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THIRD LAW FOR MALARIA

March 5, 2010 - 15:58 -- William Jobin

There is great historical and practical value in looking at the successful attack on malaria in Italy during the past century, and then going ahead to plan for the attack on malaria in Africa during this century.

Some of the most dramatic stories about malaria control in Italy concerns Dictators and Wars, namely Benito Mussolini, Adolf Hitler and the Second World War. Why is this relevant for Africa? Because any realistic attack on malaria in Africa will have to contend with the multiple dictators and recurrent warfare on the continent. None of the African dictators or wars can compare to the horror of Hitler and the Second World War, but the lessons are useful, nonetheless.

Mussolini became very popular in Italy about 1932 because he drained the Pontine Marshes near Rome, thus eliminating malaria from the area, and making it possible to establish stable and profitable agricultural communities. So he became a popular hero, and used that popularity to take over Italy with his fascist dictatorship. Mussolini simply had his troops dig drainage ditches to the sea, and put in some big pumps to lift the salt water out, letting fresh water come in from the rivers, and thus cleanse and irrigate the land.

Unfortunately for him, Mussolini then made friends with the Great Fascist, Adolf Hitler, who sent German troops into Italy as part of his Grand Strategy to take over Europe. When those plans started to fall apart, Mussolini broke off with Hitler. Adolf did not like that.

Adolf had a mean streak, don't you think?. So as his troops moved North out of Italy in the face of the advancing Allied army about 1943, Hitler had them turn Mussolini's drainage pumps around, and pumped salt water back into the Pontine agricultural zone, turning it into a marsh once again. And back came the mosquitoes and malaria.

It was not until after the war, when Italy established a democratic government, that the marshes were drained again, and malaria was finally eliminated from Italy, in 1962..

So the lesson is; you are wasting your time fighting malaria if there are dictators around.

Could this be true in Africa too? Yes, I'm afraid so. I helped establish a 10-year program for malaria control in Africa which was highly successful for the first 9 years, bringing the malaria parasite prevalence below 1% for the last 5 years of the project. Then a military officer pulled a coup. The first thing he did was go to the national bank and steal about $50 million in hard currency which we had borrowed from the World Bank for drainage pumps. It was our exit strategy, similar to Mussolini's. But the new Dictator wanted the money for fuel and ammunition to conclude a civil war, so he didn't care much about malaria control.

So unlike Hitler, this guy didn't reverse the pumps, he just stole them! And the next year, our project area had the worst malaria epidemic ever, with lots of cerebral malaria in children because they had never developed immunity.

Thus we formulated the Third Law for Fighting Malaria in Africa., namely, you better remember that the dictators are as bad as the mosquitoes.

Bill, a believer in encouraging democracy everywhere

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Comments

Submitted by Magnus Atemnkeng on

Bill, I agree to some parts of your write-up. Since mosquitoes can only lay eggs in standing water it makes but normal sense that eliminating all standing water and marshes will be an effective weapon to control malaria. However, you know the terrain in Africa cannot be compared to that of Italy where level land and lots of grassland makes it easier for such an irrigation scheme to be successful. Africa is plagued with the dense forests and the humid conditions favour a lot the survival of mosquitoes and their eggs.
Eliminating the potholes, poorly constructed wells, providing an effective urban sewage drainage system, instituting a proper garbage collection system (and not leaving them for idling domestic animals and birds to devour), proper management of streams, rivers, lakes and other water bodies that habour these insects and run through cities and villages should be a starting point for an effective mosquito control program.
On the issue of dictatorship in Africa, it will all depend on the individual in power because even some of the democratically elected presidents are prey to emblezzement of state funds. Mussolini was a dictator (a good fighter for malaria, for the rest I don`t know) and used his battalion of army to dig drainages which sucessfully eliminated mosquitoes and malaria. Other dictators and rulers can learn from this...

Magnus

Magnus Atemnkeng, PhD
Montreal, Canada

William Jobin's picture
Submitted by William Jobin on

Thanks for your comments Magnus.

Africa does have some flat, irrigated plains; the floodplains of the large rivers such as the Blue Nile, Senegal and Niger Rivers, where irrigation, drainage and malaria are all interlinked. These are the regions where environmental and engineering methods have the greatest impacts.

Regarding dictators, I have made a serious study of them, and prefer democracies where we can vote out the corrupt ones. If you rank African dictators along with some of the corruption indices and the welfare indicies, countries controlled by despots rank near the bottom.

There are several kinds of dictators, but I think they are all stupid, and then corrupt. Stupid because they haven't figured out that a monolithic approach to life will never compete in the modern world when faced with diverse options available in a democracy. Corruption takes a few years, and the longer in power, the more corrupt a government becomes. Some dictators stay in power for 20-30 years. Change helps to minimize the corruption, and the stupidity. In addition you can have military dictators, and then the worst, a communist military dictator. Someday I am going to publish my analysis, as part of my proposal for a Realistic Strategy for Attacking Malaria in Africa. Thus the Third Law.

In balance, Italy and Germany lost out with their dictators, even though Hitler made the trains run on time, and Mussolini drained the marshes. Don't you think?

Bill

William Jobin Director of Blue Nile Associates

Patrick Sampao's picture
Submitted by Patrick Sampao on

William i like the third law approach, Africa's development from economic to health has been crippled by its own leardership.If we could put in place democratic systems then things would be different.

For execution of any malaria elimination strategies African governments have to be at the forefront as it would require particiaption and involvement of local leaders who are answerable to the government.

So i quite agree with you that one of the benefits of democracy in African nations will be elimination of malaria.

Patrick Sampao

Regards,

Patrtick

Bart G.J. Knols's picture
Submitted by Bart G.J. Knols on

Patrick and Bill,

All good points, but what about communist countries like Vietnam, where a well organised bednet campaign and activities by village health workers has led to dramatic results?

Political goodwill is of great importance, no doubt, but whether democracy is the starting point for efficient malaria control remains to be seen...

With this in mind I agree with Dambisa Moyo's book 'Dead Aid' that economic development should come first, be it under dictatorial rule or as part of a democracy. Trying it the other way around may stiffle development. Perhaps the same applies to malaria control?

Bart

William Jobin's picture
Submitted by William Jobin on

Bart,

This gets tricky. There seem to be many kinds of communism, and some might be more democratic than others. There is no question that implementation of public health measures is easier in an authoritarian country. One of my worries about communism is that a communist dictator can destroy a country with crazy ideas - see N Korea, and also Chairman Mao's Great Leap Backward in China which plunged them into famine.

I would prefer a stable, open and representative government, if I were to invest money in malaria control, because such a country would provide the best assurance that my investment would bear fruit and endure. I am very suspicious of authoritarian governments because they can so easily and quickly go wrong.

You say economic development should come first. But look what happened to the USSR in which the means of production and the land were the property of the State, and then the State became those old men in Moscow, and then the rest of the folks got nothing.

Angola was a communist country for a while. Now they have huge oil and mining revenues, but it is hard to see where that money shows up in the Ministry of Health. Angola gets most of its malaria control money from others, as handouts. I think that is inherently unstable and unreliable.

Cuba was famous for advanced health care - while they were supported by the USSR. But what of the future?

I guess I am looking for a stable, democratic society with a truly representative system of governing where public health is recognized as important and where real money is put into it by the national government.

Economic development is necessary for attacking malaria, and so are a host of other things like education, literacy, adequate food, and a functioning health care system. They all have to be cultivated together, and I see democracy and representative government as the best way to do that. Snowden's book on the Conquest of Malaria in Italy developed that theme very well.

Bill, still thinking

William Jobin Director of Blue Nile Associates