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Government-Controlled Research and Development - A recipe for disaster  - Richard Tren & Roger Bate
The proposed research and development (R&D;) treaty being discussed at the World Health Assembly during the week of May 22 could end up harming those it aims to assist. Public-private partnerships, which are already delivering drugs and treatments and showing promise in vaccine development, offer a far better model to address diseases. Greater state and bureaucratic control of R&D; will not deliver results, especially given the need to deploy unique private-sector testing and development facilities. A range of market-friendly proposals to encourage research is likely to deliver practical solutions.


The World Bank: false financial and statistical accounts and medical malpractice in malaria treatment  - Amir Attaran et al
Amir Attaran & malaria experts & health policy commentators, including Africa Fighting Malaria's Roger Bate criticise the World Bank's failures in malaria control.

Still Taxed to Death: An Analysis of Taxes and Tariffs on Medicines, Vaccines and Medical Devices  - Roger Bate, Richard Tren & Jasson Urbach
Bate, Tren & Urbach update their working paper on taxes and tariffs on medicines and medical devices - published by the AEI-Brookings Joint Centre.

The WTO and Access to Essential Medicines: Recent Agreements , New Assignments  - Dr Roger Bate & Richard Tren
Roger Bate and Richard Tren discuss the recent WTO agreement on TRIPS and public health and recommend that the WTO now turn its attention towards removing import tariffs on medicines and medical devices, which have been shown to reduce access to medicines and medical care.

Brazil's AIDS Program - A Costly Success  - Richard Tren & Roger Bate
Richard Tren & Roger Bate comment on Brazil's AIDS Treatment program which has achieved some notable successes, but potentially reduces research into new AIDS medicines and could result in large long term costs down the line.

AFM testimony to the US Senate Committee on Environment & Public Works  - Roger Bate & Richard Tren
Download the testimony given by AFM's Roger Bate and Richard Tren to the US Senate's Committee on Environment and Public Works. The hearing, chaired by Sen. Inhofe (R, OK) was set up to look at the role of science and environmental policy - what better case study than DDT?

An Immesurable Crisis? A Criticism of the Millennium Development Goals and Why They Cannot Be Measured  - Prof. Amir Attaran
Prof. Amir Attaran evaluates the Millennium Development Goals and criticises them for being unmeasurable and therefore largely meaningless. He also criticises the UN for failing to discuss the measurement of these goals at the September 2005 UN meeting on the MDGs.

State in Fear - Zimbabwe's Tragedy is Africa's Shame  - Archbishop Pius Ncube, Dr Roger Bate & Richard Tren
Catholic Archbishop of Bulawayo Pius Ncube, Dr Roger Bate and Richard Tren report on the horrific abuses of human rights by Mugabe's police and military. The authors call on the G8 leaders to exert pressure on African leaders, such as President Mbeki, to condemn Mugabe's regime and support the return of peace and democracy in Zimbabwe.

AFM's Comment on the WHA Malaria Resolution  - AFM
The World Health Assembly recently passed a resolution on malaria control. The WHO and UNICEF also recently published their World Malaria Report. AFM comments here on some aspects of the resolution and report.

Senate Hearings on USAID  -
The Senate Hearings on USAID's involvement in malaria control led to significant challenges to the agency's activities. Download the testimonies from USAID, Senator Sam Brownback, Professor Amir Attaran and AFM's Dr Roger Bate here.

Eliminate Neglected Diseases Act of 2005  -
Senator Sam Brownback's Eliminate Neglected Diseases Act of 2005 has been dropped in the US Senate. Read the Act and supporting documents here.

Taxed to Death  - Roger Bate, Richard Tren and Jasson Urbach
AFM publishes a working paper on the degree to which import tariffs, taxes and bureaucratic procedures block access to essential medicines in poor countries. See the latest version of this ongoing study here.

Despotism & Disease  - Richard Tren & Roger Bate
Africa Fighting Malaria report on the destruction of the Zimbabwean healthcare sector and the probable impacts on the entire region. Download the pdf version of this report here.

Ugandan Study Highlights Best Drug Combinations for Treating Malaria in Africa  - The Lancet
Results of a randomised trial from Uganda in this week’s issue of THE LANCET suggest that the drug combination of amodiaquine and sulfadoxine-pyrimethamine might offer the optimal treatment for malaria in terms of efficacy and cost-effectiveness in this region. The study also shows that the drug combination of chloroquine and sulfadoxine-pyrimethamine—the recommended first-line treatment in Uganda—is far less effective than other drug combinations.

Climate Change and Malaria  - Indur Goklany - with response from Sir David King
Indur Goklany offers some fascinating insights into climate change, malaria, poverty and development. Sir David King, the UK Government's chief scientific adviser gives a predicable response.

