Another oped in the Mail & Guardian
-----------------------------------
In more depth, about using DDT for malaria control. The Wall
Street Journal editorial page also ran a piece today on DDT.
I'll send it shortly.
Philip Coticelli
Africa Fighting Malaria
mailto:pcoticelli@gmail.com
http://www.fightingmalaria.org
--
http://www.mg.co.za/articlePage.aspx?articleid=256050&area=/insight/insight__africa/
Wednesday, November 09, 2005 10:11 PM
How DDT can stop millions of malaria deaths
Richard Tren and Philip Coticelli
*09 November 2005 08:45*
Every year, more than a half-a-billion people suffer agonising
pains and fevers because of malaria, a disease that is entirely
preventable and curable. In Africa, someone -- normally a child
-- dies every 30 seconds from this disease, causing unimaginable
grief, human suffering and economic stagnation.
It needn't be this way, however; about 50 years ago, malaria was
eradicated from Europe and the United States, and right now some
countries have successful anti-malaria programmes. Yet, far from
helping countries with malaria, many donor agencies and United
Nations organisations actually hamper the fight against the dis-
ease and the deadly mosquitoes that transmit it.
One of the best ways of controlling malaria is to use the insec-
ticide that most environmentalists love to hate -- DDT. If mos-
quitoes and parasites were not enough to contend with, the poli-
tics surrounding the use of DDT and vested interests that oppose
it make it nearly impossible for countries to use DDT for ma-
laria control in spite of its incredible success.
DDT was first used during World War II to halt the spread of
lice-borne typhus. Typhus epidemics raged in many war-torn ar-
eas. DDT powder was dusted over civilians, soldiers and concen-
tration-camp survivors and put in their clothes and bedding, and
before long the spread of the disease was halted.
Malaria-control experts soon noted the success of DDT in typhus
control and began to apply the insecticide against mosquitoes.
When used in malaria control, DDT is sprayed in tiny quantities
on the inside walls of houses. This application repels mosqui-
toes so that they don't enter houses to feed on humans, and
kills them if they do enter.
Indoor residual spraying (IRS) with DDT eradicated malaria in
the US and Europe and led to spectacular declines in the disease
in Africa, Asia and Latin America. Wherever DDT was used in pub-
lic health, death and disease fell and the conditions for devel-
opment and wealth creation improved.
But while DDT was saving lives in malaria control, it was also
being used in agriculture. Sprayed in enormous quantities aeri-
ally, DDT protected crops from pests like boll worm. This use of
DDT raised concerns in the early 1960s from the nascent modern
environmentalist movement. In her book *Silent Spring*, Rachel
Carson described potentially catastrophic consequences for wild-
life and humans of the widespread use of DDT.
*US hearings* Growing campaigns by environmentalist groups dur-
ing the 1960s culminated in the hearings into DDT by the newly
formed US Environmental Protection Agency (EPA). After eight
months and extensive, in-depth hearings presented with evidence
from experts both for and against DDT, the presiding Judge, Ed-
mund Sweeney, ruled that DDT should not be banned. Despite the
popular view that DDT was highly damaging to the environment and
human health, there was, in fact, little scientific evidence to
support these beliefs.
Yet DDT was banned anyway by the head of the EPA, William
Ruckelshaus, in a neat example of politics trumping good sci-
ence. The EPA had just been formed and its head was keen to dem-
onstrate that the agency could and would take decisive actions
to protect the environment. The fact that banning DDT wouldn't
actually help the environment was neither here nor there.
Since the EPA banned DDT in agriculture, countless studies have
been conducted into the potential impacts of DDT on human
health, yet none of them have been able to find any concrete
evidence of actual human harm. DDT is remarkably non-toxic to
humans; people have tried to commit suicide by eating it and
failed miserably. DDT is classified as a possible human carcino-
gen by the International Agency for Research on Cancer, which
may sound alarming, but is the same classification given to cof-
fee and many other foodstuffs in our daily diet.
Even though the evidence of environmental harm from DDT has been
exaggerated, the use of DDT in malaria control cannot result in
environmental degradation. First, it is used in small quantities
indoors. Second, most environmental degradation in malarial ar-
eas arises from poverty, an over-reliance on natural resources
for food and fuel, and a lack of clearly defined property
rights. If DDT spraying can reduce disease and catalyse develop-
ment, drawing in tourists and investors, the state of the envi-
ronment is likely to improve.
*Dwindling support* The agricultural banning of DDT, in theory,
did not affect the public-health use of the insecticide. DDT re-
mained available for use in malaria control; however, the sup-
port given to the insecticide and the spraying programmes that
used it began to dwindle. Many malaria-control programmes rely
on financial, logistical and scientific assistance from donor
agencies and the various UN agencies that are involved in ma-
laria control, such as the World Health Organisation (WHO) and
the UN Children's Fund.
