Malaria: The Italian Campaigns

“It seems to me that in an eradication program one has to hit hard with everything at one’s disposal and, on that basis, I believe that the chances of success are excellent.” [1]

Squad of segnalatori (larval scouts), Sardinia (Italy) 1947

Squad of segnalatori (larval scouts), Sardinia (Italy) 1947

In the 1930s, 70,000 inhabitants on the Italian island of Sardinia were infected with malaria. By the 1950s only three or four cases persisted on the island.[2] This reduction can be attributed in large measure to Rockefeller Foundation (RF) strategies in combating the disease. In addition to its success, the Sardinian campaign is notable for groundbreaking techniques, including the first use of DDT to target mosquitoes and their breeding grounds. The campaign is also important for the debate it engendered on disease eradication versus control - a debate that continues to echo throughout the modern field of public health.

Malaria had long affected Italy, particularly the southern and coastal regions. Before RF involvement the Italian Government distributed quinine to at-risk populations. Benito Mussolini also ordered a series of land-reclamation projects intended to develop marshlands where mosquitoes were known to breed.  

Segnalatori searching for larvae in a shallow well, Sardinia (Italy) 1947

Segnalatori searching for larvae in a shallow well, Sardinia (Italy) 1947

RF’s Italian campaign against malaria began in 1924 and continued until the outbreak of World War II. In 1936 RF funding helped to construct a malaria laboratory at the Institute of Public Health in Rome. While early initiatives in Italy were successful, the RF believed that the future of malaria prevention rested on mosquito eradication, an idea first advocated by epidemiologist Fred Soper.

The Sardinian Experiment

In the post-war era the Italian campaign against malaria was reorganized with a particular focus on Sardinia. The RF concentrated efforts there from 1946 to 1951. The goal was the complete eradication of the anopheline mosquito responsible for malaria transmission.  The Sardinian campaign was viewed by those within the RF as an experiment. Sardinia, a secluded island with high rates of malaria infection, became the perfect laboratory to study the feasibility of eradication. RF scientists also planned to use dichlorodiphenyltrichloroethane, or DDT, a powerful chemical insecticide that first proved effective in fighting typhus during World War II.

Disinfectore spraying DDT, Sardinia (Italy) 1947

Disinfectore spraying DDT, Sardinia (Italy) 1947

The Sardinian campaign depended on RF money and expertise, along with significant financial and technical support from the Italian Government and the United Nations Relief and Reconstruction Administration (UNRRA). Ten thousand tons of DDT were deployed in Sardinia by 32,000 sprayers.[3]  The end results were impressive.  Officials cited a 99.9% rate of success in eradicating the dangerous mosquito from the island.[4]

Eradication vs. Control

Critics argued that the RF campaign was unnecessarily broad in scope, that species eradication was ecologically dangerous and that similarly successful results could have been achieved through more targeted mosquito control. John Austin Kerr, the first superintendent of the Sardinian campaign, numbered among these critics. In June 1946 Kerr questioned the feasibility of mosquito eradication, writing to Soper that “[a]fter spending a week in Sardinia I am of the opinion that the aim of the project there should be changed from eradiation of anopheles to the eradication of malaria.”[5] Kerr cautioned against the costs and overuse of DDT, but his concerns were brushed aside by others at the RF. G.K. Strode, Director of the International Health Division (IHD), wrote to Soper, “I see no point in carrying out the Sardinian project unless it is aimed at anopheline eradication and I agree that we should stick to our guns in reference to that objective.”[6] The debate ultimately led to Kerr’s resignation one year later.

This debate remains relevant today.  Ongoing campaigns against malaria and other diseases raise similar questions about the benefits of eradication versus control. Eradication advocates tout the long-term benefits of methods designed to eliminate vector populations, while control advocates argue that methods designed to control these populations remain the best way to use limited available resources to help the most people. Furthermore, the long-term environmental damage done by chemicals like DDT, which was key to the success of the Sardinian campaign, remain a serious impediment to similar efforts in the future.

[1] Paul F. Russell, M.D. to Dr. John A. Logan, February 18, 1948, Rockefeller Archive Center (RAC), RG 1.2, Series 700, Box 13, File 113.

[2] Marcus Hall, “Today Sardinia, Tomorrow the World: Malaria, the Rockefeller Foundation, and Mosquito Eradication”, (accessed May 13, 2011).

[3] Hall.

[4] Hall.