Malaria-control programme managers fight not only against the wily mosquito and malaria parasite that are constantly evolving, but also against fellow humans with vested interests. Earlier this month, the Stockholm Convention convened its sixth Conference of Parties (COP-6) in Geneva. The convention oversees the banning or control of various chemicals, known as persistent organic pollutants, that are either used in industry or agriculture. One of these, the insecticide DDT, is used in malaria control in several countries. The fact that DDT saves lives every day has pitted environmentalists against the public health community. So far, public health has prevailed, but the forces allied against this insecticide are powerful, well funded and determined.
In the run up to COP-6, a radical Swiss anti-DDT environmental group, Biovision Foundation, hosted a meeting of several African environment ministries, including South Africa's, to develop an "Africa position" on DDT. The position sought to impose a deadline of 2020 to halt all DDT use. Fortunately, it was rejected, thanks to the leadership of South Africa's Department of Health and the Indian government.
Not only is the 2020 deadline arbitrary, it also violates the Stockholm Convention itself, which expressly states that any country can continue to use DDT for disease control until a safe, affordable and effective alternative is developed. No new class of insecticide has been developed for almost 30 years. Given that it costs hundreds of millions of dollars to develop a new chemical, the prospect of one arriving by 2020 is virtually zero. Yet extreme environmental groups and the United Nations (UN) Environment Programme continue their campaign against DDT and even promote the false notion that malaria can be controlled without insecticides.
That South Africa's Department of Water and Environmental Affairs went along with the Biovision Foundation and big insecticide companies is shameful. South Africa should know better. We experienced first hand the disastrous consequences of a premature halt in the use of DDT for malaria control when South Africa replaced DDT with synthetic pyrethroid insecticides in 1996. A highly efficient malaria vector, Anopheles funestus, believed to have been eradicated in the 1970s, soon reappeared in South Africa, causing one of the worst malaria epidemics in South Africa's history. Malaria cases rose from about 6,000 in 1995 to more than 60,000 in 2000, with deaths rising at a similar pace.
In early 2000, South Africa reintroduced DDT to control malaria, and in 2001 introduced new artemisinin-based combination therapies to treat malaria patients. The combination of effective insecticides and drugs ensured that malaria cases fell by almost 80% by the end of 2001 to about 26,000 cases. Since then, South Africa has registered progressive decreases in the number of malaria cases: 9,866 in 2011 and 6,785 last year. DDT remains the insecticide of choice. It is imperative that South Africa continues to support the judicious use of DDT for malaria control.
At the COP-6 meeting, malaria control programmes also received support from the World Health Organisation (WHO), which supports the use of DDT. Yet the UN, big business and environmentalists are collaborating to force people suffering from malaria in poor countries to introduce measures that have not be scientifically proven to combat the disease.
The hard work of malaria control is undertaken by ministries of health. Therefore, any decision on the future of DDT should be taken by health ministers, in consultation with their malaria control programmes and the WHO. Malaria is highly complex, with different species of mosquito, different climates and geography, as well as the budgetary and political considerations. The choice of insecticide should thus rest with national malaria-control programmes. Any centralised decision on the future of DDT and other public health insecticides cannot possibly take into account the complexity these programmes face. To even attempt to do so exposes the staggering level of hubris from the UN and its apologists.