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Date:  June 18, 2007
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Ending Malaria in Africa
by Dr. Sam Zaramba

Malaria control is Africa’s right – and responsibility.

KAMPALA, UGANDA – Africa’s sad experience with colonialism finally ended in the 1960s.  Yet, a lethal vestige remains: restrictions on our malaria control efforts. This disease is the biggest killer of Ugandan and all African children. Yet it remains preventable and curable, and we are making progress.

A week ago, G8 leaders committed new resources to combat this mosquito-borne disease. Now they must honor this promise, by supporting African independence in disease control. The United States and Europe eradicated malaria by 1960, largely with the use of DDT. At the time, Uganda tested the pesticide in the Kanungu district and reduced malaria by 98 percent. Despite this success, we lacked the resources to sustain or expand the program. Rather than partner with us to improve our public health infrastructure, however, foreign donors blanched. They used Africa’s lack of infrastructure to justify not investing in it.  

Today, half a century after the West rid itself of malaria, every single Ugandan remains at risk. Every year, over 10 million of our people are infected, and 100,000 of our mothers and children die from the disease. Recently our homegrown country music star, Job Paul Kafeero, died from malaria, reminding us that no one is beyond its reach. Yet many still say Africa’s poor infrastructure makes indoor spraying too costly and complex a method to fight malaria.

Uganda is one of a growing number of African countries proving these people wrong. In 2006, Uganda worked with President George Bush’s Malaria Initiative to train 350 spray operators, supervisors and health officials. In August 2006 and again in February 2007, they sprayed the walls of 100,000 households in the southern Kabale district with the insecticide Icon, as part of a comprehensive program that also includes bednets, sanitation, education, ACT drugs, larvacides and other insecticides, and rapidly improving patient care.

Nearly everyone welcomed this protection, and the prevalence of malaria parasites plummeted. Today, just 3% of the local population is infected, down from 30 percent. 

The exercise pays for itself. With 90% fewer people requiring anti-malarial medication and other public health resources, more healthy adults are working and more children are attending school. When we repeated the initial exercise in Kabale and neighboring Kanungu districts this year, our spray teams required only short refresher training and were rapidly mobilized. Our health officials at the village, district and national level were able to educate communities, implement spraying programs, and evaluate operations. With each passing year, it will be easier and less expensive to run the programs.  

We can make it even more cost-effective by switching from the current insecticide to DDT. It lasts longer, costs less and has more modes of action against malaria-carrying mosquitoes than Icon. DDT functions as spatial repellent to keep mosquitoes out of homes, as an irritant to prevent them from biting, and as a toxic agent to kill those that land. Because the spatial repellency effect works without physical contact, and because the chemical is not used in agriculture, DDT also makes mosquitoes less likely to develop resistance. Thus DDT is both more effective and more cost-effective. 

The US banned DDT in 1972, spurred on by environmentalists and Rachel Carson’s 1962 book “Silent Spring.” Many countries in Europe and around the world followed suit. But after decades of exhaustive scientific review, DDT has been shown to be not only safe for humans and the environment, especially when used for indoor residual spraying – but also the single most effective anti-malarial agent ever invented. Nothing else, at any price, does everything it does.

That is why the World Health Organization has once again recommended using DDT wherever possible against malaria, along with other interventions. 

We are trying to do precisely this. In addition to distributing long-lasting insecticidal nets and 25 million doses of effective anti-malarial drugs, we will expand our indoor spraying operations to four more districts this year, where we will protect tens of thousands of Ugandans from malaria’s deadly scourge. We are committed to storing, transporting and using DDT properly in these programs, in accord with Stockholm Convention, WHO, European Union and US Agency for International Development guidelines. We are working with these organizations and our communities, to build broad support and ensure that our agricultural trade is not jeopardized.

Although Uganda’s National Environmental Management Authority has approved DDT for malaria control, Western environmentalists continue to undermine these efforts and discourage G8 governments from supporting us. The EU has acknowledged our right to use DDT, but some consumer and agricultural groups repeat myths and lies about the chemical. They should instead help us use it carefully and effectively for malaria control. 

Environmental leaders must join the 21st century, acknowledge the mistakes Carson made, and balance the hypothetical risks of DDT with the real and devastating consequences of malaria. Uganda has demonstrated that, with the proper support, we can conduct model indoor spraying programs and ensure that money is spent wisely, chemicals are handled properly, our program responds promptly to changing conditions, and malaria is brought under control.

In this way, we will ensure a healthier and more prosperous future for our people.

Africa is determined to take charge of its future, and to rise above the contemporary colonialism that helps keep us impoverished. We expect strong leadership in G8 countries to stop paying lip service to African self-determination – and start supporting solutions that are already working. 

[Editor's note: An abbreviated version of this article appeared in The Wall Street Journal on June 12.]

Guest Author


Notes: 

Dr. Sam Zaramba is Director General of Health Services for the Republic of Uganda. He is joined in this statement by Minister of Health Dr. Stephen Mallinga, Minister of State for Health Dr. Richard Nduhura, Minister of State for Primary Health Care Dr. Emmanuel Otaala, National Malaria Control Program Manager Dr. J.B. Rwakimali, Health Ministry Commissioner for Health Planning Dr. Francis Runumi, and the entire Ministry of Health for the Republic of Uganda.


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