Welt ohne Krankheit. Geschichte der internationalen Gesundheitspolitik 1940–1970

Zimmer, Thomas
Moderne Zeit. Neue Forschungen zur Gesellschafts- und Kulturgeschichte des 19. und 20. Jahrhunderts 29
Göttingen 2017: Wallstein Verlag
Anzahl Seiten
439 S.
€ 42,00
Rezensiert für H-Soz-Kult von
Heidi Tworek, The University of British Colombia, Vancouver

Thomas Zimmer’s excellent monograph is a very useful contribution to the growing literature on the history of health and the history of international organisations, embedded within the broader context of the early decades of the Cold War. As the book would surely interest many historians who do not read German, I have chosen to write this review in English; I hope that the book will find an English translator soon to enable other scholars to benefit from Zimmer’s nuanced insights.

Zimmer examines the history of international health politics, mainly between 1940 and 1970, though he provides a clear summary of health politics before and after those dates. The book artfully combines an analysis of the institutions and practices of international health with a history of ideas about world health.

Sharing the multi-archival perspective of much of the best recent international history, Zimmer’s work fits into newer chronologies that see 1945 less as a Stunde Null than a preparation for post-war planning and practice.[1] The book explores how and why the concept of “world health” became so prominent in 1945–46, spurring the creation of the World Health Organisation (WHO). It then traces how the WHO became the forum for a wide range of actors, including the US, developing countries, and international health experts, to try to eradicate malaria. The bulk of the book examines the creation, execution, and end of the Malaria Eradication Programme (MEP).

The MEP’s scale was enormous. Between launching in 1955 and the program’s end in 1969, around 90 states had launched campaigns against malaria, including India, Indonesia, Brazil, and Albania. About 75 million people in India caught malaria in 1950; around 1 million died. By 1961, only three years after MEP had launched in India, the country reported only 100,000 cases and not a single death. By the time that the WHO officially ended the MEP in 1969, malaria had been eliminated in 37 countries (p. 11).

But the program failed to achieve its goal of eradicating malaria and has been criticized widely ever since. The program used the pesticide DDT to spray millions of houses and fields, leading to environmental destruction. In some places, malaria even re-emerged more virulently, because populations had lost their immunity to the disease.

Zimmer seeks to nuance the current consensus on the MEP, arguing that historians have overlooked the MEP’s achievements because they judged it by the almost impossible standard of eradication set by health experts in the 1950s. While noting the MEP’s problems, Zimmer persuasively shifts our attention from condemning the program to asking why it emerged, how it functioned, and what it tells us about international history in the first decades of the Cold War.

As Zimmer notes, the historiography on international health has divided into two, somewhat contradictory trends. The first sees international cooperation developing and expanding continuously since the first International Sanitary Conference in 1853; the other trend focuses on individual aspects such as one disease, conveying an impression of isolated, innovative moments (pp. 20-21). Zimmer seeks to combine the two perspectives and move beyond them by embedding his history of the MEP within a broader chronology and context.

Zimmer sees the MEP as emerging from a combination of prior practices and ideas. The practices go back to the International Health Division of the Rockefeller Foundation, created prior to World War I, that focused on combatting individual diseases rather than the social factors enabling the spread of disease. Attempts at the end of World War II to fight malaria in places like Sardinia and Greece through DDT provided the immediate precedents along with the WHO’s “demonstration projects” in the late 1940s and early 1950s, as Zimmer ably traces.

Ideas about “world health” became ubiquitous in 1945–46 as events like the atomic bomb showed that the world was irreversibly interconnected. Utopian visions of a post-war world morphed into a dream of eradicating diseases rather than merely containing them. The growing Cold War competition over decolonized countries created new reasons for the US in particular to invest in international health. The aims of multiple actors – the WHO, US, developing countries, international health experts – coalesced at a particular moment to lay the groundwork for the WHO’s official declaration of the MEP in 1955.

Building on Sunil Amrith’s work, Zimmer takes India as his case study for exploring how governments tried to implement the MEP and how that overlapped with Cold War concerns.[2] Like Amrith, Zimmer notes that the archival situation in India makes it challenging to discover how the MEP worked on the ground. Nevertheless, Zimmer has done excellent archival digging to unearth materials conveying the massive scale of a program that employed around 150,000 Indians at its height (p. 294). He emphasizes the importance of the US that supplied over 90 percent of the funding (p. 254), combined with WHO officials’ technical insights and the enthusiastic participation of the Indian government that saw eliminating malaria as vital for economic growth.

The book is packed with insights for those interested in world health, international organisations, and American interactions with India, in particular. To name but a few, Zimmer teases out why the WHO is the only UN agency whose executive board is composed of experts rather than politicians. Contra scholars like Iris Borowy, he argues that the US was far more influential in the WHO’s foundation than League of Nations Health Organization officials.[3] He shows that India was not a passive object of international health politics; like many states, it was eager to work with the US and WHO on the MEP. Finally, he portrays programs like the smallpox and polio eradication programs as less innovative than scholars like Erez Manela have claimed.[4] Smallpox and polio were far less widespread than malaria when the WHO undertook programs to eradicate them; those two diseases required vaccination for elimination, while that was not an option for malaria, a disease spread by the vector of mosquitos. For Zimmer, these programs indicate not the WHO’s ability to broker between the US and Soviet Union and of cooperation between competing superpowers at the height of the Cold War, but rather the WHO’s reduced ambitions after the MEP.

Zimmer’s wide-ranging book provides a nuanced and detailed exposition of the ambitious and utopian project to eliminate malaria. As Zimmer’s work shows, we have far to go before we can live in a world without disease.

[1] Sunil Amrith / Patricia Clavin, Feeding the World: Connecting Europe and Asia, 1930–1945, in: Past & Present 218, no. suppl. 8 (2013), S. 29–50; Daniel Plesch, America, Hitler and the UN: How the Allies Won World War II and Forged a Peace, London 2011.
[2] Sunil S. Amrith, Decolonizing International Health: India and Southeast Asia, 1930–65, Houndmills 2006.
[3] Iris Borowy, Coming to Terms with World Health: The League of Nations Health Organisation 1921–1946, Frankfurt am Main 2009.
[4] Erez Manela, A Pox on Your Narrative: Writing Disease Control into Cold War History, in: Diplomatic History 34 (2010), S. 299–323.