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MALARIA: Obstacles and Opportunities
Credit for the first efforts at malaria control properly belongs to the Greeks and Romans, who in the sixth century B.C. undertook major engineering projects to drain marshy areas. This practice continued well into the Middle Ages and spread throughout Europe and the Middle East. By and large, however, efforts to control malaria prior to the twentieth century met with minimal success. One of the most successful modern attempts at malaria control occurred under the leadership of General William C. Gorgas, who joined the U.S. Army Medical Corps in 1880, shortly after receiving his medical degree. During construction of the Panama Canal (1904-1914), Gorgas oversaw an integrated program of malaria control that included drainage, application of larvicide, and prophylactic treatment with quinine that resulted in the virtual elimination of malaria from the Canal Zone by 1910.
Starting in the mid-1940s and continuing through the mid-1950s, public health officials began to consider eradicating malaria from all parts of the world. Successful attempts to eradicate the Mediterranean fruit fly from Florida (1930-1931) and An. gambiae from Brazil (1934-1940) and Egypt (1948) made a large campaign against malaria seem feasible. The greatest impetus for malaria eradication came with the development of the powerful insecticide DDT during World War II.
Serious attempts to wipe out malaria in the United States began in 1943. That year, a proposal to eradicate the disease based on a strategy of indoor residual spraying with DDT was presented to the National Malaria Society by the U.S. Public Health Service (PHS) (Mountin, 1944). The result was the National Eradication Program, initiated in 1947 with $7 million in federal funds. Five years later, malaria morbidity and mortality in the United States had dropped to near zero and the program was abandoned (Bradley, 1966).
The years following World War II were unparalleled for the level of international cooperation devoted to combating endemic malaria. The United Nations Rehabilitation and Relief Administration, formed in 1943 as an international emergency organization with the United States as the principal financial backer, was very active in malaria control projects (Russell, 1968). The first Expert Committee on Malaria, established by the Interim Commission of the World Health Organization, met in 1947 (Najera, 1989); the World Health Organization (WHO) was officially formed in 1948.