December 27, 2010
Malaria: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka
By DONALD G. McNEIL Jr.

Malaria cases jumped 25 percent in Sri Lanka from 2009 to 2010, the country’s ministry of health is reporting. And while this year’s total is still small, at 580, the trend is unsettling to experts.

Sri Lanka is a bellwether for the dream of malaria eradication — and Exhibit A for the argument that politics affects the disease more than climate or public health measures do.

The country — the former British colony of Ceylon, famous for tea and cinnamon — is an island, so eradication is possible.

That almost happened once. After independence arrived in 1948, Sri Lanka had an estimated one million annual cases. With DDT and chloroquine, it drove that down to 18 cases by 1963. But spraying was cut back as DDT fell into disfavor, and by 1969, there were more than 500,000 cases.

Simultaneously, the country’s ethnic fabric fell apart. The majority Buddhist Sinhalese passed laws discriminating against the Hindu Tamils, who were favored under the British, leading to 30 years of civil war. The majority was also split for decades between pro-Soviet and pro-Western factions.

Malaria persisted, with cases highest in the north and east, where the Tamil Tiger insurgency was strongest. Nonetheless, by 2005, the country was below 2,000 cases, though experts said they were undercounted in rebel areas.

Last year, the rebellion was crushed, and malariologists hoped the new national reconciliation policy would lead to eradication. As cases ticked up, a ministry official blamed global warming — a weak argument in a wet tropical country. But he also said more clinics would be opened in former rebel areas.

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