October 19, 2007 at 8:19 am

I understand the attraction of setting lofty goals. Aiming high can be a way of getting people to push harder towards a goal. Sending a man to the moon would never have been achieved if JFK hadn’t aimed at such a distant goalpost. “Eradicating” malaria, however, is much more complicated and much less realistic than sending three men in spacecraft to an orbiting hunk of rock. Promising eradication, I’m afraid is akin promising everyone a slice of “green cheese.”

Setting a goal of eradicating malaria is not audacious as much as it is ignorant. It ignores the complexity of malaria vector ecology, parasite biology, and human immunity. It ignores the human contexts that promote malaria transmission and affect its ability to be prevented or treated.
It’s not an audacious goal as much as it is pathetic, and I don’t mean it in the derogatory sense, but in the sense of true pathos, i.e. “sympathetic pity.” It makes me sad that so many people with such noble intentions will now have their energies and resources diverted into battling windmills. This is especially sad when there are lives out there waiting to be saved, right now, with existing knowledge and methods.

I hate to say it, but setting a goal of eradication may ultimately kill more people. More resources may be mobilized, but most will be diverted into high tech, high risk schemes that will advance the careers of many advocates and academics. Many more could be saved, now and in the future with sustainable, locally empowering and integrated approaches that combine personal protection, with focal, intelligent targeting of environmental determinants and minor improvements of housing. Thanks, for the green cheese, but I think I’ll pass.

October 19, 2007 at 12:56 pm

TonyK
I don’t get your criticism.
We actually came close to eradicating it back in the 1950s and 1960s, but quit for a variety of reasons (US congress defunding aid to developing world, Rachel Carson’s Silent Spring causing an overreaction to the use of DDT in mosquito control.)

I don’t think getting a bunch of concerned people together to discuss malaria is a bad thing in itself. I believe that most people who are familiar with the parasite and its vectors know that there isn’t going to be a “silver bullet” that consigns Malaria to the history books.

Instead it’s a series of battles waged at all levels and sectors of the globe. It includes everything from the use of DDT spraying of huts, to insecticide treated bednets, to genetic engineering of malaria-free mosquitoes, to better and cheaper drugs. A vaccine would be nice too, but I don’t think those participating in the meetings believe that this is the only solution.

As someone who has lived in Africa and maintains strong ties to the continent, I’ve seen the damage that the parasite does firsthand - and it’s brutal. If any disease deserves eradication, malaria is it.

October 19, 2007 at 1:03 pm

HOORAY for Bill Gates! I’m glad to hear Gates wants to stop the carnage caused by malaria, maybe he can actually be effective. DDT stopped the threat of malaria in the USA many years ago. However, after environmentals demonized the use of DDT around 1970, around 50 MILLION people in the world have died of malaria. Most of the deaths were in Africa. I spent 5 months in East Africa and South Africa in 1959 without any fear of malaria, but now both areas suffer from malaria epidemics that are the result of discontinuing the use of DDT. DDT is one of the cheapest and most effective methods of combating malaria. When South Africa recently renewed the use of DDT, they cut the incidents of malaria about 80%. Even the World Health Organization (WHO), USAID, and the Sierra club have recently recommended renewing the use of DDT in the fight against malaria. Environment groups using Rachel Carson’s error filled book, Silent Spring, are guilty of contributing to 50 million deaths.

October 19, 2007 at 1:16 pm

Why is this an American Government issue?

October 19, 2007 at 1:18 pm

I hear that DDT soves the problem instantly.

October 19, 2007 at 1:46 pm

We didn’t come anywhere near eradicating malaria on a global level in the 1950’s or 1960’s. There were places like India and Sri Lanka where that might have been the case but malaria remained robust in Africa, Southeast Asia, PNG, and other places.

I think its great to have a conference that gets concerned people together. And there are some wonderfully promising things to discuss, like the new malaria vaccine, despite its limitations. But some of the other things you list are even more limited in their potential impact.

