Venezuela's Malaria Battle

From Venezuela's Collapse: The Long Story of How Things Fell Apart, by Carlos Lizarralde (Codex Novellus, 2024), Kindle pp. 241-243:

Chávez, Chavismo, and its intellectual supporters in Venezuela and abroad, had argued since 2004 that the old liberal state could not produce people who cared for the well-being of the majority. The “representative” governments from the 20th century had not been able to deliver for all. But if there is an area where the liberal state was able to create long-lasting institutions with veritable results, it was health care.

The first nationwide, publicly funded efforts to eradicate malaria started during Rómulo Betancourt’s first government in 1945. The program had begun under the old generals in the mid-1930s. Dutch, British, and American oil companies had been active in the eradication of the disease in their areas of influence. But Betancourt’s social priorities and taxes on oil companies provided a new impetus. The efforts led by Dr. Arnoldo Gabaldón started with a massive campaign to eradicate mosquitoes in malaria zones. Within three to five years malaria had disappeared from the areas where the infecting mosquito predominated, although the WHO would not certify the disease had been eradicated from the country. Betancourt and his party would be thrown out by a coup in 1948, only to return to power by February of 1959. One of his first acts the second-time around was to name Dr. Arnoldo Gabaldón as Health Minister. The renewed emphasis and funding would officially free the country of malaria by 1961. Gabaldón’s work did not stop as efforts to build a robust central health authority continued for a decade. Critically, his lifework had been dedicated to getting the academic and practical experience necessary to build such an organization.

Gabaldón had started work as an assistant at the Ministry of Health in 1928, when generals still ruled the country. This gave him an early acquaintance with the ins and outs of the health bureaucracy across the country. He then studied at the German Institute of Naval and Tropical Diseases and the Italian Experimental Station for the Antimalarial Battle, before returning to Venezuela in 1932. He received a health science doctorate from Johns Hopkins University in 1935 through the Rockefeller Foundation and interned at Rockefeller University in New York City.

Upon returning to Venezuela, he joined the Ministry once again. At that time, fighting malaria was the country’s number one priority. By 1945 no pathogen, including the influenza virus that caused the 1918 pandemic, caused more deaths than malaria in Venezuela. The population had declined between 1891 and 1920 because of the disease. The historical devastation caused by malaria no doubt contributed to the zeal with which a generation of reformers fought a tireless battle against it.

First in his front-line role eradicating malaria, and then as the builder of a first-class health ministry and epidemiology network, Gabaldón delivered the most enduring results in the history of Venezuelan health care. Over three decades he dedicated himself to reforming, modernizing, and growing an existing, prior organization. The deep differences between Betancourt’s perspective and that of the military governments he had overturned had no real impact on Gabaldón’s work. His formula of achieving scale through incremental reforms, long-term training of middle cadres, deploying compliance systems, and creating strong legal frameworks, continued until the 1970s. Gabaldón was able to defeat every health challenge he met, to international acclaim. The epidemiology systems he created prevented the return of any serious epidemic for more than forty years, until everything he had built was dismantled.

Gabaldón’s legacy was overturned in the name of the people’s originary wisdom and the virtues of intuitive decision-making in health matters. Yet, no one suffered more than those in whose name the health sector was destroyed. By 2017, over a decade into the Chavista dismantling of the liberal state, more than 400,000 Venezuelans had been infected by malaria. This increase amounted to 84% of the rise in malaria cases between 2010 and 2017 around the world.