After decades of failure and increasing disease, things are finally changing. New WHO policies under Dr. Arata Kochi are leading the way.
“We sure could use a little good news today.”
Anne Murray’s plea certainly resonates in Africa.
In Kenya alone, 34,000 young children a year perish from malaria, says Health Minister Charity Ngilu. Uganda suffers 100,000 deaths annually, notes Minister of Health Dr. Stephen Malinga – the equivalent of a jetliner with 275 people slamming into its Rwenzori Mountains every day.
Africa has 400 million cases of acute malaria per year; up to 2 million die. Countless millions are too sick to work or go to school, countless millions more must stay home to care for them, and meager family savings are exhausted on anti-malaria drugs.
The disease costs Kenya 170 million working days and billions of dollars annually. It is a major reason that few tourists and investors go to Africa, and that the sub-Sahara region remains one of the poorest on Earth.
Instead of improving, in recent decades the disease rates have worsened. A principal reason, as epidemiologist Robert Desowitz observed, has been insecticide-resistant mosquitoes lethally combined with insecticide-resistant health authorities, who insisted on politically correct policies, instead of proven, practical solutions.
Indeed, since the US banned DDT in 1972, despite an independent commission finding that it was safe for people and most wildlife, malaria has killed an estimated 50 million people. Opponents have focused relentlessly on the alleged risks of using DDT – while ignoring the undeniable tragedies the chemical could prevent.
DDT is no “silver bullet,” nor is it appropriate in all places or cases. However, it is a critical element of many successful malaria control programs. Sprayed just twice a year on the inside walls of homes, it keeps 90% of mosquitoes from even entering, irritates those that do come in so they don’t bite, and kills any that land. No other chemical, at any price, does that.
During the past year, however, a new sense of urgency and realism has taken hold. We’re finally beginning to hear a little good news.
Archbishop Desmond Tutu and hundreds of physicians and infectious disease experts signed the Kill Malarial Mosquitoes NOW declaration, demanding changes in malaria control policies. The US Congress held hearings and directed that substantial funds be spent on DDT, other insecticides, bednets and modern Artemisia-based (ACT) drugs.
USAID inaugurated new programs to provide nets and spray the inside walls of houses with DDT and other chemicals. The President’s Malaria Initiative and Global Fund for AIDS, Tuberculosis and Malaria undertook similar actions. And African countries began emulating successful South African and Swaziland DDT-ACT programs.
Anti-pesticide ideologues predictably pushed back, claiming DDT could cause low birth weights in babies and lactation failure in nursing mothers – and asserting that the European Union might ban agricultural exports from any country that used DDT. Malaria survivor and activist Fiona Kobusingye of Uganda responded: “African mothers would be delighted if these were their biggest worries. They and their children are dying from malaria! Those are the real risks we face.”
As to trade ban assertions, EU President José Manuel Barroso removed that cloud of uncertainty with his response to a letter from physician and Senator Tom Coburn. The European Union fully supports the right and responsibility of countries to use DDT and other “appropriate malaria control techniques,” under Stockholm Convention and WHO guidelines, he declared. Only produce “contaminated with DDT above accepted residue levels” would be affected. Of course, such contamination is highly unlikely under limited modern indoor residual spraying (IRS) programs.
An even more momentous decision was announced September 15. Dr. Arata Kochi, the new head of the World Health Organization’s malaria program, issued revised guidelines that underscore the “major role” that DDT and other insecticides “will again play” in preventing malaria. Indoor spraying and ACT drugs are vital to any cohesive, comprehensive, effective program, he emphasized.
Other critical elements of the new WHO program include: strong WHO technical leadership and support; expanded focus on malaria-endemic countries worldwide; free or highly subsidized distribution of insecticide-treated bednets; prompt diagnosis and treatment of malaria cases; strengthened health systems and services; more effective monitoring and evaluation of program performance; improved efforts to find and fix bottlenecks in delivering aid; and proper training of people who will transport, store and use DDT and other insecticides.
All components, Dr. Kochi emphasized, must be carried out under well-coordinated and adequately financed partnerships at the country level, to ensure that sustainable malaria programs are aligned with national health and economic development plans and priorities.
“Please,” he appealed to everyone who cares about people and wildlife: “Help save African babies, as you help save the environment.”
The emphasis is finally being placed where it belongs. On intense, comprehensive, sustained programs that worked in other malarial nations. And away from theoretical, environmentally correct strategies that had guided previous WHO and USAID administrations – and still influence World Bank programs.
We’re not there yet, but maybe someday soon Anne Murray will be able to sing: “Nobody died from malaria in the whole Third World today – and in the streets of Nairobi all the children had to do was play.”