The Coming Plague by Laurie Garrett Page B

where the Anopheles would undoubtedly return. Pulling the plug abruptly on their control programs virtually guaranteed future surges in malaria deaths, particularly in poor countries lacking their own disease control infrastructures. As malaria relentlessly increased again after 1963, developing countries were forced to commit ever-larger amounts of scarce public health dollars to the problem. India, for example, dedicated over a third of its entire health budget in 1965 to malaria control. 45
    Everything started to unravel. The Green Revolution—a World Bankbacked scheme to improve Third World economies through large-scale cash crop production—got underway. Turning thousands of acres of formerly diversely planted and fallow land into monocultured farms for export production of coffee, rice, sorghum, wheat, pineapples, or other cash crops necessitated ever-increasing pesticide use. When an area had very diverse plant life, its insect population was also diverse and no single pest species generally had an opportunity to so dominate that it could destroy a crop. As plant diversity decreased, however, competition and predation among insects also declined. As a result, croplands could be overwhelmed rapidly by destructive insects. Farmers responded during the 1960s with heavy pesticide use, which often worked in the short term. But in the long run pesticides usually killed off beneficial insects, while the crop-attacking pests became resistant to chemicals. A vicious cycle set in, forcing use of a wider assortment of insecticides to protect crops.
    At the very time malaria control efforts were splintering or collapsing, the agricultural use of DDT and its sister compounds was soaring. Almost overnight 46 resistant mosquito populations appeared all over the world.
    As Russell kept a worried eye on the pesticide resistance problem, a
new crisis appeared: two people who were taking chloroquine developed malaria in South America. 47 Almost simultaneously, chloroquine-resistant malaria turned up in Colombia, 48 Thailand, 49 Venezuela, 50 and Brazil. 51 The drug had been in use for only fifteen years; widespread use spanned less than a decade’s time. 52 By 1950 a second drug, primaquine, was available, and many countries returned to the use of the ancient antimalarial, quinine. But resistance soon developed to those and other drugs introduced in the 1960s. 53 By 1963 U.S. forces fighting in Vietnam encountered chloroquine-resistant malaria, and the Army began a major effort to research and develop new antimalarial drugs. 54
    The drug-resistance problem could only have been aggravated by government decisions in some countries—notably New Guinea—to add chloroquine to all table salt. 55
    By the time the smallpox campaign was approaching victory in 1975, parasite resistance to chloroquine and mosquito resistance to DDT and other pesticides were both so widespread that nobody spoke of eliminating malaria. Increasingly, experts saw the grand smallpox success as an aberration, rather than a goal that could easily be replicated with other diseases. 56
    In 1975 the worldwide incidence of malaria was about 2.5 times what it had been in 1961, midway through Paul Russell’s campaign. In some countries the disease was claiming horrendous numbers of people. China, for example, had an estimated 9 million cases in 1975, compared to about 1 million in 1961. India jumped in that time period from 1 million to over 6 million cases. 57
    A new global iatrogenic form of malaria was emerging—“iatrogenic” meaning created as a result of medical treatment. In its well-meaning zeal to treat the world’s malaria scourge, humanity had created a new epidemic.

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    Monkey Kidneys and the Ebbing Tides
    MARBURG VIRUS, YELLOW FEVER, AND THE BRAZILIAN MENINGITIS EPIDEMIC
    When the tide is receding from the beach it is easy to have the illusion that one can empty the ocean by removing water with a pail.
    â€”René