Editing Malaria (section)

===Initial WHO program (1955–1969)===
[[File:L0074987 Malaria eradication - the world united against malaria (20675407876).jpg|thumb|right|1962 Pakistani postage stamp promoting malaria eradication program]]

In 1955 the WHO launched the Global Malaria Eradication Program (GMEP).<ref name="Duintjer-2009">{{cite journal | vauthors = Duintjer Tebbens RJ, Thompson KM | title = Priority Shifting and the Dynamics of Managing Eradicable Infectious Diseases | journal = Management Science | volume = 55 | issue = 4 | pages = 650–663 | year = 2009 | doi = 10.1287/mnsc.1080.0965 }}</ref> The program relied largely on DDT for mosquito control and rapid diagnosis and treatment to break the transmission cycle.<ref>{{cite journal | vauthors = Mendis K, Rietveld A, Warsame M, Bosman A, Greenwood B, Wernsdorfer WH | title = From malaria control to eradication: The WHO perspective | journal = Tropical Medicine & International Health | volume = 14 | issue = 7 | pages = 802–809 | date = July 2009 | pmid = 19497083 | doi = 10.1111/j.1365-3156.2009.02287.x | s2cid = 31335358 | doi-access = free }}</ref> The program eliminated the disease in "North America, Europe, the former [[Soviet Union]]",<ref name="Sadasivaiah-2007"/> and in "[[Taiwan]], much of the [[Caribbean]], the [[Balkans]], parts of northern Africa, the northern region of Australia, and a large swath of the South Pacific"<ref name="Gladwell-2001">{{cite news | vauthors = Gladwell M |author-link=Malcolm Gladwell |title=The Mosquito Killer |newspaper=The New Yorker |date=July 2, 2001 |url=http://gladwell.com/the-mosquito-killer/ |access-date=August 20, 2014 |archive-url=https://web.archive.org/web/20160416165010/http://gladwell.com/the-mosquito-killer/ |archive-date=April 16, 2016 |url-status=dead }}</ref> and dramatically reduced mortality in [[Sri Lanka]] and India.<ref name="Harrison-1978"/>

However, failure to sustain the program, increasing mosquito tolerance to DDT, and increasing parasite tolerance led to a resurgence. In many areas early successes partially or completely reversed, and in some cases rates of transmission increased.<ref name="Chapin-1981">{{cite journal | vauthors = Chapin G, Wasserstrom R | title = Agricultural production and malaria resurgence in Central America and India | journal = Nature | volume = 293 | issue = 5829 | pages = 181–185 | year = 1981 | pmid = 7278974 | doi = 10.1038/293181a0 | s2cid = 4346743 | doi-access = free | bibcode = 1981Natur.293..181C }}</ref> Experts tie malarial resurgence to multiple factors, including poor leadership, management and funding of malaria control programs; poverty; civil unrest; and increased [[irrigation]]. The evolution of resistance to first-generation drugs (e.g. [[chloroquine]]) and to insecticides exacerbated the situation.<ref name="van den Berg-2008">{{cite web|url=http://www.pops.int/documents/ddt/Global%20status%20of%20DDT%20SSC%2020Oct08.pdf|title=Global status of DDT and its alternatives for use in vector control to prevent disease| vauthors = van den Berg H | date=October 23, 2008|publisher=[[Stockholm Convention on Persistent Organic Pollutants]]/[[United Nations Environment Programme]]|access-date=November 22, 2008|archive-url=https://web.archive.org/web/20101217022138/http://www.pops.int/documents/ddt/Global%20status%20of%20DDT%20SSC%2020Oct08.pdf|archive-date=December 17, 2010|url-status=dead|df=mdy-all}}</ref><ref name="Feachem-2007">{{cite journal | vauthors = Feachem RG, Sabot OJ | title = Global malaria control in the 21st century: a historic but fleeting opportunity | journal = JAMA | volume = 297 | issue = 20 | pages = 2281–2284 | date = May 2007 | pmid = 17519417 | doi = 10.1001/jama.297.20.2281 }}</ref> The program succeeded in eliminating malaria only in areas with "high socio-economic status, well-organized healthcare systems, and relatively less intensive or seasonal malaria transmission".<ref name="Sadasivaiah-2007">{{cite journal | vauthors = Sadasivaiah S, Tozan Y, Breman JG | title = Dichlorodiphenyltrichloroethane (DDT) for indoor residual spraying in Africa: how can it be used for malaria control? | journal = The American Journal of Tropical Medicine and Hygiene | volume = 77 | issue = 6 Suppl | pages = 249–263 | date = December 2007 | pmid = 18165500 | doi = 10.4269/ajtmh.2007.77.249 | doi-access = free }}</ref>

