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The Centers for Disease Control and Prevention are America’s first – and last – defence against disease. By Carrie Arnold.

Billion-dollar efforts made by the World Health Organization and the Bill and Melinda Gates Foundation to stop the spread of malaria have focused their efforts on Africa and India. But a little more than 50 years ago, one of the largest battles against malaria was fought and won in the USA. A little-known monument to that battle can be found in Atlanta, at the headquarters for the Centers for Disease Control and Prevention (CDC).

Europeans brought the malaria parasite with them to the New World, but in order to cause disease, Plasmodium needed mosquitoes to spread it. Unfortunately, several species in North and South America had just this capability. As a result, many Americans died from malaria. Those that survived reported bouts of ‘intermittent fever’ and ‘ague’ that plagued them for years. The southeastern USA – with its heat, humidity and swampy lowlands that were perfect for malaria-transmitting mosquitoes – was the country’s malaria epicentre. It was a problem, sure, but it seemed like a problem limited to certain Southern backwaters.

That changed during World War II. Many military training sites were located in the very Southern backwaters that were home to malaria. And when soldiers finished training, they headed overseas to other areas in which malaria was endemic. The need for an effective fighting force galvanised the government into action. In early 1942, citing a need for better malaria control in military areas, the Public Health Service obtained money to create Malaria Control in War Areas (MCWA), which they headquartered in Atlanta, Georgia.

The MCWA used a multi-pronged approach to malaria that included inputs from physicians, engineers and entomologists. Within the first year, the MCWA was operating in 1,161 war establishments in 317 counties of 21 states. Elizabeth Etheridge in Sentinel for Health, a history of the CDC, writes:

“From the beginning, engineers and entomologists dominated. Physicians assessed malaria cases in the field, and parasitologists ran the laboratory, but major emphasis was always on mosquito control, the engineers’ specialty. They determined control methods, directed operations, surveyed and designed drainage construction projects, and mapped field activities. Entomologists, first commissioned in large numbers in 1943, provided the necessary expertise on mosquitoes. The wartime need to save time, money, and equipment dictated that temporary measures like larvicidal control take preference over permanent drainage projects.”

As the war ended, MCWA began focusing on the tropical diseases that returning troops might bring back home, as well as other infectious diseases that could be found on American soil. The then-head of the MCWA, Joseph Mountin, pushed for a centre for disease control to continue the work of the MCWA. Soon, the fledgling CDC was handling not just malaria control but also other threats, such as bubonic plague and amoebic dysentery. In 1947, the CDC’s headquarters became permanently attached to Atlanta when Emory University provided 15 acres of land.

The CDC is unique among many large federal agencies in that its headquarters is not located in the Washington DC metro area. It sounds like a random happenstance, until you trace its history to America’s long fight against malaria.

Today, the CDC continues to be involved in tropical disease research, which includes gaining a better understanding of the underlying biology of these pathogens and how they interact with human and animal hosts, as well as performing routine surveillance to determine how many people are infected.

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