Death to Mosquitoes

Roger Bate | 01 Mar 2004
Weekly Standard

While the world understandably focuses on AIDS in Africa, malaria continues to devastate the children of that continent. Dr. Wenceslaus Kilama, a Tanzanian malaria specialist and head of Malaria Foundation International, alarmingly explains that every 30 seconds a child in Africa dies from the disease. "That's like loading up seven Boeing 747s with children and crashing them into the ground every day, . . . a September 11 every 36 hours," he says.

But there is one success story to point to. South Africa has reduced its malaria burden by using a combination of the widely reviled insecticide DDT and a new therapeutic drug called Coartem. According to Donald Roberts, professor of tropical diseases at the Uniformed Services University of the Health Sciences in Maryland, "the insecticide DDT is still the best method to control mosquito-borne dangers like malaria around the tropical impoverished parts of the world." Unfortunately, no aid or health agencies are learning from the South African experience because of concerns about being seen to endorse DDT. But is DDT really deadly?

"The 1972 banning of DDT in the United States was based more on politics than on any scientific evidence," says Roberts. The judge presiding over the scientific hearings on DDT ruled, after reviewing all the evidence, that DDT should not be banned, yet he was overruled by William Ruckelshaus, the Environmental Protection Agency head at the time. DDT does persist in the environment, but problems (such as to bird populations) arise only when it's used in massive doses for farming, not when spraying mosquitoes for disease control. DDT dissipates in the environment slowly but consistently. Furthermore, even after 60 years of human exposure, "there has never been a replicated study published in a peer-reviewed journal showing harm to human health from DDT," says malaria expert Dr. Amir Attaran.

Spraying DDT on inside walls of houses is only one of a number of tools available to fight malaria. There are alternative insecticides, and insecticide-treated bed nets can be effective. Bio-environmental controls, such as the removal of mosquito breeding pools, can also help. In addition, both prophylactic drugs to prevent malaria and therapeutic drugs to cure it should be a part of any malaria control program. All these approaches have their uses, but the key constraint is cost. The alternative insecticides are all at least twice as expensive as DDT. It is prohibitively expensive for a whole family to use bed nets. And drug therapy is even more expensive.

For countries that spend less than $10 per person per year on health care (most of Africa), cost is the overriding consideration. Given the increasing risk of malaria across the African continent (more than 1 million deaths and 300 million cases a year), it is understandable that a few countries, such as Zambia and South Africa, still use DDT for malaria control. But international political pressure against DDT deployment is undermining wider use. There is even a United Nations treaty--the Stockholm Convention on Persistent Organic Pollutants--which restricts DDT production, trade, and use, making it more expensive. In effect, disease control is being sacrificed for the sake of an international environmentalist agenda. Worse still, aid agencies, especially the U.S. Agency for International Development, have pressured countries not to use DDT, implicitly conditioning even non-malarial aid on halting DDT use.

South Africa, however, is the wealthiest country in Africa and entirely funds its own malaria-control program. Its health budget is close to $200 per person per year. Therefore, it is not subject to the whims of international aid agencies. However, when joining the international community, with its first free elections in 1994, it was sensitive to international pressures. Given how important tourism is to the country, environmental concerns were thought to be crucial to its image. In response to pressure from green groups, South Africa stopped using DDT in 1996 and switched to the more environmentally friendly insecticide. At the time, South Africa had a few thousand malaria cases and about 50 deaths a year (far lower than any other sub-Saharan country).

By 2000, malaria cases had climbed to over 80,000 and deaths approached 500 a year. The South Africa Health Department then switched back to DDT and also introduced Coartem as a first-line treatment. Existing drugs, Chloroquine (CQ) and Sulphadoxine-Pyrimethamine (SP), were exhibiting resistance problems, but Coartem, a leading Artemisinin Combination Therapy (ACT), was more expensive. However, resuming DDT spraying controlled the caseload to such an extent that all malaria patients could be treated affordably with Coartem. This new strategy was spectacularly successful, reducing malaria cases and deaths by a remarkable 85 percent within 18 months.

Success stories are rare in Africa, so one would think that South Africa's lesson might be emulated. Think again. The World Health Organization, USAID, and the Global Fund for AIDS, Tuberculosis and Malaria (40 percent of whose budget comes from U.S. taxpayers) are paying no heed. All three refuse to condone the use of DDT (probably out of ideological opposition to insecticides in general and DDT in particular), or to promote the use of Coartem or other ACTs (probably out of inertia). They promote bed nets, which, although effective, cover only a small number of people. They also deliver cheap drugs like CQ and SP, which allow them to treat more patients but work as little as 25 percent of the time in some countries. Drug resistance is not merely a nuisance, it is deadly. Children in aid-dependent countries like Mozambique and Tanzania are dying in far greater numbers than they should.

Environmental ideology ought not to be driving malaria control strategies. Developing countries need to be able to use technologies that are appropriate to their levels of development. The anti-DDT eco-imperialism actively pursued by the WHO, the Global Fund, and USAID shuts off a number of development options for these countries, keeping them poor and unhealthy.

Roger Bate is a visiting fellow at the American Enterprise Institute and director of Africa Fighting Malaria.

http://www.aei.org/publications/pubID.19982,filter.all/pub_detail.asp