How well and for how long is DDT going to be effective with kdr resistance spreading all over Africa, not to mention the other resistance mechanisms that hamper its efficacy in South Africa?

Kdr also affects the efficacy of bednets, and selection by insecticides is starting to alter the biting behavior of vectors in some places such that they bite outdoors and earlier in the evening before people get under their nets. Utilization rates of ITNs also leave a lot to be desired, as I have found in my visits to places where bednets have been widely distributed but infrequently used.

As for the genetic-engineering of malaria free mosquitoes, that’s the most laughable strategy of them all. It certainly may be possible to engineer something like this in a laboratory but releasing something like that in nature is akin to dropping a white lab mouse on an island full of rats and expected it to take over.

I’ve seen plenty of Africa myself and I agree that malaria would deserve eradication if it were possible. But I think its hackneyed and irresponsible to dredge up the old eradication concept yet again. And I’m speaking as someone who has helped draft a plan to eliminate malaria on an isolated island off the coast of Africa. Even that poses a daunting challenge, with terrible consequences (epidemic resurgence) if it fails.

I’m glad people care and want to do something. I just wish they would take the time to become more familiar with the problem before declaring a goal of eradication.

October 19, 2007 at 2:10 pm

TonyK, as has often been said don’t let perfect be the enemy of better. Even if one were to concede your point that teh eradication of malaria is impossible (a question that will never be answered by a bunch of commenters on blogs, even if we are all brilliant ;-)), I imagine you would concede that much more to combat malaria could be done.

As a first measure, I would recommend a controlled study on the actual deletarious effects of DDT and a comprehansive information campaign to combat the boogey-man myth that has grown over the past 50 years. I’m not saying that it is a panacea or that there are no disadvantages to its use, but a scientific approach to the questions of risk and benefit would help to provide logical use of this proven effective agent.

October 19, 2007 at 2:11 pm

This is a perfectly achievable goal and long past time. TonyK’s comments seem terribly close-minded. It’s pathetic to dismiss what could be achievable, just because you can’t see the path to achieve it yourself.
Here’s one relatively simple solution: Eliminate malaria through elimination of the mosquito. Species erradication is well within our current technological grasp, whether through chemical or biological means.

October 19, 2007 at 2:26 pm

Yikes. Elimination of the mosquito? Do you know what it would take to eliminate every Anopheles mosquito in Africa? For one, thing if we had the enormous resources that are currently diverted to the conflagration in Iraq, that might make a dent, but I’m sure plenty would remain.

I don’t think my mind is closed at all. I think that we have the means to make great advances in improving the lives of those living in malarious countries. I am open to many malaria intervention methods that never get considered because they either don’t involve technologies sufficiently advanced to entertain academia, they don’t involve commodities that can be packaged and sold, or because it’s too complicated for people to figure how to make several intervention methods work together for maximum effect.

Certainly I’m all for much more being done about malaria. DDT is of some use, but it’s efficacy is already limited and will decline further the more it is used due to selection for resistant mosquitoes. It is affected by cross-resistance produced by the pyrethroid insecticides now being used to treat bednets. There’s plenty of data to look at already that shows this, and you don’t have to look far. I’m not worried about the deleterious efects of DDT. I don’t think that it harms people to any significant extent when it’s used to spray indoor surfaces.
Just Google “DDT resistance.”

October 19, 2007 at 2:35 pm

TonyK
Okay, I get your point. As Submandave points out, it’s the “perfect being the enemy of the good.” You’re thinking two steps ahead of most of us, fearing a backlash when we fail to eradicate malaria.

So you suggest… what?

I am open to many malaria intervention methods that never get considered because they either don’t involve technologies sufficiently advanced to entertain academia, they don’t involve commodities that can be packaged and sold, or because it’s too complicated for people to figure how to make several intervention methods work together for maximum effect.

Like what? What are we missing?

