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For two years the United Nations (UN) paid lip service to the truth that the insecticide DDT is a vital component of malaria control. However, in May the UN abandoned science in favour of superstition. The result is UN promotion of more dangerous and less efficient malaria control techniques.
The World Health Organization (WHO) and the United Nations Environment Program announced plans to reduce DDT use by 30% by 2014 and completely eliminate it by around 2020. In the meantime the UN will roll out initiatives in 40 countries to test non-chemical methods of malaria control. In particular the UN wants to scale up the programmes of Central America, which have relied on ‘pharmacosuppression’. Essentially, uninfected people in high-risk locations are given the anti-malarial drug chloroquine to suppress any future infection. In 2004, 3,400 malaria cases were diagnosed in Mexico, 6,897 in Nicaragua, and almost half a million in Brazil. But both Mexico and Nicaragua each distributed more anti-malaria pills (mostly chloroquine pills) than Brazil. Chloroquine is a wonderful drug for combating malaria and has saved millions of lives when used therapeutically, as in Brazil, but prophylactic use is not safe because it is quite toxic and has led to heart problems when used repeatedly.
Ironically, chloroquine is only slightly less toxic than DDT, yet people have to eat chloroquine pills, they don’t eat DDT. The UN does not mention this, or that the Central American policy cannot be used in most other regions because of the extensive resistance to chloroquine and high cost. So even if pharmacosuppression were clinically appropriate, it couldn’t be done in Africa anyway.
The UN’s push for a ‘zero DDT world’ ignores the millions of lives DDT has saved over the past century with little-to-no adverse environmental impact and no harm to human health. From the late 1940s until the early 1970s, spraying DDT was the mainstay of anti-mosquito campaigns responsible for successfully eradicating malaria from North America and much of Europe. Thanks to DDT, by 1970, an estimated one billion people no longer lived in malaria-endemic areas.
But, by the 1980s, aid agencies lost interest in funding malaria control. When malaria re-emerged as a global priority in 1998, even the most limited use of DDT was off the table. Deaf to appeals from Southern African public health experts who were successfully using the chemical, aid groups opted to promote less controversial bed nets and anti-malarial drugs.
Bed nets save lives, especially when impregnated with insecticides, and are relatively cheap. But they must be used consistently. Studies suggest most people do not routinely sleep under their nets, and when bed nets are accompanied by the necessary education campaigns their unit cost increases.
Recognising this, WHO reversed its policy in 2006. Dr Arata Kochi, Director of WHO’s Global Malaria Programme announced in September 2006 ‘One of the best tools we have against malaria is indoor residual house spraying. Of the dozen insecticides WHO has approved as safe for house spraying, the most effective is DDT.’ Dr Kochi wanted all the tools available to combat malaria.
Still, even with this WHO endorsement, only a few national governments tried using DDT. Most nations were reliant on governmental donors and NGOs, which favour net distribution. The only large donor that has even tried using DDT in Africa since the 1970s has been the US President’s Malaria Initiative. So only a moderate increase in DDT use occurred and none was funded by the UN. And then last year Dr Kochi was sidelined along with his pro-DDT policy. The result was that WHO, which had weakly championed DDT for less than two years, was back in step with the rest of the UN agencies.
In its place the UN promotes the highly dubious Central American pharmacosuppression project as well as other marginal techniques, such as fish which eat mosquito larvae. Since many mosquito species can breed in tiny amounts of water trapped in old tyres or even in hoof prints, it is easy to see why they are not widely deployable.
So while there are many alternatives to DDT, it is still a key, yet largely unfunded, part of the anti-malaria arsenal. The children of Africa pay the price for the UN’s political correctness.
Roger Bate is the Legatum Fellow in Global Prosperity at AEI.
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