For example, in [[Sri Lanka]], the program reduced cases from about one million per year before spraying to just 18 in 1963<ref>{{cite book|title=The Coming Plague: Newly Emerging Diseases in a World Out of Balance|page=51| vauthors = Garrett L |url=https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|year=1994|publisher=Farrar, Straus and Giroux|isbn=978-1-4299-5327-6|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019223243/https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|url-status=live}}</ref><ref>{{cite news | url = https://www.nytimes.com/2010/12/28/health/28global.html | title = Malaria: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka |  vauthors = McNeil Jr DG | work = The New York Times | date = December 27, 2010 | access-date = February 7, 2017 | archive-date = January 4, 2017 | archive-url = https://web.archive.org/web/20170104050535/http://www.nytimes.com/2010/12/28/health/28global.html | url-status = live }}</ref> and 29 in 1964. Thereafter the program was halted to save money and malaria rebounded to 600,000 cases in 1968 and the first quarter of 1969. The country resumed DDT vector control but the mosquitoes had evolved resistance in the interim, presumably because of continued agricultural use. The program switched to [[malathion]], but despite initial successes, malaria continued its resurgence into the 1980s.<ref name="Harrison-1978">{{cite book|title=Mosquitoes, Malaria, and Man: A History of the Hostilities Since 1880|isbn=978-0-525-16025-0| vauthors = Harrison GA |url=https://books.google.com/books?id=mfkBr2oskyEC|year=1978|publisher=Dutton|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019210418/https://books.google.com/books?id=mfkBr2oskyEC|url-status=live}}</ref><ref>{{cite journal | vauthors = Karunaweera ND, Galappaththy GN, Wirth DF | title = On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs | journal = Malaria Journal | volume = 13 | pages = 59 | date = February 2014 | pmid = 24548783 | pmc = 3943480 | doi = 10.1186/1475-2875-13-59 | doi-access = free }}</ref>

Due to vector and parasite resistance and other factors, the [[Eradication of infectious diseases|feasibility of eradicating malaria]] with the strategy used at the time and resources available led to waning support for the program.<ref name="Nájera-2011">{{cite journal | vauthors = Nájera JA, González-Silva M, Alonso PL | title = Some lessons for the future from the Global Malaria Eradication Programme (1955-1969) | journal = PLOS Medicine | volume = 8 | issue = 1 | pages = e1000412 | date = January 2011 | pmid = 21311585 | pmc = 3026700 | doi = 10.1371/journal.pmed.1000412 | doi-access = free }}</ref> WHO suspended the program in 1969<ref name="Duintjer-2009"/><ref name="Nájera-2011"/> and attention instead focused on controlling and treating the disease. Spraying programs (especially using DDT) were curtailed due to concerns over safety and environmental effects, as well as problems in administrative, managerial and financial implementation.<ref name="Chapin-1981"/> Efforts shifted from spraying to the use of [[Mosquito net|bednets]] impregnated with insecticides and other interventions.<ref name="Sadasivaiah-2007"/><ref name="Rogan-2005">{{cite journal | vauthors = Rogan WJ, Chen A | title = Health risks and benefits of bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT) | journal = The Lancet | volume = 366 | issue = 9487 | pages = 763–773 | year = 2005 | pmid = 16125595 | doi = 10.1016/S0140-6736(05)67182-6 | url = https://zenodo.org/record/1259797 | access-date = June 13, 2019 | url-status = live | s2cid = 3762435 | archive-url = https://web.archive.org/web/20191017205259/https://zenodo.org/record/1259797 | archive-date = October 17, 2019 }}</ref>