October 19, 2007 at 3:15 pm

For starters:

1. Targeted focal manipulation or elimination of larval breeding sites with simple hand tools
2. Make modest enhancements to home construction that render homes refractory to mosquito entry
3. Promote stabilized earth methods of construction that are compatible with local construction methods, but reduce the need for replastering, thus reducing the production of borrow pits that are the most productive breeding sites for malaria vectors.
4. Space the planting of maize fields in relation to other crops such that the maize pollen does not nourish larval anophelines producing more, larger and longer-lived female mosquitoes.
5. Use low cost repellents to enhance the efficacy of bednets by driving more mosquitoes to insecticide treated surfaces while protecting people from bites that would occur outdoors or earlier in the evening when they are not under the protection of nets.

None of these sorts of things are currently being done anywhere despite the fact that they are sustainable by empowering those most at risk of acquiring malaria.

October 19, 2007 at 3:23 pm

None of these sorts of things are currently being done anywhere despite the fact that they are sustainable by empowering those most at risk of acquiring malaria.

Are you serious? I would have assumed this was part of any strategy. I’m most familiar with #2, having lived in areas where screened windows were non-existent and screen doors were impossible for people to imagine. Even in Japan screens go missing on apartment windows, and people resort to burning mosquito coils.

October 19, 2007 at 3:33 pm

TonyK
Got links to your ideas?
I want to quote them.
Thanks,
SK

October 19, 2007 at 4:24 pm

Scott,

Certain of these activities might be happening on a small local scale in certain areas, so I probably shouldn’t have said “none are being done anywhere” but they are certainly lost in the flood of bednets. I think bednets are great. They’re just not universally applicable to all malarious areas, and in some areas they would benefit from support with complementary interventions.

Here are some links, that at least provide some background.

1. http://www.dur.ac.uk/Ecology/disease_ecology/Final%20Report%20uganda.pdf
2. http://www.bmj.com/cgi/content/full/322/7296/1209
3. http://unesdoc.unesco.org/images/0012/001282/128236e.pdf
4. http://www.bu.edu/africa/resources/psae/Malaria1.pdf
5. http://www.malariajournal.com/content/6/1/101

Used together, with good drugs, bednets and IRS, I don’t expect these to eradicate anything, but the dramatic reduction of burdens should result in some economic benefits that could lead to a sustainable cycle of “health and wealth” as Dr. Andrew Spielman used to say. Another idea of his that I like is the promotion of a “virtuous circle” of positive feedback that progressively reduces the burden of malaria by breaking the “vicious cycle” of poverty.

October 19, 2007 at 7:23 pm

The following quotes are from “Malaria Atonement and Forgiveness” By Paul DriessenSaturday, September 22, 2007

“…many people have their own lists of folks who “ought to be seeking forgiveness.” …At the top of my own list are the radical environmentalists – and foundations and others who give them the money and political clout to perpetrate mischief worldwide. …. The worst cabal of pressure groups remains virulently opposed to spraying tiny amounts of DDT on walls to keep mosquitoes out of houses, and using other insecticides to kill blood-sucking insects that carry malaria, dengue and yellow fever, and a host of other killer diseases. A year ago, the World Health Organization, U.S. Agency for International Development, President’s Malaria Initiative and other agencies again recognized the vital role of these chemicals – and reintroduced them in their comprehensive, integrated disease control programs. But Pesticide Action Network, Beyond Pesticides and Physicians for Social Responsibility demand that the agencies return to the disastrous policies of recent years, when disease and death rates were rising every year

… Meanwhile, an African child dies from malaria every 30 seconds – a million a year…

The entire article can be found at:
http://www.townhall.com/columnists/PaulDriessen/2007/09/22/malaria_atonement_and_forgiveness?page=full&comments=true

October 19, 2007 at 8:40 pm

At the Forum this week, Bill & Melinda outlined a dual-pronged approach to work toward eventual eradication, with rapid scale up of currently available tools and the development of new ones over time (including a vaccine).

