Another year has passed and Africa Malaria Day has come around again. Tomorrow, April 25, marks the day we are supposed to assess our successes and failures and renew the political will to tackle the disease.
In the last year, some important advances have been made, but obstacles to saving lives remain and,
if we are to overcome them, more political will and steadfastness from African governments and their allies will be needed.
Some of the recent successes in malaria control policy have come about as a direct result of African leadership, much of that from SA. This country has successfully controlled malaria in the lowveld and by working with our neighbours, particularly Swaziland and Mozambique, has shown that malaria can be controlled and that deaths from the deadly Plasmodium parasite are preventable.
The experience in southern Africa in recent years has demonstrated that the careful application of insecticides inside houses is a highly effective and remarkably safe way of preventing malaria. This form of control, known as indoor residual spraying, uses a variety of insecticides. DDT, the totemic enemy of many environmentalists, continues to be used successfully to save lives in around ten African countries.
Only a few years ago it seemed that DDT would be banned for all uses, including public health, under the Stockholm Convention on Persistent Organic Pollutants. Malaria scientists and some African governments, such as SA, saved DDT though and millions at risk from malaria should be forever grateful.
The Global Fund for AIDS, Tuberculosis and Malaria has demonstrated that it follows sound public health policies in that it supports the use of, and purchases, DDT for malaria control. The US Agency for International Development (USAID) has now committed itself to buying DDT for those countries that want it.
USAID has been shunning DDT for years, so it was a welcome turnaround when, in congressional testimony earlier this year, USAID's Michael Miller noted that "in at least three of the eight countries in which USAID will support indoor residual spraying this year, DDT will be the primary insecticide".
Last year, the World Health Organisation (WHO) appointed a new head of malaria control, Dr Arata Kochi, who has a reputation of being a hard hitter and is probably the right person to reform the WHO's Roll Back Malaria programme, which is widely seen as a failure.
Dr Kochi comes from the WHO's tuberculosis programme and has little history in the malaria programme. Perhaps for this reason, he has been very open to new ideas and has no constituency to represent.
Since taking up the post, he has aggressively pushed through new malaria treatment guidelines and has travelled to many malarial countries in order to understand what they want and need.
Against all this positive action sits the European Union (EU). The EU has been actively frustrating malaria control in Uganda by threatening to ban any agricultural exports from that country if they use DDT in malaria control. Their fear is that some DDT will be diverted from the public health programme to agriculture. The EU has chosen to ignore the fact that those countries that use DDT have set in place strict controls and regular audits to ensure that this dose not happen. No other country that uses DDT has been singled out like Uganda, pointing to the arbitrary and capricious nature of EU policies.
There is no logical or scientific basis to the threats made by the EU.
Most recently Tom Vens, the head of economic, trade and social sectors with the EU delegation to Uganda stated that DDT could cause cancer if ingested and that Uganda was taking a risk if it used it in malaria control.
These statements simply show how out of touch the EU is. First,
DDT is rated as a possible human carcinogen, which may sound scary, but that is the same rating given to coffee and a host of other everyday products that we happily consume. Second, DDT is sprayed on the inside walls of houses and last time I visited Uganda, I saw no one licking the walls of their houses.
One thing is sure, if there were as many Europeans dying from malaria as there are Africans, Europeans politicians would not stand for the unscientific, ignorant and highly damaging statements of their officials. Tragically though, Europe is showing a callous disregard for the lives of Africans. African leaders can and should use their new found allies in the US and WHO to challenge Europe and put a stop to their absurd position on DDT.
Tren is a director of the health advocacy group, Africa Fighting Malaria.
https://www.businessday.co.za/articles/opinion.aspx?ID=BD4A189817