Free the Fight Against Malaria

Richard Nchabi Kamwi | 08 Nov 2023
Wall Street Journal Europe
This week southern African countries commemorate Malaria Week, with events to increase awareness of a disease that continues to claim lives and stunt development in Africa, Asia and Latin America. Coincidentally, and perhaps ironically, an expert committee convened by the Stockholm Convention on Persistent Organic Pollutants is also meeting this week, in Geneva, to discuss dichlorodiphenyltrichloroethane or DDT, an anti-malaria insecticide that has been saving lives since 1945. The Geneva meeting, thousands of miles from any malaria-spreading mosquito, could have important implications for disease control and development in poor countries.

Namibia is a party to the Stockholm Convention, which laudably seeks to remove harmful pollutants from the environment. As DDT is essential for malaria control, it is the only chemical classified as a "persistent organic pollutant" that can still be used. Yet my country and others working to eradicate malaria still face ongoing pressure from anti-insecticide activists, and in recent years the manufacturers of DDT have dwindled to only one, a state-owned factory in India. Regrettably the secretariat of the Stockholm Convention envisages halting all production of DDT in just seven years. Yet there is no true replacement for DDT, and malaria-inflicted countries will continue to need it for the foreseeable future.

Malaria is a disease that we should not have to live with, and happily most developed nations eradicated it in the 1950s, mostly thanks to the targeted use of DDT.

Namibia together with seven countries in the Southern African Development Community has been designated for malaria elimination over the coming five years. As part of a phased intervention to roll back malaria from the south to the north, Namibia, Botswana, South Africa and Swaziland are on track to eliminate the disease by building a comprehensive, evidence-based approach that includes using bednets, improving diagnosis, and making available safe, effective treatment. But the cornerstone of this highly successful campaign is the spraying of small amounts of insecticide, including DDT, inside houses.

There are several reasons to defend DDT and ensure we have ongoing supplies. First, DDT is safe for humans and the environment. Since the 1940s thousands of scientific studies have investigated potential harm to human health from DDT. Almost all these studies are weak, inconclusive or contradictory; in other words there is no evidence of harm. On the other hand there is well-documented evidence of its great public-health benefits. As Minister of Health, I have to evaluate the full body of scientific evidence and balance risks. With regard to DDT and malaria, any rational balancing of risks will favor DDT.

As for the environment, DDT produces no environmental contamination when sprayed in small quantities inside. Yet even if there were some concerns about environmental harm, we would still place greater value on human life.

Second, DDT is essential for managing insecticide resistance. There are few alternative insecticides suitable for malaria control and approved by the World Health Organization. None equal the efficacy of DDT nor do they work in the same way as DDT, which primarily stops mosquitoes from even entering houses. The well-documented experience of a number of countries in southern Africa is instructive in this regard. For example, South Africa in 1995 switched from DDT to deltamethrine, a pyrethroid. But the malaria-carrying Anopheles funestus mosquito proved resistant to deltamethrine early on, and the resultant increases in fatalities due to malaria necessitated the reintroduction of DDT, which continues to be used.

Third, failing to protect DDT, secure supplies and defend our right to use it will mean that the global community puts the sensibilities of anti-insecticide activists and the agendas of the Stockholm Convention Secretariat ahead of the lives of poor people in malarial countries. This will set a worrying and damaging precedent and would be grossly unjust.

In general, ministries of health work with limited budgets and have many competing demands. Public-health insecticides save lives just as medicines or vaccines do. If there were coordinated campaigns against life-saving medicines, there would be a global outcry. Unfortunately because of the stigma associated with insecticides and DDT in particular, we are often left to defend these life-saving chemicals alone. If we are to achieve our goals of malaria elimination though, we are going to need a more robust and global effort to defend the tools we need to get there.

I have long labored to control this complex and challenging disease in Namibia. My staff understands the strengths and weakness of different malaria-control methods. Drawing on this knowledge and experience, I call on the international community to act against those who seek to eliminate or restrict our freedom to use DDT. First and foremost, we must protect the health and welfare of those who are at risk of disease and death from malaria.

Mr. Kamwi is the minister of Heath and Social Services in Namibia and chairperson of the South African Development Community's Malaria Elimination Eight (E8) group of countries.