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Commentary

20 May 2002

The call by African heads of government for greater use of insecticides in vector control is most welcome. South Africa recently managed to reduce the incidence of malaria in the KwaZulu Natal province by over 80% by bringing back DDT. The spraying programme in Southern Mozambique, funded by the Mozal Aluminium smelter among others has reduced parasite prevalence by 40%. In Zambia, insecticide spraying on the Copper Belt has reduced malaria cases by 50% after only one spraying session.

To fight malaria one needs as many tools as possible and it seems that insecticide spraying has taken a back seat in the WHO programmes. While bed nets certainly have their place, they do not provide the kind of public health protection that a well managed and well funded insecticide spraying programme does. In addition, a well planned residual house spraying programme also protects people from other diseases such as yellow fever and dengue which are not impacted upon by bed nets.

Taxes & Tariffs

African governments however have to eliminate the absurd taxes and tariffs on mosquito bed nets, insecticides and drugs. One can only assume that the health ministries are not communicating effectively with the finance ministries in many of the African states and there is simply no understanding of the damage that caused in taxing life saving chemicals and drugs. Still, this is no excuse and the taxes and tariffs should be scrapped immediately. See the recent Wall Street Journal piece.

The Private Sector

Governments should also be enlisting the help of the private sector. The benefit in the private sector funding malaria control is that they are far less likely to come with the kind of environmentalist baggage that donor agencies have. None of the major donor agencies will fund vector control using DDT as it is not used in their home countries. This is despite the fact that it under the right circumstances is it one of the most effective and cheapest ways of control malaria. Donor agencies should decide whether they are in developing countries to do good and improve the standard of living of the local population or to appease the green movement. Unfortunately the evidence suggests the latter and the donors have got away with this for far too long.

Drugs

The use of Coartem in South Africa has been very successful and the use of artemisinin based combination therapies provides an outstanding alternative to ineffective drugs such as choloroquine and sulphadoxine-pyramythamine. It is interesting to note that South Africa introduced this drug without threatening parallel importation or compulsory licensing. The Directorate of Vector Borne Diseases negotiated with Novartis, the patent holder, and ensured favourable pricing for the public sector while allowing the company to price discriminate and make a profit in the private sector. For more on information on Coartem, go to http://www.malariaandhealth.com

Working with rather than against the drug industry is the best way of ensuring that malaria drugs are discovered, tested and made available. The drug activist activities on HIV Aids drugs have only ensured that the investment by drug companies into Aids drugs has declined. The danger is that this could occur with malaria drugs. However the public private sector partnerships provide great hope for drugs into the future. See Medicines for Malaria Venture for example

 
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