The Real Obstacles to Sound Treatment of AIDS in Poor Countries  - Roger Bate & Richard Tren
Writing for the American Enterprise Institute's Health Policy Outlook, Bate and Tren explore some of the reasons for low drug access in poor countries. Despite promises of cheap or free antiretroviral drugs, Bate and Tren argue that access to treatment in poor countries is abysmally low because of a lack of infrastructure, political indifference, excessive bureaucracy and taxes and tariffs.

South Africa's War Against Malaria - Lessons for the Developing World  - Richard Tren & Roger Bate
The Cato Institute published Richard Tren and Roger Bate's analysis of South Africa's recent history with malaria control. They argue that its policy on DDT use and Artemesinin based combination therapy provide excellent examples for other malarial countries.

SA's Leading Malaria Researchers Support DDT Use  -
South Africa’s leading malaria control experts, researchers and doctors support and endorse the use of the insecticide DDT to control malaria. Their statement is released in light of recent claims that DDT is harmful to human health and should be removed from South Africa’s malaria control programme.

South African Malaria Data  - SA Dept of Health
November 2003 - the malaria statistics show that malaria is still well under control in South Africa. A recent epidemic in the Limpopo Province was primarily caused by late spraying and poor case management.

South Africa Malaria Data  - SA Dept of Health
The latest data on malaria cases and deaths from South Africa show that the country's policy of indoor residual spraying with DDT (among other insecticides) and the use of artemesinin based combination therapy is working. KwaZulu Natal, traditionally the province with the worst malaria and the centre of the recent epidemic has only recorded 1 malaria death this year!

South Africa Malaria Statistics  - Dept of Health
The 11th Dept of Health Malaria Update shows the latest number of confirmed cases and deaths from malaria in the three malarial provinces of South Africa.

Saving Lives Today and Tomorrow  - Dr. Roger Bate
This paper analyses trends in drug development using data from the drug industry association, the Pharmaceutical Research and Manufacturers of America (PhRMA). Worryingly, the findings suggest that far fewer AIDS drugs are in development compared to several years ago, and at a time when drug development for other communicable diseases is increasing. There are several probable explanations for this phenomenon, but the least benign is the likelihood that continual pressure group and media attacks on the industry over pricing of drugs in Africa has reduced incentives for development of new AIDS medicines

South African Malaria Update  - SA Dept of Health
The latest malaria update from the Directorate of Communicable Diseases.

SA’s Leading Malaria Researchers & Doctors Support the use of DDT to Control Malaria

South Africa’s leading malaria control experts, researchers and doctors support and endorse the use of the insecticide DDT to control malaria. Their statement is released in light of recent claims that DDT is harmful to human health and should be removed from South Africa’s malaria control programme.

In a media statement, researchers from, among others, South Africa’s Medical Research Council, National Health Laboratory Services and the World Health Organisation assert that since its introduction to disease control, DDT has been associated with improved human health and population growth, not the reverse.

In malaria control, Dichloro-Diphenyl-Trichloroethane (DDT) is sprayed in tiny quantities on the inside walls of houses and under the eaves of houses. It is highly effective at killing the female Anopheles mosquito that transmits malaria and has been used in South Africa since 1946. In 1996 South Africa removed DDT from its malaria control programme and the result was one of the worst malaria epidemics in the country’s history when hundreds of people lost their lives. The epidemic was subsequently controlled when DDT was reintroduced in 2000.

South Africa’s leading malaria researchers dismiss claims by University of Pretoria’s Professor Tiaan de Jager who recently claimed that DDT “descrambles the entire hormone system which does not only impact on reproductive health but on general health as well”. Richard Tren, director of health NGO Africa Fighting Malaria points out that the risks associated with malaria are far greater than any of the supposedly negative human health effects of DDT.

Says Tren, “the claims that DDT negatively affects reproductive health ring hollow when one considers that wherever it has been used mortality and morbidity have fallen and populations have grown.”

The researchers strongly support the South African Department of Health’s decision to use DDT as it is one of the most effective ways of controlling malaria, reducing death and disease and promoting good health.

Contact Information:

Richard Tren Africa Fighting Malaria

011 646 6750 082 921 1081

rtren@fightingmalaria.org

www.fightingmalaria.org

Statement on the use of DDT in malaria control

April 2004

In the light of recent media reports, we the undersigned, wish to support the use of DDT in indoor residual spraying programmes (IRS) in South Africa. Recent media attention has been focused on claims that DDT, when used in malaria control, negatively affects human reproductive health and general health. While we welcome the ongoing research into the use of DDT we feel that the publicity concerning the risks associated with DDT are disingenuous and misleads the public.

