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The Malaria Fight Continues

Richard Tren

Richard Tren is a environmental economist and is a director of the South African non-governmental organisation, Africa Fighting Malaria. He attended the UNEP workshops in Pretoria.

Jocchonia Gumede, a South African who resides in the malarial region of northern KwaZulu Natal, would have welcomed the recent calls by malaria activists, including the highly regarded economist Jeffrey Sachs, to increase the funding and commitment to fight the disease. His enthusiasm however could be dampened by the outcome of U.N. Environment Program meetings in Pretoria in November.

Gumede lost several relatives during the malaria epidemic in South Africa in the late 1990s when the number of cases rose by over 1,000 percent and the hospitals and clinics simply could not cope with the crisis. A major reason for the epidemic was the removal of DDT from the malaria control program -- the result of ferocious environmentalist pressure.

The South African Department of Health reintroduced DDT in 2000 and in one year saw an 80 percent reduction in the number of cases. Since then malaria has almost become a rarity for physicians.

It is not only in South Africa that DDT is saving lives. Dr. John Goyere from World Health Organization Africa estimates that over 16 million people in seven different African countries, including Ethiopia, Eritrea and Madagascar, are currently protected by the insecticide.

In an exciting example of private provision of public health, the Konkola Copper Mine in Zambia started malaria control in the two towns around its mining operations using DDT. As explained by Dr. Brian Sharp and others in a recent paper in the Journal of Tropical Medicine and International Health, after one spraying round, the number of malaria cases was dramatically reduced.

Some environmentalists now recognize the importance of DDT to public health programs in poor countries. The remarkable insecticide has been given an exemption for production and use under the Stockholm Convention, which aims to restrict or eliminate 12 persistent organic pollutants, (known as POPs), of which DDT is one.

There is concern about DDT because of its persistence in the environment and its ability to bio-accumulate in the fatty tissues of animals. But it is used highly selectively in malaria control, and is sprayed in tiny quantities on the insides of houses where it kills the deadly Anopheles mosquitoes. The human health concerns around DDT have been widely exaggerated. DDT is not a human carcinogen and in the 50 years of its widespread use, not a single scientific paper has been able to replicate a case of actual human harm from its use.

When it comes to malaria control, DDT's persistency is a great asset. Before DDT use, malaria control officers had to spray the natural pyrethrum insecticide almost every two weeks. DDT only needs to be sprayed once a year, greatly reducing the costs of malaria control and increasing efficacy.

But UNEP came to Pretoria to discuss the implementation of the Stockholm Convention, which has been signed by numerous African countries. Ensuring the continued availability of DDT is of great concern for public health officers around the world and it is a relief to them that the convention allows provision for this. However the convention places onerous obligations on poor countries as regards the continued need, use, storage and trade of DDT. For health systems that are already stretched, these additional directives from Geneva are not helpful.

UNEP is calling for "sustainable" alternative strategies for malaria control. But most of these, like the use of fish that eat mosquito larvae, are expensive and haphazard in effect. UNEP will only countenance insecticide spraying as a last option.

For most malaria scientists, the pronouncements by UNEP must be viewed as somewhat patronizing. For decades medical entomologists, parasitologists, physicians and other scientists from around the globe have been studying the Anopheles mosquitoes and the malaria parasite in an attempt to improve malaria control.

When malaria control officers choose to use DDT, or indeed any other insecticide, it is not out of laziness or an unwillingness to try other methods, but because it is the best and most cost effective way to save lives. When the United States and Europe used DDT and the 11 other POPs, their populations became ever more healthy and wealthy. They could afford to develop and use cleaner technologies and could pay for an improved natural environment. The use of POPs, superficially at least, is highly consistent with sustainable development, however one chooses to define it.

Under the convention, DDT remains an option for vector borne disease control until affordable and effective alternatives are available. And new insecticides are needed. Mosquito resistance to other insecticides is a reality and hampers the fight against malaria. However the development of new, long-lasting and effective insecticides is made ever more difficult by the excessive risk aversion in Europe. European regulators often reject technologies if they cannot be proven to have no negative impacts. This is unscientific and places impossible burdens on any new insecticide developer.

Add to this the reluctance of donor agencies and U.N. organizations to use insecticides, and the prospect for new insecticide development remains poor.

One may well then question why countries like Rwanda, Burundi and the Congo would be interested in implementing the convention when the public health benefits are small and they clearly have other, more pressing problems. This was all made clear by the UNEP Chemicals deputy director, John Whitelaw when he encouraged those countries to ratify the convention so that they could access the donor funds to deal with POPs.

Financial transfers to bureaucrats in Africa have done little to improve the lives of most Africans (except of course the bureaucrats). Donor funding has only ensured continued poverty, environmental destruction and has propped up some of the world's most vile and corrupt regimes.

Malarial countries should avoid the poisoned chalice offered by UNEP and should make decisions based on what makes best sense for their people and economies -- if that means continued use of POPs, then hooray.

This article was originally published by United Press International and is reproduced with permission. Mr Tren has a close association with G&G and G&G plays a role in Africa Fighting Malaria. For more information see www.fightingmalaria.org.


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