Senator Brownback (R-Kansas) is concerned that even though in the past five years US-funded malaria control efforts -- through the offices of the United States Agency for International Development (USAID) -- have increased several-fold, global malaria rates have skyrocketed -- increasing 10% at least.
Asia, the Near East and Africa account for ninety-six percent of deaths caused by malaria. Indeed, "conditions in many Asian countries are far worse today than they were decades ago when insecticides were sprayed on house walls to combat malaria" argued Dr. Donald Roberts, a malaria expert testifying last month before Senator Brownback, chairman of the Senate International Relations subcommittee on East Asia.
Testifying alongside Dr. Roberts was Dr. Robert Desowitz, tropical diseases expert and Emeritus Professor at the University of Hawaii and Dr. Anne Peterson of USAID. It was left to Dr. Peterson, Assistant Administrator for Global Health to defend why USAID is not providing DDT and other insecticides as part of a comprehensive prevention strategy.
USAID's Peterson claims "Insecticide Treat Nets (ITNs) are unquestionably the most effective way that families can protect themselves from malaria." But because of this one-pronged ITN approach, conditions in many Asian countries have deteriorated since the time when DDT was used in combination with effective drug regimes. Dr. Roberts revealed that many countries were pressured to stop using DDT by WHO in the late 1970s and today other aid agencies, including USAID, continue the pressure.
For the countries of Burma, Sri Lanka, Bhutan and India, the most malarious in Asia, the contrast in rates from the 1960s to today is horrifying. The malaria burden has grown 6.7, 6.4, 17.5 and 807-fold, respectively, since insecticide spraying was stopped or reduced. Even Vietnam, touted as a success story by USAID, was denied its request to purchase DDT in the 1990's by all donors, forcing it to switch to a less effective insecticide. Dr. Roberts, pointed out that malaria rates remain high at 350,000 cases a year in Vietnam even after US investment in malaria control of $28 million.
Asian malaria control policy changed in the 1970s halting the most effective global spraying programs, with the necessary infrastructure for indoor spraying decaying as a result. Dr. Peterson explained her reason for not supporting DDT: "spraying requires major infrastructure, including a high level of organization, geographic coverage, application personnel and financial resources." An ironic and disingenuous response considering USAID was partly responsible for the elimination of the well-developed infrastructure in the first place. Even more questionable, if spraying was possible over forty years ago, why not now?
Drs. Roberts and Desowitz pointed out the undeniable effectiveness of DDT spraying, and Dr. Peterson agreed: "contrary to popular belief, USAID does support use of DDT in its malaria control programs." she said. Puzzled, Sen. Brownback could not understand why USAID claims to support full-heartedly a multi-pronged prevention strategy that includes DDT and combination therapy drugs, but does not use its funds to purchase either?
With an $80 million budget for 2004, Sen. Brownback was interested to know the breakdown of USAID's malaria budget. Peterson, unable to provide the exact numbers, responded that USAID funds the training of personnel, surveillance of drug quality and resistance, research for a malaria vaccine and insecticide-treated nets. USAID does not purchase DDT or drugs.
Wanting only a straight answer to the seemingly simple question of why USAID does not purchase DDT or drugs, the Kansas Senator continued to press Dr Peterson. When asked whether or not USAID would buy DDT if funds were provided for that purpose, Peterson refused to say that USAID would indeed make those purchases.
Its becoming pretty obvious that USAID is not coming clean; it must give ongoing policy guidance against the use of DDT. Reports from the field show that they continue to privately advocate against their own public rhetoric of using all tools in the toolbox, pushing an undoubtedly less effective one-pronged approach of only using ITNs. The end result? Other aid agencies, governments and corporations will continue to mimic this deadly approach.
Malaria is a preventable and curable disease. Yet it continues to claim the lives of over one million people each year, with Africa, Asia and the Near East suffering the most losses. USAID must change its policy or its health officials should be replaced by those who will.
Roger Bate is a fellow and Samantha Dovey and Emma Morrison researchers at the American Enterprise Institute.