The 'Knock-Out' Punch

Vanessa Narine | 20 Jan 2011
Guyana Chronicle Online
In the last 20 years there have been at least 20 million deaths because of malaria, one million deaths annually, and 250 million cases of fever cause by malaria each year across the globe.

Last year alone the world saw a new picture - globally over 800 million cases of malaria were recorded and in Guyana alone the incidence of malaria climbed to 17,000 cases.

While locally this was a decrease from the 100,000 cases seen in the 1990's, it was an increase from 2009's 10,000 cases.It is in this context that Health Minister Dr. Leslie Ramsammy contends that Guyana - and the world over - needs the 'knock out punch' to eliminate the malaria scourge that plagues the health sector.

Guyana needs DDT (dichlorodiphenyltrichloroethane).

"Unlike in the 50's and the 60's we do not have the knock out punch we need...we have been making progress in reducing malaria yes, but we can never have complete elimination without DDT," he said.

Ramsammy said using alternative methods to address malaria will only "stagger" an opponent, which has the potential to return stronger and deadlier to inflict major losses on a country - tragically too that loss includes the loss of lives in the millions.

Past Success

In the 1940's malaria was rampant, particularly on the coast, at which time DDT was introduced by an Italian Doctor George Giglioli.

He first headed the Demerara Bauxite Company, Ltd., a subsidiary of the Aluminum Company of America (ALCOA).

The company offered medical services to its employees and the surrounding population through a hospital in Mackenzie, Region 10 (Upper Demerara/ Berbice) and Giglioli was integrally involved in the delivery of these services.

In his autobiography, 'Demerara Doctor: Confessions and Reminiscences of a Self-Taught Physician', Giglioli noted that malaria proved a much more intractable problem, compared to other diseases.

According to the book, between 50 and 75 per cent of all those who sought treatment at the hospital were suffering from malaria in the 1940's.

"The mosquitoes that carried the disease bred prolifically around Mackenzie following the May-July rainy season; there was no practical way to get rid of them or their breeding ponds. The only way to control the disease was through a prolonged course of the unpopular, bitter-tasting drug quinine," the book read.

In 1936, he was asked by Booker's, the country's largest sugar producer, to head a laboratory in Georgetown the company was setting up to conduct systematic medical surveys and improve health conditions on all the sugar estates in the country.

"This was exactly the kind of development I had hoped for when I accepted the job with Davsons," he wrote.

In 1939, another malaria milestone was achieved: a Malaria Research Unit was established with funds from the Colonial Government, the Rockefeller Foundation, and the British Guiana Sugar Producers' Association, and Dr. Giglioli was selected to head it.

Giglioli came to be recognised as a valuable a resource and in August 1942 he obliged to accept the appointment of Government Malariologist.

The following year, three distinguished British scientists made an unscheduled visit to Guyana when their flight from Trinidad to Washington, D.C., was delayed for several days.

One of the scientists, Dr. Alexander King, talked about the new insecticide DDT, which the Allies (in the Second World War) were using as a 'secret weapon' to protect their troops from malaria.

A month later, the first 500-pound consignment was on its way to Guyana. The preliminary work needed for the field experiment, Giglioli's detailed mosquito and malaria surveys, had already been done.

The trials expanded into a large-scale control program in 1946 and into a countrywide campaign in 1947.

By 1951, malaria and its principal carrier had been completely eliminated from the coastal areas, including Georgetown, by means of a highly focused house spraying campaign.

In the interior, where settlements were widely scattered and difficult to get to, it was impossible to completely eliminate the disease. The mosquito lived in the forest there, not in houses.

To date there is no malaria on Guyana's coastal plains, as is the situation in the Caribbean, most parts of the US, Europe and parts of Asia, among other territories. This work was also promoted by the late Janet Jagan who served as Health Minister. Ramsammy noted that when the People's Progressive Party lost power in 1964, it handed over a country where there was no malaria on the coast.

"This was one of the legacies of the administration under Dr. Cheddi Jagan...when we emerged into independence the PPP gave a country over that had no malaria," the Health Minister said.

However, with time and change, DDT's continued use was not to be.

In 1962, American biologist Rachel Carson wrote Silent Spring. The book cataloged the environmental impacts of indiscriminate DDT use in the United States of America (USA) and questioned the logic of releasing large amounts of chemicals into the environment without fully understanding their effects on the environment or human health. The book suggested that DDT and other pesticides cause cancer and that their agricultural use was a threat to wildlife, particularly birds.

The book produced a large public outcry that led to a 1972 ban in the US and the use of DDT was subsequently banned.

Under the Stockholm Convention on Persistent Organic Pollutants (POPs), which are chemicals capable of affecting human health and the environment far away from the regions where they are used and released, the production and use of DDT in vector control is 'restricted'.

Review

However, the Health Minister made it clear that while a 'ban' on DDT is not implicitly stated, a ban virtually exists because of the regulations governing, in particular, its production and shipping.

