It has been 51 years since November 17, 1970, when the World Health Organization (WHO) declared Italy officially malaria-free.
The same malaria that still poses one of the greatest global health challenges today, causing an estimated 228 million cases of infection and 400,000 deaths each year.
Historically, the three malarial parasites (P. vivax, P. falciparum, and P. malariae) are estimated to have been endemic in Italy since the second century B.C., thus for more than 2,000 years, especially in the marshy areas of the Veneto region, the islands, and central and southern Italy.
Thanks to the first data collection in 1887, it was estimated that until then there were millions of cases of infection and over 20,000 deaths each year.
Fig1: Map of malaria distribution in Italy. Torelli, Florence, Pellas, 1882. (Reprinted from: The Laboratory of Malariology. Edited by Giancarlo Majori and Federica Napolitani. Rome: Istituto Superiore di Sanità; 2010. (The Historical and Scientific Assets of the Istituto Superiore di Sanità, Notebook 5)
.Already from the early twentieth century, malaria was combated with important national policies directed at land reclamation, mandatory reporting of the infection, free access to quinine, and education and prevention campaigns aimed at the population. "The state assumed the burden of purchasing quinine of guaranteed quality on the international market, packaging it in tablets and distributing it in all malaria areas included in the program. The drug would be provided free of charge to the poor and to all those who worked in the open air: quinine, which until then had been the exclusive preserve of the wealthiest citizens, was finally within everyone's reach" (Snowden, p. 61). However, in view of the fact that the population most at risk of infection was those living in the countryside, and given the difficulty of reaching this population, the success of the malaria elimination campaign was the result of collective efforts among governmental, local, medical, health and volunteer authorities. The joint efforts were not limited to distributing the drug to the community, but jointly implemented real information and health education campaigns on prevention practices and treatment schemes in order to maximize their effectiveness.
The efforts resulted in the elimination of malaria from the malaria epidemic.
The efforts quickly translated into achievements. By 1914, at the dawn of World War I, annual cases of infection had been reduced to 110,000 and 2045 deaths, down from 15,865 in 1900.
The number of annual cases of infection was reduced to 110,000 and 2045 deaths, down from 15,865 in 1900.
Subsequently in 1928, the fight against malaria became one of the central goals of Fascist policy. The strategy, called "integral," consisted of adding three reclamation practices to the use of quinine: hydraulic (draining swamps and controlling water sources), agrarian (repopulating the area through agricultural incentives), and hygienic (safe housing conditions with whitewashed masonry). The Agro Pontino, south of Rome, has been the target area on which most efforts have been focused: 10 years of effort, more than 120,000 workers, 16,500 km of drainage canals, five new towns built.
The area has been the target area for the most efforts: 10 years of effort, more than 120,000 workers, 16,500 km of drainage canals, five new towns built.
Not too far away, however, with Italy's entry into the war in 1940, the antimalarial fight had a slowdown, resulting in an increase in cases. until 1945.
The health plan that subsequently led to the elimination of malaria came from the United Nations Relief and Rehabilitation Administration (UNRRA) and the Rockefeller Foundation, which in 1946 offered 1.18 billion liras for a five-year program, where the use of the new insecticide, DDT, was favored. With the use of DDT along with intensive initiatives they enabled the liberation from malaria throughout Italy.
In 1962 the last two cases occurred in Palermo, and in 1965 the last case of transmission of P. malaria e by a local mosquito occurred.
"Malaria was endemic in Italy until 1950. In the early 1900s, when the first national campaign to eliminate the disease was undertaken, more than 2 million cases and about 10,000 deaths a year were reported in Italy. It was considered an "occupational" disease responsible for unsustainable economic damage to the country. And we can well understand now, in this time of the COVID pandemic, how real this claim is. In less than 50 years, strong political commitment, adequate investment and the application of scientific knowledge by the excellent Italian School of Malariology made it possible to implement decisive interventions that led to the elimination of malaria in Italy as early as 1960," Professor Taramelli recalls.
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