They expect that full eradication - meaning no humans suffering from malaria and no mosquitoes carrying it - will take decades to achieve at least, but they make the point that we can start now by radically reducing the 1 million deaths a year from malaria using time-tested interventions like long-lasting insecticide-treated bed nets, spraying, intermittent preventative treatment of pregnant women, and Artemisinin-based medicines. Used in concert, these technoloies have been shown to dramatically reduce the disease burden and death caused by malaria (anywhere from 60% to 90% according to Global Fund data).

The current best candidate vaccine - RTS,S - may be available as soon as four years from now, but with a 65% efficacy rate in children under 1, it is not a silver bullet. Rather, it’s another powerful tool to add to the arsenal.

October 20, 2007 at 1:02 am

TonyK,

Do you have any knowledge of what the Gate Foundation does now to combat malaria? It might be good if you educated yourself a little. You seem to simply dislike people like Bill Gates or anyone else who would have the temerity to try to actually accomplish something. Of course, except for the damage people like you do to the spirit of all of the rest of us, your concerns won’t amount to a hill of beans. The TonyKs of the world are the ones that are busy explaining to everyone why nothing good will ever happen while good things happen every day.

October 20, 2007 at 4:58 am

I am very much aware of the many important activities that are supported by the Bill and Melinda Gates Foundation and appreciate all that they support. They don’t have to care, so it is a testament to their humanity that they recognize the dire condition that is malaria and want to do something about it.

I have no idea how “monketlumber” can construe that I have any personal dislike for the Gates Foundation. I wouldn’t have even noticed that this conference ever happened if they hadn’t struck that single blaring, sour note of proposing “eradication,” (which may have been they whole point of resurrecting this hackneyed concept). Talk about doing damage to the spirit of those who want to accomplish something against malaria, but understand what it takes. Hopefully, it’s just a harmless conceit, a marketing ploy. But I worry that the repercussions may be more damaging.

I realize that they are not malaria experts, but I just wish that their advisers had dissuaded them from taking this tact. The reason I’m speaking out is because of the damage that this strategy is likely to cause by diverting attention and resources away from the more immediate needs of malaria intervention.

I can only ridicule the idea of eradicating something with ecological,political and epidemiological roots as complex as malaria in only a matter of decades, when we can’t even eradicate something simple like polio, and probably won’t for decades more. Someone needs to say these things. I am sure that there are those who don’t dare speak up for fear of affecting career or funding opportuntiies.

If they indeed plan to go on supporting more immediate and consider more sustainable measures, maybe I shouldn’t worry so much about additional deaths that might result from this diversion of attention and resources, I wonder what more could be done if those resources were not wasted on pie in the sky projects like genetically engineering a malaria-free mosquito,

October 20, 2007 at 5:44 am

Scott,

By the way, I tried to provide some links for you some 14 hours ago, but the moderators seem to have prevented that comment from being displayed as it “awaits moderation.”

October 20, 2007 at 9:58 am

Hey TonyK- Our system automatically throws blog posts with three or more links into the “moderation” que - as a way of cutting down on spam. I went through and approved your message by hand just now. I also want to underscore Martin from Malaria No More’s comments a couple of posts up. Ginny

October 20, 2007 at 12:06 pm

TonyK
Thanks for the links (and Virginia for moderating the post quickly).

Like you I have no ax to grind with the Gates Foundation or Bill Gates the philanthropist. Now if you want to talk about operating systems, considering I got another BSOD just this morning on my XP SP2 laptop… that’s another issue…

I know for a fact that Gates himself visited a research site in Tanzania I worked at in the early 1990s, and note that the Gates Foundation has handled itself well when it comes to its mission - eschewing the headlines for concrete progress. I like that.

