Malaria kills over one million children a year in Africa, more than any other disease. Last September the World Health Organisation (WHO) released new policy guidelines for malaria control that call for increased spraying of insecticides inside houses, or indoor residual spraying (IRS), and encourage the use of DDT, which is the most successful public-health insecticide ever produced.
Indoor spraying is one of the most effective methods of malaria control. It is safe for humans and the environment and is the main method used in most southern African countries. Yet despite its proven efficacy, developing countries - particularly those dependent on foreign aid - were encouraged to dismantle their spraying programmes and concentrate on using insecticide-treated nets for malaria control. Treated nets are an important component of any malaria control programme, but they cannot control the disease on their own.
In the late 1990s, South Africa suffered a disastrous malaria epidemic, largely because it stopped using DDT in its indoor spraying programme. It was only in 2000, when DDT was reintroduced, that the epidemic was brought under control. Other countries, such as Mozambique and Zambia, also restarted their indoor spraying programmes. The result has been a steady decline in malaria cases wherever indoor spraying with DDT is practised.
Rwandans should not fear DDT. It eradicated malaria from Europe and U.S. in the 1940s and 1950s. Sixty years ago over a million dwellings in America were sprayed every year with DDT to save lives. There was not a single case of harm from this spraying, nor to the hundreds of millions of people around the world whose dwellings were sprayed in later decades. America and Europe stopped using DDT after malaria was eradicated. But if an American child died every thirty seconds from malaria (as is the case in Africa), then you can be sure that America would re-introduce DDT.
Last year, the U.S. Agency for International Development (USAID) announced its $1.2bn Presidential Malaria Initiative. Having discouraged indoor spraying for many years, this new initiative is putting substantial resources into such programmes in Angola, Uganda, and Tanzania.
But while the U.S. government is getting things right, most other donors are lagging behind. Few European donors will support indoor spraying and the European Union has set the proverbial cat among the pigeons in East Africa by suggesting that agricultural exports could be turned away from Europe if DDT is used in malaria control.
These threats have been partially retracted, but some damage remains and some exporters in Uganda and Kenya still oppose DDT. We expect that Rwandan exporters are similarly concerned. They really shouldn't be, and with sensible controls (to make sure that the small amount of DDT used is not diverted into farming) DDT will save lives and cause no loss of business. No African produce has been rejected by the EU due to DDT contamination.
Opposition to DDT remains from some extreme environmentalist groups such as Greenpeace, but many, such as the Sierra Club and South Africa's Endangered Wildlife Trust, support indoor spraying using DDT and other insecticides. The WHO and USAID are now endorsing and encouraging what many malaria scientists and governments in southern Africa have been doing for years. Now is the time for other donors, non-governmental organisations, and the private sector to do the same. With more than a million preventable deaths every year, there is no time to lose. Rwanda's current policies will certainly save lives. But many more lives could be saved if Rwanda adopts indoor residual spraying using DDT as part of its malaria control programme.
Roger Bate and Mauro De Lorenzo are resident fellows at the American Enterprise Institute for Public Policy Research in Washington, D.C.