George Clooney Answers Your Questions About Malaria

Nicholas Kristof | 08 Feb 2011
New York Times
My former travel buddy, George Clooney, caught malaria in January on a trip to Sudan (see what happens when I'm not around to look out for him?). This seemed an opportunity to shine a spotlight on malaria, one of the scourges of much of the developing world, and George agreed to respond to reader questions. Thanks to all for submitting your questions-and I'm truly sorry that the answers were delayed. We were about to post these answers when Egypt intervened and I was too busy dodging pro-Mubarak thugs in Cairo to focus on this. So without further ado, George and I are finally responding.

Q. How helpful are those mosquito net programs?

A. Bed net programs seem very effective, especially when the nets are treated with insecticide. The problem tends to be getting the nets to rural areas, and then getting people to use them. The kind of mosquito that carries malaria is normally active only in the evening, when people are in bed, and that's why the nets work so well. But ideally the nets are accompanied by vigorous treatment of suspected cases and also indoor spraying with small amounts of an insecticide like DDT: that keeps the mosquitoes out. That combination seems to work very, very effectively, but even net programs alone have resulted in plummeting rates of malaria in some countries recently. One of the saddest things I've seen was a family in Cambodia years ago. The mother had died of malaria, and the grandmother was looking after four children. She had one bed net that could cover three of them — and so every night she had to choose which child to leave out.

I should also add that there's a lot we don't know. Peter Agre of the Johns Hopkins School of Public Health tells me that a combination of insecticide treated nets and aggressive treatment using effective medicines has reduced malaria deaths more than 90 percent in parts of southern Zambia. But a similar approach in northern Zambia seems to have been much less effective. Agre's team is now trying to sort out why. There are also high tech solutions being studied, from malaria vaccines to efforts to tinker with the fertility of the mosquitoes that carry malaria, but no breakthroughs seem imminent. — Nicholas Kristof

Q. Given the following:
1. DDT is extremely effective at killing mosquitoes
2. Malaria kills 850,000 people a year
3. DDT has never killed a single human being

How can we justify encouraging the slaughter of nearly a million humans every year when DDT will reduce that to under 100,000?

A. DDT should definitely be part of the solution, and almost everyone in the public health world — including those with strong environmental concerns — agrees with that. These days the idea is not to use massive amounts of DDT trying to wipe out every insect, but to use tiny amounts with what is called indoor residual spraying. This keeps mosquitoes out of houses and seems to reduce malaria rates significantly. — Nicholas Kristof

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