Failure-as-success: multiple meanings of eradication in the Rockefeller Foundation Sardinia project, 1946-1951.

In the history of malaria control programs there were important tensions between proponents of the concept of eradication and those of malaria control. In this debate the concept of eradication has had multiple meanings. This paper concerns the post-hoc interpretations of the outcomes of the Rockefeller International Health Foundation-sponsored project conducted in Sardinia between 1946 and 1951. The Ente Regionale per la Lotta Anti-Anofelica in Sardegna (regional agency for the anti-Anopheles struggle in Sardinia) (ERLAAS) project was conceived as a large-scale, field-based pilot demonstration project to test the feasibility of the strategy of "species eradication" in an area with an endemic malaria vector. Species eradication, a strategy championed by Soper, was aimed at the total annihilation of an anopheline vector from an area. Under the leadership of the Rockefeller Foundation, the ERLAAS project used postwar UNRRA funds to purchase local labor and imported DDT, oil-suspension, and war-surplus equipment in an "all-out" campaign against Anopheles labranchiae, even in sparsely populated areas. The original aim was entirely entomological; species eradication was expected to be completed in two years for a cost of $2.7 million. Ironically, malaria mortality on the island had already been lowered before WWII by a series of public health interventions. The ERLAAS project encountered severe technical and logistical difficulties; its ultimate failure was foreshadowed in the resignation of the first American director who doubted the feasibility of species eradication. Ultimately, the ERLAAS project was ended after four and a half years and an expenditure of $11.2 million. Although new malaria transmission on the island ended the project failed to eliminate A labranchiae. Finally, the regional government was counselled to continue mosquito control efforts; the continuation of a substantial mosquito control program for fifty years after this famous "malaria eradication" project runs contrary to the basic cost/benefit logic of the eradication concept. Nevertheless, in the popular press both in the U.S. and Italy, the project was presented and heralded as a major success in liberating the island from the age-old stranglehold and misery of malaria. In the course of the project, the goals of ERLAAS became transformed from species eradication to malaria eradication; this was an important political spin that was put on the evaluation of the program. The consequences of this tactical change in discourse included two important facts: the contribution of the Rockefeller Foundation to the island was exaggerated, and the legitimacy of the concept of global eradication was maintained. In the framework of the World Health Organization and the agreement for a global malaria eradication program, the "failure" of the Sardinia project was seldom recognized or mentioned. The technical, economic, and logistical problems faced by ERLAAS were very similar to the problems associated with the end of the WHO global malaria eradication policy in 1972. The Sardinia project is presented as a case of "failure-as-success"; an ideological transformation was made, not simply for local political expediency, but more importantly because of the predominance of the modernist cultural model of "progress through technology" that characterized international Public Health in the postwar era.