Malaria malpractice

08 May 2007
OC Register

Misguided ban on DDT is easing and the US is helping to ease the logjam in the production of mosquito nets. 

It's gratifying to see the more than $60 million in private donations raised by TV's ubiquitous "American Idol" to help ameliorate the scandalous malaria epidemic in sub-Saharan Africa, an epidemic that never should have happened.

The World Health Organization estimates that each year more than 500 million people suffer from acute malaria, resulting in more than 1 million deaths. At least 86 percent of those deaths are in sub-Saharan Africa, and most of the dead are children under age 5. The disease, primarily transmitted by infected female mosquitoes, disproportionately affects poor people, "with almost 60 percent of malaria cases occurring among the poorest 20 percent of the world's population," the WHO reports.

It was only last year that the World Health Organization stopped living in the past - 1962, to be exact - and began to ease restrictions on the single most effective pesticide against mosquitoes, Dichlorodiphenyltrichloroethane, or DDT. It was 1962 when Rachel Carson wrote "Silent Spring," an environmental jeremiad against the use of pesticides, and against DDT use in particular. Up to that point, DDT had been used in most developed countries to virtually eradicate malaria as well as typhus. It had not been used in sub-Saharan Africa.

The United States officially banned DDT for nearly all uses in 1972, and its use was significantly curtailed worldwide about the same time. While it was true that DDT did have harmful effects, notably on bird reproduction by causing the thinning of egg shells, the pesticide also had great benefits for humankind in disease control. Its ban had a severe and immediate impact.

"In at least one country, Sri Lanka, a DDT spraying program, which had virtually eliminated malaria in Sri Lanka, was stopped," wrote Jane Shaw and Michael Sanera in the book "Facts Not Fear." "When Sri Lanka stopped using DDT, the number of malaria cases rose again to 2.5 million in the years 1968-69."

In recent years, many developed nations have begun to use more advanced, and more expensive means to combat malaria and mosquitoes. This has led them to heed the cries of environmentalists to discontinue the use of DDT and, in some instances, ban its use outright. That's all well and good for countries that can afford new, more environmentally appealing pesticides, but what about the poorer Third World countries, where malaria is most likely to devastate?

In Kenya, for example, many species of mosquito are becoming resistant to the chemical pesticides the government uses, leading the government, rightly, to push for a reintroduction of DDT spraying. In many cases, DDT opponents will make no distinction between the more environmentally damaging mass spraying with the far safer practice of home spraying.

Fortunately, WHO did make the distinction when it announced last September that it is "recommending the use of indoor residual spraying not only in epidemic areas but also in areas with constant and high malaria transmission, including throughout Africa," according to a statement at the time. The change can't come soon enough.

The other major method of dealing with the problem - mosquito nets - also has political constraints. WHO issues recommendations for certain nets, and, in turn, those are often the only nets bought and donated by African relief organizations. The problem is that only two companies have received the WHO's gold star recommendations.

The limited recommendations and the propensity of charities to only purchase WHO-endorsed netting led to a duopoly of providers. Such lack of competition inherently stifles innovation, and this is an instance where competition and innovation are desperately needed. The U.S. government has taken the initiative to circumvent WHO approval though the President's Malaria Initiative, which commissioned a non-WHO-approved company to produce mosquito netting. The company's nets cost about half of what the two WHO-approved companies charge.

All these are small if positive steps - private funding, sensible application of DDT, enhanced competition in the mosquito net arena - that if pushed forward aggressively, could send malaria the way of polio and smallpox.