eradication was not technically or economically feasible in many areas (World Health Organization Expert Committee on Malaria, 1967). In fact, Africa south of the Sahara had been excluded from the eradication plan altogether because of the perceived magnitude of the region 's malaria problem and the lack of technological capability within those countries (Lepes, 1974). The number of malaria cases decreased dramatically in some regions, but most of these successes were recorded in less threatened temperate zones or on island nations, not in the continental tropical countries, where by the late 1960s malaria was still a serious health threat (Brown et al., 1976).

Research had almost no role in the initial years of the eradication effort. Indeed, there was little interest in involving scientists in a field many thought would soon be obsolete. It was only as the complexity of malaria became apparent that research assumed a more prominent place in eradication programs. Recognizing this, WHO in 1965 began to actively encourage malaria research. In 1969, the World Health Assembly passed a formal resolution to stimulate and intensify multidisciplinary malaria research.

The deemphasis of science combined with a decline in the number of malariologists left countries ill prepared for two major, interrelated changes in international health policy: the shift from malaria eradication to malaria control, and the move toward integration of health services.

Financial Support for Eradication

Many countries invested heavily in the eradication effort. In 1958, two powerful U.S. senators, Hubert H. Humphrey from Minnesota and John F. Kennedy from Massachusetts, attached legislation to the Mutual Securities Act that committed the United States for five years to the goal of worldwide malaria eradication (Spielman and Kitron, 1990). An annual appropriation of $23 million was provided, an enormous investment for the time. The United States spent $85 million in just three years (1957-1960), and the worldwide commitment to the project exceeded $100 million in 1960 alone (International Cooperation Administration Expert Panel on Malaria, 1961). WHO obligations to malaria eradication jumped from $768,000 in 1955 to almost $8 million in 1964 (Gramiccia and Beales, 1988). A number of countries also shifted funds within their own health budgets to accommodate the eradication goal. During the mid-1960s, for instance, India devoted 35 percent of its health dollars to malaria. The tremendous resources devoted to malaria eradication throughout the world meant that less could be spent on other important public health projects (Farid, 1980).

Eradication to Control

In 1969, the World Health Assembly revised its global malaria eradication strategy. The new approach emphasized strategies that could be justi-



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