Wednesday, July 06, 2005

Compare and Contrast: Malaria and the Iraqi Insurgency

The correlation between the interaction of man with a disease and the US and it’s coalition with the Iraqi “insurgency” have something in common. Laurie Garrett published her lengthy work, “The Coming Plague” in 1994. While the book is not about malaria, that is one case study she presents to show how we made some poor decisions, which allowed the disease to carry on, even today. In the reading of her well researched book, there are many other parallels between man’s interaction with man that tracks remarkably close to how we have interacted with creatures of far fewer cells and complexity over history. When I read the book years ago, her comments on malaria stuck with me, despite it being a relatively minor portion of the discussion. In Chapter 2, she discusses how the 1951 World Health Organization “was so optimistic that it declared that Asian malaria could soon reach a stage through careful local management wherein ‘malaria is no longer a problem of major importance.’ The discovery of DDT and other organochlorines, all of which possessed remarkable capacity to kill mosquitoes and other pests on contact…” The insurgency can be looked at in a similar way, that by the application of effective methods and means, the terrorists could be reduced to being “no longer a problem of major importance.” DDT certainly had it’s downside from a public health standpoint, but it did get us out of the starting blocks in the eradication of malaria and killed many mosquitoes. In 1967, the Surgeon General reported to the President and a gathering of health officials that it was time to close the books on infectious diseases in the US and take on chronic diseases. This then, obviously, would shift the focus away from the eradication of malaria, but it didn’t end the efforts towards that planned move to make it no longer a major problem. Malaria has plagued the US Military, and of other countries before ours, since the Revolutionary times. In 1947, Congress budgeted $47M to take on the problem of malaria in the 48 continental states. Five years later, funding was stopped, as there hadn’t been any cases of malaria found within the US borders. Other countries around the world still had the problem… Come 1956, a malariologist named Paul Russell of Harvard’s School of Public Health began lobbying for a program to eradicate malaria on a worldwide basis. In a report to Congress, Russell had these words to indicate the degree of commitment required:
”This is a unique moment in the history of man’s attack on one of his oldest and most powerful disease enemies. Failure to proceed energetically might postpone malaria eradication completely.”
With minor changes, this sounds much like the speeches of President Bush, but when he speaks of the terrorist threat. The comparisons in this story are quite striking. Enemies that are not alike. Someone with a vision to know what is not good for society. Lobbying to get the support, and there are many more I’m sure you’re picked up on by now. “Having won World War II, Americans were of a mind to ‘fix things up’: it just seemed fitting and proper in those days that American should use their seemingly unique skills and common sense to mend all the ailments of the planet.” Funding from Congress came in 1958, but with stipulations of and end to funding by 1963. Why the time frame? Paul Russell’s report indicated that four years of spraying, followed by four years of sure that three consecutive years of no infections were noted. Like all plans, whether for war fighting, or building, or fighting diseases, the “program manager” makes projections based on generally ideal conditions. In the case of the worldwide eradication of malaria, as with dispensing with the threat of terrorism, the campaign must pretty much proceed in parallel everywhere simultaneously, or you’re likely to have the enemy merely slip away to somewhere safe. This does, however, require a high degree of commitment to the plan, as well as a high expense to keep the attack going everywhere. This, of course is much of the discussion today. As far as ideal planning, the general desire if to get moving as soon as funding flows, but sometimes you have to begin in a piecemeal fashion, which, as with combating malaria and terrorists, can not be very effective. Top that off with a bunch of, for the most part, lawyers who don’t always grasp the technical detail of the plan, and therefore take the Reader’s Digest version and also apply simplistic measures to the plan. In this case, handing out money, then demanding it be done in a few years. As life and much of history dictates, things change. Along comes a bright graduate student, Andy Speilman, who figured out DDT wasn’t the final answer. What he observed was the Anopheles mosquitoes were dying, but some were resistant to DDT, and still reproducing. A wrench in the gearbox of the plan had just been discovered. Speilman met Rachel Carson, a marine biologist at Woods Hole, and she explained that evolution would get in the middle of the eradication plan. By 1963, malaria was certainly beat back tremendously, an example being India going from 1 million cases a year in 1955 to 18 by 1963. Congress, checking their notes, realized it was the terminal date of the plan and therefore, committed no more funding to the project. “As far as Congress was concerned, failure to reach eradication by 1963 simply meant it couldn’t be done, in any time frame. And virtually all spare cash was American; without steady infusions of U.S. dollars, the effort died abruptly” says Garrett. The story continues from there and is fascinating reading, but look at the connections to the current debate about how to handle the GWoT. Once more today, I heard a caller on a talk show bring up the President’s “major hostilities are over” speech on the aircraft carrier. Anyone with any military experience would agree that when artilleymen and tankers are doing foot patrols in the crowded streets of another country, major hostilities are over, otherwise, they’d be rocking the bad guys with the really cool hardware they were trained to use with deadly efficiency. Also, when B-52s no longer fill the skies over the battlefield, it’s a big hint that major operations are concluded. The President was correct. He didn’t say “the war is over and we are victorious.” Had that been the case, it would have been proper to remove a major portion of the deployed military. And, despite that proclamation by the President, as was the case in 1963, the enemy is still around; diminished, but still there. What lessons are to be extracted from a historical account of how the American leadership took on malaria and the GWoT? - It’s difficult to judge the exact end of a major plan, regardless of the discipline involved. - Arbitrary constraints linked to Congressional budget cycles can actually delude you into thinking it’s easy to see the day things will change/end. Oh, if it could just be so simple. On the other hand, the person championing the cause needs to be forthright in indicating the expected “variation” in the timeline. I feel President Bush has been honest about saying this war will be a long and complex one, and he said that early on. - If you really want to make something “no longer a major problem,” don’t make artificial end dates, instead make milestones with evaluation criteria. At those junctures, see what the state of the plan is and modify your responses accordingly. Make sure the checkbook holders understand this clearly, and get the will of the people to line up with that understanding. - A form of tactical evolution has happened on the battlefield. We have most likely gotten to the point where we have killed off the weakest of the terrorists, and not are locked in a war with the ones that are resistant to the military tactics applied to date. - Most times, the weapons you begin the fight with aren't the ones that will win the conflict Congress is a big group of “bean counters.” I have had life experiences with such people, on a smaller scale, and it was always interesting to see “them” grasping the pennies and not seeing the bigger picture. Sometimes spending a few dollars more today will guarantee you spend far less a few months of years from now. If they can’t let go of the funding to get that done, then you’re pretty much locked in to dealing with it longer. Regardless of how rosy an initial plan looks, it’s best to evaluate it realistically along the way. Adapt and survive. Don’t declare victory when that’s not the case. Stay the course when your life depends on it. We have a chance to end the story of the GWoT differently than the one about our war against malaria, which is still with us. Thanks to Mudville Gazette Dawn Patrol Link

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