ARTICLES
Malaria: Saving Lives and Protecting the Environment
By Thompson Ayodele - posted 10 June 2003
In April, Africa Malaria Day was celebrated with pomp and pageantry. Across African cities, towns and villages thousands of young ones and adults died of malaria. The 2000 Abuja Declaration seeks to reduce malaria cases by 50 per cent, yet malaria still claims millions of lives. Malaria is the biggest health problem in Africa. In several fora, there is a general consensus that malaria is indeed a problem that needs to be tackled headlong. But several contradictions and backsliding on the part of most African governments and pressures from western donor agencies continue to constitute the stumbling block.
Malaria is a life-threatening parasitic disease transmitted from person to person through the bite of a female Anopheles mosquito. Its toll in Africa is the heaviest yearly. Ninety per cent of malaria deaths occur in Africa. It is responsible for over 300 million cases of acute illness each year leading to deaths in young children. Pregnant women are the most vulnerable. It makes them anaemic during pregnancy and lead to delivery of under-weight babies. In economic front, malaria costs Africa more than $12 billion annually. It has slowed economic growth in African countries by 1.3% per year. Had the disease been wiped out decades ago, $100 billion would have been added to sub-Saharan Africa's current GDP of $300 billion this year.
Malaria used to be a global problem. After the World War II, the U.S. Military introduced dichlorodiphenyl trichloroethane (DDT) for malaria control and eradication. Considering its spectacular success, hope was rife that malaria would in fact be wiped out from the entire globe. In Europe and North America, DDT was widely used and within a short time malaria was curtailed in both continents. That eradication was through vector control. The League of Nations Malaria Commission that once supported the elimination of malaria through drug therapy and prophylaxis, which it found impossible in actual practice, later supported vector control. The Rockefeller Foundation was founded to control the vector and it favoured the use of DDT in its malaria programme. Spectacular successes were recorded in many countries where it was used.
Vector control programmes were more successful in many areas using DDT in controlling malaria cases. In 1946, South Africa used DDT in its malaria eradication programme. Within some few months malaria cases were reduced to about one tenth of the reported cases. In Sri-Lanka, DDT spraying began in 1946. The death rate from malaria fell from 20.3 to 14.3 per thousand. In less than a decade, DDT use had cut malaria down from 3 million cases to 7,300 and had eliminated all malaria deaths. In the same period, India also had bad malaria problem where 75 million people contracted the disease and about 800,000 died. By using DDT the number was brought down from 75 million in 1951 to around 50,000 in 1961. However, these successes in many parts of the world in combating malaria were later reversed.
The first salvo against DDT use was fired by Rachel Carson in her book entitled Silent Spring. The book claimed that the pesticide has 'devastating impacts on birds' life.' Despite numerous scientific data and evidence indicating the benefits of using DDT, the United States banned it in 1972. Many developed countries followed the same path. They also pressured developing countries to stop its use. For example, South Africa banned it in 1974 and later unbanned. Thereafter, using the same previous excuse, it was again banned in 1996. However, when malaria rate jumped from few thousand cases to over 50,000, it re-introduced DDT. Sri Lanka, under the illusion that it had combated malaria, stopped its use in 1964. Malaria cases reared its heads in 1969 from as low as 17 to over 500,000. With the huge success achieved by DDT in checkmating malaria, many organisations led by environmentalists and western donor nations and agencies continue to oppose its use in the Third World.
The World Health Organization and United States Agency for International Development are generally against pesticide-based vector control and have not sponsored vector control efforts to date. Officials of Mozambique's Department of Health have been strongly advised by its donors not to introduce DDT in its vector control programme. USAID pressured the Bolivian government not to use DDT in its malaria control programme and it complied. In Madagascar, the United Nations Development Programme tried to stop its use for malaria control. Creditably, Madagascar refused to budge.