However Jeffery Sachs’s recent essay (see: http://www.sciam.com/article.cfm?chanID=sa006&colID=31&articleID=88C1FE9F-E7F2-99DF-3B5E4B2A74DC5BD1) on Malaria in Scientific American is typical of the do-gooders who have proven time and time again the aphorism that the “road to hell is paved with good intentions” when it comes to Africa. His solution is “cheap” drugs and bednets. I found that extremely naive given the fact that malarial treatment runs $1/day - and the course of treatment lasts at least 6 days. Most of the people in the area of Tanzania I worked with provided for families on $1/day - and the odds were good that someone in their family was sick with malaria at any given time.

This meant that the $1/day earned by the worker was enough to cover treatment of someone in his family, and nothing else. For an economist like Sachs to make such a basic mistake explains why his efforts in the late 1980s and early 1990s as an economic advisor to the Russian government were so disastrous. He should know better.

I am no expert, but having been back to Tanzania this past December, it’s becoming clear to me that the only way to control this disease (eradication is pie in the sky - I think it would be easier to eradicate AIDS than malaria - I’ll settle for control) is for an all out assault on it from every possible front. Vaccines. Cheap drugs. Bed nets. DDT spraying. All these things are necessary - but so is behavior modification - getting people to wear repellent, use screening, and change cultivation practices and social habits.

People allow themselves to get bitten and view it as part of daily life. We need to get them to treat mosquitoes the way the wazungu do - slathering themselves in repellent, putting screens on the windows of their dwellings, keeping their doors shut, repairing holes in nets, etc. Getting people to change how they live is tough - especially since we in the West get all squeamish about “cultural imperialism” and “imposing our values” on others. For me it’s easy. I tell them: You want your kid to die? No? Then get serious about mosquito control and bite prevention.

But I digress as usual. Thanks again for the links.
Scott Kirwin

October 20, 2007 at 12:54 pm

Thanks Virginia, for releasing the message with the links..

Scott,

I agree that eradicating HIV is a much more achievable and accessible goal relative to malaria, not that I believe that eradicating HIV is achievable in any forseeable future. I also agree with you regarding the importance of small, community level efforts. And I don’t think that it needs to be imposed imperialistically.

One thing I’ve noticed in working in Africa is that the local malaria control people are quite competent, they know their terrain and ecology very well, and have realistic ideas on what needs to get done using integrated methods. But they don’t often get listened to by people in more powerful international organizations. It is more common that the “conventional wisdom” gets imposed from the top-down and they are forced to follow suit or else not receive funding that comes with strings attached.

I noticed this in one recent trip where local entomologists expressed concerns about outdoor, early biting Anopheles mosquitoes in an area where an intensive bednet distribution effort was underway. Their concerns were ignored in the rush to push more nets into the community, despite the fact that significant malaria transmission was occurring early and outdoors before people get under their nets.

October 20, 2007 at 1:36 pm

The following is a post from Instapundit.com. Search the site for “DDT” and find more posts.

August 20, 2007
SOME KIND WORDS FOR DDT — in the New York Times, no less. “Today, indoor DDT spraying to control malaria in Africa is supported by the World Health Organization; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the United States Agency for International Development. . . . Even those mosquitoes already resistant to poisoning by DDT are repelled by it.”

The debate over DDT is over. There’s scientific consensus. Anyone who disagrees is a DDT denialist and a mouthpiece for Big Mosquito.

October 20, 2007 at 2:13 pm

The following article explains who banned the use of DDT in the USA and why they banned it. It also suggests that those who kept DDT from being used to stop the spread of malaria in Africa and other countries are guilty of contributing to the deaths of millions of people.

DAY OF RECKONING FOR DDT FOES?
Thursday , September 21, 2006
By Steven Milloy

Last week’s announcement that the World Health Organization lifted its nearly 30-year ban on the insecticide DDT is perhaps the most promising development in global public health since… well, 1943 when DDT was first used to combat insect-borne diseases like typhus and malaria.
Overlooked in all the hoopla over the announcement, however, is the terrible toll in human lives (tens of millions dead — mostly pregnant women and children under the age of 5), illness (billions sickened) and poverty (more than $1 trillion dollars in lost GDP in sub-Saharan Africa alone) caused by the tragic, decades-long ban.

