In 1943 the Allies advanced on German-occupied Rome. In response the Nazi regime reflooded the Pontine Marshes to the southwest of the city, hoping that malaria would spread from the marshy terrain to soldiers in the American and British armies and halt their rapid northward progress through Italy.
The marshes had been drained some 20 years earlier under Fascist leader Benito Mussolini to increase arable land and keep Rome safe from outbreaks of the mosquito-borne disease.
The German opening of the dykes had the desired effect. Food output decreased and Anopheles labranchiae, the mosquito that carries malaria, returned with a vengeance.
Some historians have argued that the move should be labelled an act of biological warfare.
Fast forward to today and the deadly disease is still present in many countries across the world. But as of last month, China was officially declared malaria-free after a 70-year battle with the debilitating illness.
As recently as the 1940s, China was reporting as many as 30 million malaria cases a year leading to huge numbers of fatalities in some areas.
The World Heath Organisation certified China as malaria-free on June 30 after the country proved that it had gone more than four-years without a single case of indigenous transmission.
“Their success was hard-earned and came only after decades of targeted and sustained action. With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement.
Malaria sickens at least 200 million people a year and still kills at least 400,000. Many of the infected are children under the age of five. In reality the numbers are probably far higher because many sufferers live in remote areas and are never diagnosed.
China’s eradication of the disease is a major step towards the possibility of ridding the world of the disease entirely, the WHO said. Other countries which have recently eradicated malaria within their borders include: El Salvador, Paraguay and Uzbekistan.
So how did China achieve this milestone? As the WHO said, it was the work of many decades, starting in the 1950s with the distribution of anti-malarial treatments to vulnerable populations and a nationwide campaign to reduce the mosquito population by destroying waterlogged areas and spraying homes with insecticides.
In 1967, prompted by China’s unofficial involvement in the Vietnam War, the government felt the need to accelerate its anti-malarial work (for its ‘volunteer’ soldiers’ health) – so it established the so-called ‘523 Project’ to find a drug that would treat chloroquine-resistant malaria.
It was that team, led by Nobel laureate Tu Youyou, that discovered artemisinin – the core-compound in the most effective anti-malarial drugs still used today.
China also went on to pioneer the use of insecticide-treated nets that prevent mosquitos biting people and transmitting the disease. Beijing also mandated the creation of a free service for testing and treatment, and devised the so-called 1-3-7 strategy, which required health facilities to report a malaria case to public health officials the same day they learn of it, establish risk of spread by day three, and take wider measures to stop further community infection by day seven.
By 2013 China was down to about 5,000 cases annually and in 2016 it had its first malaria-free year. Last year, it applied for the WHO’s malaria-free certification – even as it and the rest of the world battled Covid-19.
In May the WHO travelled to China to check on the application and approved it.
“China’s tireless effort to achieve this important milestone demonstrates how a strong political commitment and strengthening national health systems can result in eliminating a disease that once was a major public health problem,” said Takeshi Kasai, regional director of the WHO Western Pacific Regional Office.
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