The WHO and UNICEF malaria campaign programme, which favours the use of bed nets, is mainly to prevent and treat malaria rather than its eradication. The Roll Back Malaria (RMB) programme favours the use of insecticide treated nets. The RMB agenda is merely following the WHO and UNICEF strategy. Bed nets might be useful elements in malaria control but unless the entire country has insecticide-treated bed nets and they are used effectively, they prove ineffective in malaria control. However, how many Africans can afford to buy new bed nets when the old ones do not serve their purpose.
Many rich countries continue to dangle the carrot of aids to African countries on the promise that recipient countries will not use DDT. Malaria is a developing country problem. Ironically, developed nations and their agencies formulate its control policy. Their policy prescriptions are not in conformity with local circumstances and reality. Following their so-called environmental friendly policies, western donor agencies and governments withdraw their support for DDT and pesticides use in general in disease control.
DDT is highly effective in killing malaria vector and interrupting the transfer of malaria parasite. It is cheap, safe and easy to use which put it within the reach of even many African countries' dwindling health budget. Its use is based on a conviction that vector control, and in particular pesticide spraying, is the only way in which the disease could be tackled. DDT has saved countless of lives in Europe and North America. Despite its efficacy in controlling malaria, environmental concerns continue to take centre stage at the expense of saving human lives. Environmentalists continue to find evidence that the chemical harms human beings and damage the environment. Their arguments against its use grossly conflict with those of over 400 malaria scientists and physicians across the world. Interestingly, many Nobel Laureates have recently endorsed a letter arguing that DDT should be actively used rather than banned.
Quite recently, Kenya Medical Research Institute, a leading research center in Nairobi, came out with findings favouring using DDT. Its reports, in part, are based on the situation in South Africa, Ethiopia, Eritrea and Mauritius all of which use DDT to combat malaria and save millions of their citizens. The Institute proposes the re-introduction of DDT for in-door residual spraying in Kenya. The WHO has honestly admitted most of the drugs use in treating the disease, choloroquine and sulphadoxine-pyrithemaine, are no longer effective in dealing with malaria. In Tanzania resistance rates range from 28% to 97%, from 66% to 87% in Kenya and from 10% to 80% in Uganda, yet it continues to oppose DDT use.
A line should clearly be drawn between protecting the environment and saving African lives. Most of the countries now opposing use of DDT once used it to exterminate Anopheles mosquitoes. Now under the guise of protecting the environment, the same countries and their environmental based NGOs continue to oppose the use of the chemical, saying it is an environmental disaster. DDT was invented and used extensively in the past by the same countries trying to stop its use while denying developing countries of the chemical that enhanced the economies and welfare of the developed world.
Most Western countries and donor agencies do not really grasp the situation in Africa. They can therefore afford to prescribe health policies in their capitals to be executed in African countries. African bureaucrats and politicians, unable to read between the lines, always accept these foreign policies hook, line and sinker not minding whether they would harm their citizens as long as there are financial compensations attached. The paradox is most of these compensations ultimately wind up in the private pockets with members of their countries bearing the brunt of these insensitive policies.
African lives could be saved and the environment protected if strict spraying methods of DDT are followed. Placing a blanket ban on DDT is, by implication, practically retarding Africa growth and progress. African countries should be bold enough to follow South Africa example who despite intense protests and bullying from Europe, the United States and environmental NGOs has continued to use DDT in its malaria control programme. Zambia has decided to re-introduce the chemical for malaria control. Also Uganda has indicated its intention to re-introduce the use of DDT. A country like Nigeria in which over 400,000 died of malaria in 2002 should consider its use to control malaria.
Malaria kills thousands everyday in Africa. Each life lost is a potential Mandela, Obasanjo, Annan, Gates, Soyinka, Rice, Achebe, Powell or Johnson. Malaria is undoubtedly one of the factors responsible for a painful economic burden and poverty level in the continent. Obviously, this may not be the intention of opponents of DDT, but it will surely be the outcome.
Thompson Ayodele (thompson@ippanigeria.org) is the Coordinator of the Institute of Public Policy Analysis, Lagos and a Fellow of International Policy Network, London