E-DRUG: Malaria: Developing a market for bed nets and insecticides
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[Bed-nets are "essential technology": how can we stimulate their use in
Africa? But, is DDT an essential drug? Copied as fair use. Thanks to valeria
for spotting. WB]
BMJ��2004;328:1378�(5�June), doi:10.1136/bmj.328.7452.1378-b
Letter
Roll Back Malaria: a failing global health challenge
Developing a market for bed nets and insecticides is problematic
EDITOR�As shown in Yamey's recent editorial on the failure of
the Roll Back Malaria campaign,1 appropriate economic thinking
for sustainable development in Africa continues to be ignored.
Thus, the customer for bed nets is not the individual African but the
large non-governmental organisation, whose orders are largely
based on price, not quality.
Economic lessons show, however, that markets are developed by
the quality of a product. People, even poor Africans, are prepared
to pay for quality, and although it is true that not everyone can afford
to buy nets, once a critical mass of users of impregnated nets has
been established then non-net users are also protected.
Rather than insisting on a low price, non-governmental
organisations could instead set the manufacturers of nets the
more difficult target of producing, say, a permanently impregnated,
durable net that works against Culex quinquefasciatus as well as
anophelines.
Similarly, while the arguments rage over the possible
reintroduction of dicophane (DDT),2 the Achilles' heel of many past
and present indoor residual spraying programmes is people's
refusal to have their houses sprayed, irrespective of the insecticide
used.
The World Health Organization (WHO) issues guidelines to
malaria control programmes so that workers know when to
consider changing treatment as drug resistance increases.
Perhaps WHO should do the same for malaria control
programmes based on indoor residual spraying in the face of
increasing refusal rates. At least DDT, because of its repellent
effect, might provide some measure of personal protection to
individual householders in the absence of a mass effect due to a
high refusal rate among the population as a whole. But whether
spraying an ever diminishing number of houses is the appropriate
role for a malaria control programme is questionable.
J Derek Charlwood, honorary fellow
Danish Bilharziasis Laboratory, Furvela, Mozambique
dc@bilharziasis.dk
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Competing interests: None declared.
References
1. Yamey G. Roll Back Malaria: a failing global health campaign.
BMJ 2004;328: 1086-7. (8 May.)[Free Full�Text]
2. Rosenberg T. What the World needs now is DDT. New York
Times 2004 April 11.
Related editorials in BMJ:
Roll Back Malaria: a failing global health campaign.
Gavin Yamey
BMJ 2004 328: 1086-1087. [Full text] [extra: Figure showing effects
of malaria] �
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