The Department of Health has used DDT highly effectively in malaria control since 1946. It is used in carefully controlled and scientifically monitored indoor residual spraying programmes in KwaZulu Natal, Mpumalanga and Limpopo Province. In South Africa, and indeed in numerous countries around the world, where DDT has been used in disease control, mortality and morbidity have fallen dramatically.

Professor Tiaan de Jager of the University of Pretoria maintains that DDT “descrambles the entire hormone system which does not only impact on reproductive health but on general health as well.[1] Yet actual data from around the world contradicts this assertion. The association of DDT with reduced maternal deaths and infant mortality is a strong and consistent one. Additionally there is statistical coherence at all levels of DDT action to prevent contact between man and the Anopheles mosquito and to control malaria transmission. In just 2-3 years DDT spraying in Guyana reduced maternal deaths by 56% and infant mortality by 39%[2]. There was no offset of maternal and infant deaths due to adverse affects of DDT. The health improvements from DDT use were remarkable and accounted for 21 to 56% of increased population growth in Guyana during the post-war years[3]. In Sri Lanka, DDT use accounted for between 51 and 68% of rise in rate of population growth in the post-war period[4].

The advent of DDT use for disease control in the mid-1940s witnessed an unprecedented period of increased population growth, and this growth was greatest in those countries, including the United States, which used DDT to lift the burden of malaria from the backs of suffering populations. Without DDT, malaria has returned as a major health problem in many regions previously free of high infection rates. The causality is clear and unambiguous – DDT use in malaria control saves lives and improves human health, not the reverse.

DDT was removed from South Africa’s malaria control programme in 1996 for a number of reasons, among them environmentalist pressure and concern among residents that the insecticide leaves a white stain on their walls. However the development of insecticide resistance by Anopheles funestus mosquitoes to the synthetic pyrethroid insecticides that replaced DDT resulted in one of the most disastrous malaria epidemics in the country’s history. Between 1996 and 2000 the number of malaria cases in South Africa increased by over 450% and malaria mortality increased by almost 1000%[5].

In the face of the epidemic and based on sound scientific and medical advice, the South African Department of Health reintroduced DDT to the IRS programme. Within 1 year, malaria cases in KwaZulu Natal alone (the province worst hit by the epidemic) had fallen by around 80% and they continue to decline[6]. DDT was not reintroduced because the Department of Health, malaria control officers, scientists and malaria researchers were too dilatory or neglectful to find alternatives, but rather because it was the correct scientific and medical decision at the time.

No public health professional should object to scientific studies into DDT with regards to the human health effects of the insecticide. However given the unquestionable public health benefits that arise from DDT use, we wish to stress that claims made about the potential human health effects of DDT use in IRS programmes need to be placed in the context of the severe risks posed by malaria. Recent media attention has failed to do this and thereby misleads the public and undermines the country’s malaria control programmes. DDT has been used highly successfully to control malaria in South Africa and around the world and is responsible for saving millions of lives. In the absence of any proven actual human harm from the insecticide we continue to advocate for its use. We support any research into alternative methods for malaria control and for alternatives to DDT simply because this will strengthen any malaria control programme. However DDT has been and still is a crucially important tool for saving lives in South Africa and many other malarial countries.

We believe that the Department of Health is correct in its choice of DDT in its malaria control programme and as scientists, medical practitioners, and public health professionals endorse its use.

Signed:

TITLE

NAME

ORGANISATION/AFFILIATION

Dr

John Govere

World Health Organisation (Afro Region)

Dr

Brian Sharp

Medical Research Council

Dr

Maureen Coetzee

National Health Laboratory Services

Dr

Rajendra Maharaj

Medical Research Council

Dr

Musa Mabaso

Medical Research Council

Dr

Lucille Blumberg

National Institute for Communicable Diseases

Dr

Hervey Williams

Mosvold Hospital, KwaZulu Natal

Dr

Victor Fredlund

Mseleni Hospital, KwaZulu Natal

Dr

Joyce Tsoka

Medical Research Council

Mr

JJP Le Grange

Mpumalanga Dept of Health

Mrs

Caron Johnson

SA Department of Health

Mr

Richard Tren

Africa Fighting Malaria



[1] Prof. Tiaan de Jager, SABC TV interview, 17 March 2004. http://www.sabcnews.com/south_africa/general/0,2172,76041,00.html

[2] Giglioli G “Eradication of Anopheles darlingi from the inhabited areas of British Guiana by DDT residual spraying. J Nat Malaria Soc 191; 10:142-61

[3] Newman, P “Malaria eradication and population growth, with special reference to Ceylon and British Guiana.” School of Public Health, The University of Michigan, Bureau of Public Health Economics, Research Series no 10. 1965

[4] ibid

[5] South African Department of Health, “Malaria Updates” www.doh.gov.za

[6] ibid