Much of this human catastrophe was preventable, so why did it happen? Who is responsible? Should the individuals and activist groups who caused the DDT ban be held accountable in some way?
Rachel Carson kicked-off DDT hysteria with her pseudo-scientific 1962 book, “Silent Spring.” Carson materially misrepresented DDT science in order to advance her anti-pesticide agenda. Today she is hailed as having launched the global environmental movement. A Pennsylvania state office building, Maryland elementary school, Pittsburgh bridge and a Maryland state park are named for her. The Smithsonian Institution commemorates her work against DDT. She was even honored with a 1981 U.S. postage stamp. Next year will be the 100th anniversary of her birth. Many celebrations are being planned.
It’s quite a tribute for someone who was so dead wrong. At the very least, her name should be removed from public property and there should be no government-sponsored honors of Carson.

The Audubon Society was a leader in the attack on DDT, including falsely accusing DDT defenders (who subsequently won a libel suit) of lying. Not wanting to jeopardize its non-profit tax status, the Audubon Society formed the Environmental Defense Fund (now simply known as Environmental Defense) in 1967 to spearhead its anti-DDT efforts. Today the National Audubon Society takes in more than $100 million per year and has assets worth more than $200 million. Environmental Defense takes in more than $65 million per year with a net worth exceeding $73 million.

In a February 25, 1971, media release, the president of the Sierra Club stated that his organization wanted “a ban, not just a curb” on DDT, “even in the tropical countries where DDT has kept malaria under control.” Today the Sierra Club rakes in more than $90 million per year and has more than $50 million in assets.

Business are often held liable and forced to pay monetary damages for defective products and false statements. Why shouldn’t the National Audubon Society, Environmental Defense, Sierra Club and other anti-DDT activist groups be held liable for the harm caused by their recklessly defective activism?

It was, of course, then-Environmental Protection Agency administrator William Ruckelshaus who actually banned DDT after ignoring an EPA administrative law judge’s ruling that there was no evidence indicating that DDT posed any sort of threat to human health or the environment. Ruckleshaus never attended any of the agency’s hearings on DDT. He didn’t read the hearing transcripts and refused to explain his decision.

None of this is surprising given that, in a May 22, 1971, speech before the Wisconsin Audubon Society, Ruckleshaus said that EPA procedures had been streamlined so that DDT could be banned. Ruckleshaus was also a member of — and wrote fundraising letters for — the EDF.

The DDT ban solidified Ruckelshaus’ environmental credentials, which he has surfed to great success in business, including stints as CEO of Browning Ferris Industries and as a director of a number of other companies including Cummins Engine, Nordstrom, and Weyerhaeuser Company. Ruckelshaus currently is a principal in a Seattle, Wash., -based investment group called Madrona Venture Group.

Corporate wrongdoers — like WorldCom’s Bernie Ebbers and Tyco’s Dennis Kozlowski — were sentenced to prison for crimes against mere property. But what should the punishment be for government wrongdoers like Ruckleshaus who, apparently for the sake of his personal environmental interests, abused his power and affirmatively deprived billions of poor, helpless people of the only practical weapon against malaria?

Finally, there is the question of the World Health Organization itself. What’s the WHO been doing for all these years? There are no new facts on DDT — all the relevant science about DDT safety has been available since the 1960s. Moreover, the WHO’s strategy of mosquito bednets and malaria vaccine development has been a dismal failure. While the death toll in malarial regions has mounted, the WHO has been distracted by such dubious issues as whether cell phones and French fries cause cancer.
It’s a relief that the WHO has finally come to its senses, but on the other hand, the organization has done too little, too late. The ranks of the WHO’s leadership need to be purged of those who place the agenda of environmental elitists over the basic survival of the world’s needy.

In addition to the day of reckoning and societal rebuke that DDT-ban advocates should face, we should all learn from the DDT tragedy.