He pointed out that there is currently only one producer of DDT, a company in India which only produces based on relatively large demands.

"Guyana would only need about two to thee tonnes of DDT annually for a few years to completely eliminate malaria...there is only one company and it will not produce that small amount for Guyana and even then if they did how would it get around the regulations surrounding the shipping restrictions...virtually there is a ban on DDT," Ramsammy said.

To this end, he called for a review of the perceptions surrounding the use of DDT, pointing out that the non-use of DDT was based on the effects its use had in the agricultural sector - since DDT had a dual purpose, for agriculture and for vector control.

The Health Minister noted that there is not sound evidence which indicates that DDT as a vector control method is a hazard.

"There is no evidence that DDT in vector control led to mass deaths," Ramsammy posited.

He agreed that the use of DDT in the agricultural sector will have negative impacts; that the positives will outweigh the benefits and indicated his support for this position. "There is no one doubting that we should not use DDT in agriculture," the Health Minister said, "We are not talking about using it in the fields where it will get into the water and foods. We are talking about protection from mosquitoes."

However, Ramsammy stressed that in the agriculture sector there are affordable and accessible alternatives which can be used, for example gramoxzone.

He noted that chemicals like gramoxzone do not stay in the environment as long as DDT, when used in agriculture, hence is not included in the Stockholm Convention and its use is permitted.

On the other hand though, there are negative impacts of gramoxzone - an absolute prerequisite in agriculture sectors across the world - but over the years methods have been developed to control those effects.

For example, persons handling the chemical must wear certain gear to protect themselves and there is evidence to prove that people's fertility can be affected by gramoxzone.

Ramsammy "It is a balancing act with the negatives and the positives...there can be do doubt that DDT has biological effects and there are no chemicals that are without such effects, whether it is at an environmental level or at an individual level."

DDT - A Different Story

The Health Minister said since the virtual ban on DDT a number of powerful insecticides have been developed, but they are costly and are inaccessible to most populations.

"What we have are very expensive alternatives to DDT...either we make these more affordable or push to have those insecticides that have shown to be extremely effective," he said.

A point for concern, he highlighted is that the current treatments for malaria, in particular the Pyrethroids, is slowly becoming ineffective, since the mosquitoes are developing a resistance to the drug.

"We have not even reached the stage where we can make one of the alternatives more affordable and it is already showing resistance," Ramsammy said.

The Health Minister stated that for the millions that are dying and the losses caused by malaria, the world over is missing an opportunity to use a product, which can be safely use in the small quantities that are needed.

"The world has done the right thing in identifying the dangers, but in the process of doing that we have neglected to consider that there could be good use of DDT," he said.

Ramsammy stressed that with DDT Guyana can be free of malaria is as little as three years. "It seems an unwise decision not to consider wider use of DDT in a controlled manner," he said.

In this light, Ramsammy proposed that the World Health Organisation (WHO) and the United Nations (UN) ensure the restricted production of DDT.

"The proposal is that there is a global entity responsible for the procurement and distribution of DDT...the distribution will only be made to those countries with a high disease burden for malaria...this way we ensure that it is not abused. We know where it is going and who is getting it, we can monitor it," he opined.

The Health Minister said the Millennium Development Goal (MDG) target, relative to malaria, is attainable, but the alternatives - biological control, fogging, bed nets and treatment (all good once used in the right setting) - are not enough to completely eliminate malaria.

However, Ramsammy said vector control via DDT; plus the combination of good medicines for treatment, better trained health care workers in diagnosing malaria, among other things; will give Guyana a chance to eliminate the malaria scourge.

"There will always be an up and down problem...it will be a yo-yo effect, something we will see for decades to come with the potential to cause us many losses," Ramsammy said.

According to him, malaria has in the past, and will continue to: be a major contributing factor to the death toll; be the cause of disability; be the cause of impoverishment in families and within communities; impact national economies; and impact productivity, expressly it mining and forestry sectors.

"The cumulative effect of what malaria has done globally and then look back at 100 years of DDT use in vector control, before is was less accessible, the negative impacts do not come close to the devastation we saw in just the last 20 years...you cannot equate the negative impacts of DDT in vector control and what we have seen in the last two decades," Ramsammy said.

The Health Minister stressed that no method outside of vector control has ever led to elimination of malaria.

"Everywhere we don't have malaria, if you go back in history, one would see that there was malaria in that area, but it was eliminated through vector control. It was eliminated through DDT," Ramsammy said.

The Health Minister maintained that unless the "knock-our punch" is considered malaria will continue to plague Guyana - continue to plague nations across the globe.

"As long as it is there it will always come back strong...unless we make use of that knock out punch we will be constantly dealing with malaria in a yo-yo way, down and up, down and up...this is a tragedy because if I had DDT today, 2011, Guyana would have been malaria free," the Health Minister said.

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