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A perspective on the use of DDT for fighting Malaria
REVIEW & OUTLOOK
Death by Environmentalist
December 29, 2004; Page A8
Aid workers tending to the ravaged islands and coastlines of southern Asia say a big concern is an outbreak of malaria and other waterborne diseases in the aftermath of Sunday's tsunami. Which reminds us of a just-out World Health Organization report anticipating a shortage in a key antimalarial drug for next year.
The drug, known as Coartem, is the most effective on the market. WHO officials estimate that 60 million doses are needed for 2005. But Novartis, the maker of Coartem, says its Chinese supplier of an essential natural ingredient for the combination therapy came up short. Therefore, only about 30 million doses of the drug will be available.
This news about treatments wouldn't be so devastating but for the fact that the international groups in charge still can't get malaria prevention under control. And that's the real tragedy. A blight that has been all but eliminated in the West, malaria still claims between one million and two million lives every year in the underdeveloped world. Most of its victims reside in black Africa, and 90% of those are pregnant women and children under five.
Beyond the human toll are the economic consequences, which help keep these nations in poverty's tight grip. It's been estimated that malaria costs Africa 1.2% of its GDP, or some $12 billion annually. The pandemic compromises the educational development of the children it doesn't kill, and it depletes the mental and physical vigor of the adult population.
The saddest aspect of this tragedy may be that making things right isn't that complicated or expensive. We have the means and the know-how. What's missing is the political will. HIV infections are a fraction of malaria's, but the former affects more people in the West, where advocates see to it that foreign aid budgets keep AIDS front and center. Third World victims of malaria don't have lobbyists and Hollywood A-listers calling attention to their situation.
But the bigger problem is the politicized international health agencies that discourage the employment of all available tools of prevention -- specifically insecticides containing DDT that is anathema to environmentalists. Bed nets and preventive medicines play important roles, but spraying homes with pesticides is vital. Use of DDT, developed during World War II and the main reason that America and Europe no longer harbor malarial mosquitoes, has been most successful in containing the disease. Still, influential groups like the U.S. Agency for International Development want DDT left out of malaria-control efforts.
Senator Sam Brownback of Kansas noted the hypocrisy of this position at a subcommittee hearing in October. AID "refuses to support and endorse the use of insecticides," said the Senator, "even when used in small amounts -- much smaller than the mass, airborne spraying that the U.S. implemented to eliminate its own malaria problem decades ago."
This ideological opposition to synthetic chemicals has no basis in science -- there is no evidence that the pesticide harms humans or causes widespread damage to nature -- but it amounts to a death sentence for millions of African women and children. When South Africa stopped using DDT in 1996 at the urging of environmentalists, malaria cases rose from 6,000 in 1995 to 60,000 in 2000. DDT use resumed in 2000 in the country's worst-hit province, KwaZulu Natal, and malaria cases fell by nearly 80% by 2001. Zambia, one of Africa's poorest countries, also saw a tremendous drop in malaria cases when insecticide-spraying was reintroduced four years ago. Today, DDT is protecting a Zambian population of 360,000 at a cost of about $6 per household.
Earlier this year AID, which U.S. taxpayers funded to the tune of $65 million in 2003, was called to the carpet by Senators Judd Gregg and Russ Feingold for supporting the distribution of obsolete drugs in Africa. The agency's opposition to DDT is no less appalling, especially since United Nations organizations such as WHO and the Global Fund feel pressured to follow our lead.
Congress might consider looking into exactly how AID spends its allocation and how the agency measures results. We are nearly halfway though a 12-year effort to halve malaria deaths world-wide by 2010, yet malaria cases have increased by 10% in the past few years. Obviously, bed nets aren't getting the job done.
Letters to the Editor
Strategies for Fighting the Scourge of Malaria
January 11, 2005; Page A21
The Wall Street Journal
We applaud your astute synopsis of the problems plaguing global malaria prevention ("Death by Environmentalist," Review & Outlook, Dec. 29). Most appropriately, you point out that people are poor because they have malaria and not, simplistically, that they have malaria because they are poor. Your recognition of the tremendous burden of malaria world-wide (each year 300 million to 500 million cases and more than a million deaths, mainly among children less than age five), the increasing incidence of disease despite coordinated global countermeasures to halve deaths by 2010, increasing drug resistance, supply-chain problems with effective drugs, and the lack of populist support is both laudable and sobering.
Although your call for action for the funding and wider use of DDT by the U.S. government recognizes environmentalist sensitivities, it falls short of offering a comprehensive malaria solution. Cost-effective and proven preventive strategies for malaria currently exist and include immediate treatment of infected individuals with the most efficacious drug, prevention of malaria among pregnant women with intermittent drug therapy, and integrated mosquito control strategies. Insecticide-treated bednets have become the cornerstone of the prevention effort based on excellent data that they reduce a fifth of all deaths among children under age two in areas with high malaria transmission. Contrary to your assertion, bednets work. Unfortunately, due to funding constraints they have not been widely provided to vulnerable populations analogous to our efforts with childhood vaccines or antiretroviral therapy for HIV. Selling bednets to the poorest in poor countries as a health marketing concept has not worked and is unlikely to until there is greater economic development in these areas.
DDT also has a clear role for the prevention of malaria under select circumstances. It is well recognized that judicious use of DDT in indoor spraying is both environmentally safe and safe for the inhabitants of the household. This role has been codified in its exemption for health use in the treaty to ban persistent organic pollutants. However, the use of DDT, even if supported by environmentalists, will also be to naught if there continues to be insufficient political will to fund the proven preventive strategies and if the strategy to use all interventions, including DDT, are not monitored and evaluated in accordance with established scientific principles. Without these conditions, the acceptance of DDT by environmentalists will amount to little more than a distraction from the ongoing malaria tragedy that robs parents of their children, and countries of their best future hopes.
Ali S. Khan, M.D.
Associate Director for Science, Parasitic Diseases
DHHS/Centers for Disease Control and Prevention
Atlanta
(The letter was also signed by Richard W. Steketee, M.D., chief, Malaria Branch, and Robert A. Wirtz, Ph.D., chief, Entomology Branch, DHHS/Centers for Disease Control and Prevention.)
Source: The Wall Street Journal
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