With the exception of Rachel Carson (who died in 1964), all of the groups and individuals above mentioned also promote global warming alarmism. If they and others could be so wrong about DDT, why should we trust them now? Should we really put the global economy and the welfare of billions at risk based on their track record?

Steven Milloy publishes JunkScience.com and CSRWatch.com. He is a junk science expert, an advocate of free enterprise and an adjunct scholar at the Competitive Enterprise Institute.

October 20, 2007 at 3:34 pm

So how do you propose to use DDT Louise, and what do you expect the outcome to be? Eradication of malaria?

I’ve got nothing against DDT. I work in a country that already uses it for malaria control. But to me, its just another insecticide. It’s cheaper than pyrethroids, but you need a much larger dose to get the same effect. So, all in all, it’s only a little more cost-effective.

October 20, 2007 at 6:27 pm

I believe the point being made regarding the use of DDT in the ’60’s and ’70’s BC(Before Carson) is that malaria cases were being seriously reduced in those countiries that were using it. AC(after carson) the number began to rise and and continued to do so. And other chemical pesticides were considerably more expensive to use.

Carson(postumously) and her butt-buddies(the living) should be brought up on charges of genocide - seeing as the number of deaths directly attributable to their lies regarding DDT useage caused those deaths. And I remember reading about the results of stopping the use of DDT vis malaria and other mosquito-carried diseases back in the ’80’s.

October 20, 2007 at 6:53 pm

What’s with all the DDT fanatics here?

DDT is just an insecticide. In many places, it’s no longer as efficacious as it was when they first started using due to the multiple forms of resistance that have popped up. Excito-repellency alone is not enough to prevent transmission in areas that have BRNs greater than 100.

Yes, it’s cheap, but the differential in cost per unit of active ingredient is mostly negated by the much larger amount of DDT (33-200X) required per square meter of wall surface to achieve the same killing effect as pyrethroid insecticides such as deltamethrin or lambda-cyhalothrin.

In certain areas of India, malaria cases began trending upwards even before DDT-based IRS programs were suspended (Sharma VP. 2003. DDT: the fallen angel. Curr. Sci. 85: 1532-1537.). The resurgence of the 60s might have been delayed several years if DDT had not been pulled, but it probably would have happened just the same.

October 20, 2007 at 9:01 pm

Can I simply get in here to say “WELCOME, BILL GATES, TO OUR ONE BLOG”?

I hope so. (smile)

A wonderful and lively discussion about one of the worst and totally preventable killers in our world today, malaria.

It’s important that ONE supporters are able to discuss our issues in some depth so as to meet the questions that we get when trying to sign people up to ONE with some competency.

Our knowledge about the complexities of extreme poverty and what will actually help to end it will only help us to be able to bring more people over to our movement.

Take very good care of each other, my friends. Blessings always.

ALWAYS ONE in the Spirit, debbie

October 21, 2007 at 12:55 pm

When DDT was used in Sri Lanka (formerly called Ceylon) from 1948 to 1965, malaria cases dropped from over 2,000,000 a year to 17 a year. I was in Sri Lanka in 1959 when malaria had almost been eradicated, but malaria came back when Sri Lanka stopped using DDT, because of the efforts of misquided environmental activists. I propose that we support the current (and rather late) efforts of WHO (World Health Organization) and USAID to use DDT as one of the major tools in the fight against malaria. DDT is cheap, long lasting, safe, and effective. I believe malaria can be eradicated in the majority of countries that want it eradicated enough to follow a program leading to eradication. Malaria has been eradicated in the USA and many other countries. Unfortunately there are still environmental extremists who are doing all they can to stop any use of DDT. It amazes me that such people can sit back and ignore the deaths by malaria of at least 50 MILLION people since 1970, and yet claim to be concerned that DDT may harm someone, even though there are no examples of humans dying from DDT when DDT is used for malaria control. I believe the lies Rachel Carson wrote in her “fable” should be widely exposed and the followers of her “ban DDT cult” should be held accountable for the deaths of 50 MILLION people. But I recognize that may not happen very soon, since it took over 30 years for WHO to accept the need for DDT as a tool to fight malaria.

