1952.70 Three years later, the paper was warning: DDT “in danger of losing the war” against malarial mosquitoes.71 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.72

  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.73 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.74

  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.75

  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).76

  • • •

  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).77 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.78 It was “a Christmas gift directly to more than a billion people,” The New York Times enthused.79

  Multimillion-dollar checks went out to WHO, PAHO, and those countries willing to convert their malaria-control programs into eradication programs.80 The developing world’s biggest campaign was launched in India, with $38 million from the United States and $50 million from the national government.81 Ninety-two other malarious countries devoted themselves to the eradication cause, with several allocating as much as 35 percent of their tiny public health budgets to sending teams of workers into the field, canisters of DDT tied onto their backs.82 Between 1957 and 1963, the United States would spend $490 million on the campaign, its single largest contributor.83

  For the first few years, the global malaria-eradication program was every thing Paul Russell and IDAB said it would be. By 1960, eleven countries had banished malaria from their borders, and a dozen or more had sent malaria rates plummeting.84 Cases across Central America and in demonstration villages in Papua New Guinea fell to negligible levels.85 In India, an annual caseload of seventy-five million dropped to fewer than one hundred thousand.86 In Borneo, the parasite rate fell from 35.6 percent to less than 2.0 percent.87

  Newly malaria-free populations were as beasts of burden relieved of their loads. Life expectancy in Sri Lanka increased from forty-three to fifty-seven years, and the prime minister envisioned repopulating the uncultivable malarious parts of the island. Life expectancy in Sardinia increased from 30 percent below national rates in Italy to 3 percent above.88 Rice cultivation increased tenfold in Greece, Morocco, and Indonesia. In Cambodia, land values doubled.89

  According to the experts, it was only a matter of time before the disease would be no more and these gains secured for all time. “If such a degree of control can be obtained” as quickly as it had been in so many places, WHO reported, “complete eradication can be expected in the near future.”90 Showered with honors as the Man Who Ended Malaria, Paul Russell watched the proceedings from a new position at Harvard University, confident in an imminent victory.91

  Across Europe and North America, tropical medicine departments closed their doors. What was the point of furrowing brows over a soon-to-be-extinct disease? The study of how insects transmit malaria and other diseases became “a dead field,” said a Johns Hopkins malariologist. “DDT is killing it.”92 Malariologists drifted into other, more well-funded fields, and new young scientists did the same.93The nuanced, multidisciplinary field, enlisting the insights of engineers, entomologists, ecologists, clinicians, and anthropologists, had devolved into a single brute question: how to coat interior walls with two grams of chemical per square foot.94

  Even before eradicating malaria, the joke went, the campaign eradicated malariologists.

  The spraying continued.

  According to the IDAB plan, every single domicile in the program had to be sprayed with DDT twice a year for at least four years. Across the globe, teams of workers appeared in villages and towns toting large canisters of strange-smelling chemicals. They demanded that residents leave their homes, and take all their food and eating utensils with them. They removed all the pictures from the walls and moved the furniture around, leaving the walls covered with a powdery residue. It smelled like chlorine.

  Locals found that the DDT didn’t just repel and poison Anopheles mosquitoes and the pesky houseflies and bedbugs. It killed their chickens, too, and, in Malaysia, the flies that parasitized the caterpillars that fed on thatched roofs. Not long after DDT spray teams left, the village roofs collapsed.95 In Borneo, the DDT killed the cockroaches, which killed the cats that ate the cockroaches. The cat-free villages were left with a rampaging rat population, and their crop-destroying, disease-carrying ways.96

  For all this and more, suspicion reigned. In North Vietnam, local revolutionaries suspected that the spray teams were somehow collecting military information with their strange equipment. Villagers feared that evil spirits would enter their huts through the small holes campaign staff had made to install mosquito-catching traps.97 Buddhist leaders in Cambodia and earlier nonviolent leaders such as Mohandas Gandhi in India objected that the campaign offended their religious sensibilities.98

  The benefits of malaria eradication would likely have outweighed many of these admitted downsides, but there’d never been any attempt to enlist the support of the malarious masses for the DDT campaign. From the beginning, the program had been a top-down affair, hatched, funded, and overseen by experts in distant lands. The residents whose homes would be doused with DDT had barely been asked for permission.

  Even after suspicions and objections arose, campaign leaders did not call for a massive public education push or for greater local participation in the conduct of the campaign. Instead, they practiced damage control. In Borneo, WHO opened special centers to collect donations of new, healthy cats. In the most remote areas, it arranged for the Royal Air Force to air-drop, along with vegetable seeds and “4 cartons of stout for a recuperating chieftain,” twenty cats ensconced in specially devised cat baskets.99 (“Many thanks to R.A.F.,” wrote one local, “also to cat donors and cat basket makers . . . very accurate dropping.”)100 In Vietnam, they organized
soldiers to accompany the spray teams for protection.101 To Gandhi and the Buddhists, they offered the following bit of convoluted logic: Nobody was forcing DDT upon the mosquito. “If she chose to break into his home to drink his blood,” as one campaign malariologist said to Gandhi, “and died in the course of her trespass, that was her doing, not his.”102

  None of this proved particularly persuasive. “Operation Cat-Drop,” as one bemused local called it, earned the lasting mockery of environmentalists every where (thanks in part to a fictionalized version of the story by the novelist T. C. Boyle).103 Far from being reassured by the presence of troops, Vietnamese villagers groused that the DDT spraying was being forced upon them.

  Before long, spray teams around the globe found themselves in villages where no one was home and every door locked. In India, fewer than one in nine spray teams adequately sprayed their assigned areas. In a village of sixty-three houses, ten doors would be locked, thirty-five residents would refuse access, and one house would be forgotten by the spray team. Of them all, only seventeen houses would be sprayed.104

  Growing recalcitrance of the public took its toll on the morale of the spray teams themselves. Some started taking bribes from those who wanted their homes spared. Others grew weary of carrying their tanks around all day, and so doubled their morning spraying so they could rest in the afternoon. Still others sold their DDT on the black market, spraying homes with a worthless dilution instead.105

  As the spraying stumbled, so did the business of surveillance. Surveillance was both a much bigger job than spraying, requiring more resources and infrastructure, and much more hidden from public view. Teams of workers had to go door to door, collecting blood samples and actively hunting for fever cases. Each slide of blood had to be meticulously examined for parasites, and if any were found, workers had to go back out and find and treat the host. Mosquitoes had to be collected and their susceptibility to DDT tracked. Few countries had the skilled workers, clinics, or support systems required.