Malaria on the March

Of all the diseases that plague man, one of the most resilient is malaria. As recently as a dozen years ago, health authorities believed they had the disease on the run in South Asia, where throughout history it had taken its greatest toll. Now the World Health Organization admits that its victory bulletins were premature. Malaria has returned to the region -with a vengeance. The total number of victims in South Asia this year is expected to reach 20 million.

All of Asia's southern tier, from Afghanistan to Indonesia, is affected by the outbreak. But malaria has struck hardest at the Indian subcontinent. India, which cut malaria cases from a 1947 high of 75 million to only 125,000 by 1965, expects to record 4 million this year. Pakistan, which then included Bangladesh, had reduced its annual toll from tens of millions to only 9,500 in 1961, estimates 10 million cases in 1975. Sri Lanka (formerly Ceylon), which once had 2.5 million cases per year, counted only 16 victims in 1963. So far in 1975, however, it has recorded at least 500,000 cases.

The reasons for the resurgence of malaria are complex. Throughout the '50s and early '60s, the governments of South Asia armed themselves with the newly developed miracle weapon DDT, and waged all-out war on the mosquitoes that carry malaria, spraying ponds, swamps and other breeding areas, and even sending health teams into homes to track down the insects. For a while, the campaign to combat malaria was spectacularly successful. "If you just wrote DDT on the wall, mosquitoes used to die," says Dr. M.I.D. Sharma, commissioner of India's rural health services. The disease that once made vast stretches of the Himalayan foothills practically uninhabitable almost disappeared from many communities. Formerly infested areas were opened to development, and governments began to phase out the spraying programs, diverting resources to seemingly more pressing health problems. "We became complacent," acknowledges Indian Health Minister Karan Singh. "We thought we had it licked."

That complacency proved costly. The spraying slowdown allowed the mosquitoes to thrive and multiply again. Quinine, used to treat malaria, is in short supply in some areas; India has not encouraged cultivation of the Cinchona trees from whose bark the drug is obtained (the malaria parasite is showing a rising resistance to the drug chloroquine, a synthetic substitute for quinine). Furthermore, rising petroleum prices have sent the costs of insecticides soaring, placing another burden on the shaky economics of the region. DDT, which cost India about $500 per ton in 1974, now costs $1,500.

Modest Goal. The governments of South Asia have responded with a host of emergency programs. Pakistani officials are importing $35 million worth of insecticides and spraying equipment from the U.S. Authorities in Sri Lanka are trying to crack down on illegal gem miners, who contribute to the malaria problem by digging pits which then fill with water in which mosquitoes breed.

None of the afflicted countries expect to eradicate the disease; it is just too well entrenched to be defeated by current control methods. "We will be satisfied with containment," says India's Singh. His modest goal: to bring the malaria incidence in his country down to 500 per million, or about 300,000 cases, by 1984.

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