Without support from these organisations, maintaining malaria-
control programmes became increasingly difficult, and from the
1970s onwards, malaria gradually increased worldwide, claming
more and more lives and condemning hundreds of millions to re-
peated bouts of illness.
South Africa has maintained its IRS programme for decades and
used DDT very successfully until 1996, when it was withdrawn in
part to comply with WHO resolutions to reduce reliance on the
insecticide. The result was one of the worst epidemics in the
country's history.
Tragically, the *Anopheles* mosquitoes were resistant to the in-
secticides that replaced DDT. After malaria cases had risen by
about 1 000%, South Africa reintroduced DDT in 2000 and in just
one year achieved an 80% reduction in cases in KwaZulu-Natal,
the worst-hit province. Malaria cases remain at almost all-time
lows in the country thanks to DDT.
In 2000, a private mine, Konkola Copper Mine on the Zambian Cop-
perbelt, restarted its IRS programmes using DDT. Malaria control
had declined along with the economic fortunes of Zambia in the
early 1980s and, as a consequence, the disease had returned with
a vengeance to many areas. Yet after just one season of DDT
spraying, malaria incidence was halved, and was halved again the
following year. So successful has the application of DDT been
that the Zambian government restarted its IRS programmes in sev-
eral other parts of the country.
Uganda has been trying to restart its IRS programme and use DDT.
Yet, recently, the European Union threatened to ban Ugandan ag-
ricultural exports should the programme go ahead. The EU's fear
that some DDT could leak on to agricultural produce is largely
unfounded and ignores the fact that most countries that use DDT
have instituted tight controls and strict audits of their ma-
laria-control programmes. The EU position is shameful and a dou-
ble whammy to the health and development of Uganda.
*Importance of IRS and DDT* Fortunately, the Global Fund to
Fight Aids, Tuberculosis and Malaria (GFFATM) clearly recognises
the importance of IRS and DDT to malaria control, and has there-
fore been funding several IRS programmes in Southern Africa.
Other donors, such as the US Agency for International Develop-
ment (USAid), do not have the foresight or good sense of the
GFFATM and fail to fund IRS programmes in any significant way.
In fact, in 2004, of USAid's $80-million malaria budget, only
$4-million was spent buying commodities such as drugs and insec-
ticide-treated bed nets that could actually save lives.
The vast majority of its budget is spent in the US and used by
consultants that fly to Africa to tell malaria-control scien-
tists what to do -- but that doesn't actually buy the tools to
do the job. Additionally, USAid promotes bed nets as a malaria-
prevention strategy to the near-exclusion of IRS with DDT.
So, when a country wants to improve its malaria-control pro-
gramme and tries to use DDT, which has been shown time and again
to be highly effective, it faces opposition from the well-paid
consultants that prefer to promote policies that keep them em-
ployed and earning air miles. They also face opposition from the
trade-protectionist EU that panders to alarmists and mischie-
vously uses junk science, even though it hampers malaria control
and costs lives.
*Role of business* The obstacles to good malaria control unfor-
tunately do not end there. Big business also plays a distasteful
role in this saga. Recently, the *Financial Times* reported that
Gerhard Hesse, business manager for vector control of Bayer Crop
Sciences and a board member of the Roll Back Malaria Partner-
ship, wrote an e-mail to various health academics claiming: "We
fully support EU to ban [sic] imports of agricultural products
from countries using DDT
DDT remains for us a commercial
threat [but] mainly a public image threat."
Bayer produces alternatives to DDT and clearly attempts to di-
rect malaria-control programmes so that they benefit its bottom
line. Recently, the Bill and Melinda Gates Foundation donated
more than $50-million to the Innovative Vector Control Consor-
tium to create new insecticides. Regretfully, the commercial-
development arm of the project is none other than Bayer Crop
Sciences.
New insecticides are enormously important for malaria control,
but the existing ones -- such as DDT -- are working extremely
well right now and saving thousands of lives. Many more could be
saved if donors, the UN and the private sector start to listen
to African malaria scientists and put science ahead of politics
and their own vested interests.
A noble attempt is being made to ensure that this happens with
the Kill Malarial Mosquitoes Now! declaration, which calls for
widespread changes to malaria control and demands that the US
government start to spend the majority of its malaria-control
budget on insecticides and drugs that will actually save lives.
Recently, Archbishop Desmond Tutu joined a broad array of scien-
tists, public-health experts, human rights advocates and reli-
gious leaders in demanding change in malaria control. If the
declaration is successful, millions of Africans will be freed
from the vice-like grip of this ancient and devastating disease.
--
Richard Tren is a director and Philip Coticelli is a researcher
of the health advocacy group Africa Fighting Malaria. The Kill
Malarial Mosquitoes Now! declaration can be downloaded from
http://www.fightingmalaria.org/