How could a fascist dictator realize how to control malaria in Italy 80 years ago, when we can’t figure out what to do in Africa today ?
NOTE; He did it in 3 steps: larval source management with larviciding, improved housing and education, and finally medical treatment
In 1899, by field experiments in the Italian countryside, Grassi confirmed findings from Cuba, Panama and Malaysia that anopheline mosquitoes transmit malaria, and that people can be protected by sleeping in houses with metallic screens. As he repeated these field experiments in other parts of Italy, he gradually convinced health professionals and the general public, who had previously been skeptical (Snowden 2007 The conquest of malaria, Yale University Press.)
Details on the origins and accomplishments of the successful Italian campaign against malaria can be found in Snowden’s prize-winning book. It is the most detailed, perceptive and analytical report on any country’s fight against malaria. Snowden’s book is also an important source of lessons on how we can succeed in the fight in Africa.
Drainage of the marshes
After 1930, in another large field experiment on the Italian coast west of Rome, the dictator Benito Mussolini drained the 80,000 hectares of the Pontine marshes, the first of 3 steps in a process he called Bonifacio Integral, or “Integrated Improvements”. The drainage was part of a detailed engineering effort to ditch, dike and pump surface waters out of the marshland and into the sea. In addition this attack on the larval stages of the mosquitoes included chemical larviciding with Paris Green.
The Pontine marshes, along the Appian Way, had been known as a malarious hazard since antiquity, also described more recently by Lord Byron and by Goethe.
Housing, screens and education
The second step in the Bonifacio was to construct healthy housing, schools, health centers and extensive roadways for 60,000 settlers brought in to reclaim the land. Although Mussolini claimed credit for this effort, in fact he had good advice from a number of Italian malaria experts like Grassi and Celli who had gradually accumulated an understanding of the local problems. Previous experience had shown that simple drainage was not enough; it was also necessary to maintain the drainage system and develop the new settlement by reclaiming the land for agricultural purposes. This area is still the most productive agricultural area in Italy.
The third step was medical treatment of malaria infections. This three-step program developed by Mussolini and his malaria advisors was a direct and carefully planned attack on disease and poverty, aimed at the impoverished country people, the paisanos.
Because of illiteracy and superstitions, paisanos had initially been suspicious of all government officials, including physicians who were insisting that people take the bitter quinine, which the paisanos suspected was a poison. Initially these superstitions impeded the medical effort. This is why Snowden concluded that education was fundamental to the success of the anti-malaria campaign.
Successful experience in the Pontine marshes was used to reclaim agricultural land elsewhere in Italy. Thus after the Second World War when DDT and chloroquine became available, suppression was simplified and economical, as the extent of transmission was reduced geographically and seasonally.
The spread of education as part of the three-step program made government efforts to spray houses and treat infected people more successful as people understood and trusted government. The attack on malaria was thus part of the formation of the modern state of Italy.
Although the disease persisted in many parts of Italy up to the Second World War, the death rate had been reduced 80%-90% by the Bonifacio Integrale and social improvements.
Lessons about timing
From 1900 when the malaria problem was finally understood and control methods were developed, it took 60 years to eliminate it from the national territory. Even after DDT and chloroquine became available, it still took another 20 years before elimination was achieved. And this was in Italy with a European climate and cold winters which impede the anopheline mosquitoes.
Thus suppression of malaria in Africa - with its ecology favorable to mosquitoes - should be organized with the understanding that several decades will be needed before real progress is achieved.