對蚊子宣戰：二次戰後台灣根除瘧疾的科技與社會研究

二次戰後WHO以噴灑DDT消滅瘧蚊，在世界各國展開根除瘧疾計畫，台灣是戰後全球除瘧行動中，極少數完全根絕瘧疾，並且長期維持無本土病例的國家。本研究從科技與社會的觀點，回顧從日治到美援台灣瘧疾防制「對人法」與「對蚊法」的爭議；戰後以DDT家戶噴射對瘧蚊宣戰的準備、攻擊、肅清與保全；批判檢視台灣戰前／戰後瘧疾死因與盛行率的變化；最後從社會世界的理論觀點，討論台灣成功除瘧的歷史與社會脈絡。本研究發現，台灣戰後的除瘧行動，有延續自日治時期的瘧蚊研究，瘧原蟲檢驗技術，藥物治療，以及防瘧體系的支持。戰後世界衛生組織、美國與國民黨政府耗費眾多人力與物力，全力支持DDT家戶噴射，有冷戰與戒嚴的特殊歷史脈絡。台灣根除瘧疾得以長期維持，除了對人法舊技術與對蚊法新技術同時並行，以及戒嚴時期限制人民海外旅行之外，矮小瘧蚊也不敵台灣生態環境的變遷，節節敗退。此外，台灣在1952年代全面噴射DDT之前，瘧疾盛行率已經大幅下降。DDT是戰後全球瘧疾根除計畫的邊界物，標準化的家戶噴射作業流程雖然無法在全球各地同步執行，但是和台灣的人與非人行動者，組成穩固的防瘧技術網絡，成為非常少數的成功案例。本研究具體回應「超越國家單位的國際書寫架構」，從社會世界的理論觀點，討論DDT在台灣除瘧所扮演的角色，不但可以協助理解技術物的多重社會性格，對當前全球公共衛生政策，也有重要貢獻。

關鍵字

瘧疾；戰後； DDT ；根除計畫；科技與社會

並列摘要

After World War II, the World Health Organization promoted the use of residual DDT spraying to eradicate malaria. Taiwan was one of the very few countries to successfully eradicate malaria and to stay malaria-free for many years. In this study, I took the Science, Technology and Society (STS) perspective to review the Taiwanese history of malaria eradication, starting from the Japanese colonial period up to the USAID after WWII, as well as the scientific controversies surrounding malaria control. I explored the ”war against mosquitoes” from the phases of preparation, attack, consolidation, and maintenance, and re-analyzed the malaria mortality and morbidity data to elucidate the social and historical context of malaria eradication in Taiwan. I suggest that the malaria eradication efforts in Taiwan had indeed continued from the Japanese Colonial period. There were entomological studies, parasite-examining techniques, medication, and anti-malaria public health systems. During the post-war period, the WHO, US and Taiwanese governments spent a lot of money and manpower to support DDT residual spraying. Other than treating the patients and the mosquitos, Taiwanese people were not allowed to travel under marshal law, and An. Minimus retreated because of the ecological changes in Taiwan. Furthermore, the prevalence of malaria in Taiwan had dramatically dropped before DDT spraying began in 1952. DDT was a boundary object in the post-war global malaria eradication program. While the standardized house-spraying methods could not apply to many countries during this time, there were human and non-human actors forming to consolidate malaria eradication networks in Taiwan. This study aims to retell the Taiwan story on the international level. Social world theory helps clarify the multiple social characters of objects, and may contribute to global public health policies.