October 21, 2007 at 1:27 pm

Louise, you continue to dodge the question of how you expect to eradicate malaria with DDT given the inevitable effects of natural selection. It is difficult to take your arguments seriously until you address this issue. Just saying something is so, doesn’t make it so.

October 21, 2007 at 1:49 pm

By the way, DDT doesn’t even work against Anopheles culicifacies (the principal vector) in Sri Lanka anymore according to this recent study:

Anopheles culicifacies sibling species B and E in Sri Lanka differ in longevity and in their susceptibility to malaria parasite infection and common insecticides. S. N. Surendran, M. S. Ramasamy, B. G. D. N. K. De Silva, R. Ramasamy Medical and Veterinary Entomology 2006 20:1 153

October 22, 2007 at 1:41 am

TonyK, I believe that DDT is one of many tools that can and should be used in the battle against malaria. In some areas DDT may be the most effective tool, in some areas other methods may be more useful. Some countries, like the USA, will eradicate malaria more quickly than others. Other countries may suffer from malaria for several generations more.

The following article discusses the value of DDT as a tool in the current fight against malaria. The author mentions that indoor DDT spraying to control malaria in Africa is supported by the World Health Organization; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the United States Agency for International Development. Do you think you know more about fighting malaria than these organizations (WHO etc) and the author, Donald Roberts?

A New Home for DDT
Donald Roberts | 20 Aug 2007
New York Times

DDT, the miracle insecticide turned environmental bogeyman, is once again playing an important role in public health. In the malaria-plagued regions of Africa, where mosquitoes are becoming resistant to other chemicals, DDT is now being used as an indoor repellent. Research that I and my colleagues recently conducted shows that DDT is the most effective pesticide for spraying on walls, because it can keep mosquitoes from even entering the room.

The news may seem surprising, as some mosquitoes worldwide are already resistant to DDT. But we’ve learned that even mosquitoes that have developed an immunity to being directly poisoned by DDT are still repelled by it.

Malaria accounts for nearly 90 percent of all deaths from vector-borne disease globally. And it is surging in Africa, surpassing AIDS as the biggest killer of African children under age 5.

From the 1940s onward, DDT was used to kill agricultural pests and disease-carrying insects because it was cheap and lasted longer than other insecticides. DDT helped much of the developed world, including the United States and Europe, eradicate malaria. Then in the 1970s, after the publication of Rachel Carson’s “Silent Spring,” which raised concern over DDT’s effects on wildlife and people, the chemical was banned in many countries. Birds, especially, were said to be vulnerable, and the chemical was blamed for reduced populations of bald eagles, falcons and pelicans. Scientific scrutiny has failed to find conclusive evidence that DDT causes cancer or other health problems in humans.

Today, indoor DDT spraying to control malaria in Africa is supported by the World Health Organization; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the United States Agency for International Development.

The remaining concern has been that the greater use of DDT in Africa would only lead mosquitoes to develop resistance to it. Decades ago, such resistance developed wherever DDT crop spraying was common. After the DDT bans went into effect in the United States and elsewhere, it continued to be used extensively for agriculture in Africa, and this exerted a powerful pressure on mosquitoes there to develop resistance. Although DDT is now prohibited for crop spraying in Africa, a few mosquito species there are still resistant to it. But DDT has other mechanisms of acting against mosquitoes beyond killing them. It also functions as a “spatial repellent,” keeping mosquitoes from entering areas where it has been sprayed, and as a “contact irritant,” making insects that come in contact with it so irritated they leave.

In our studies, in which we sprayed DDT on the walls of huts in Thailand, three out of every five test mosquitoes sensed the presence of DDT molecules and would not enter the huts. Many of those that did enter and made contact with DDT became irritated and quickly flew out.

The mosquitoes we used were the kind that carry dengue and yellow fever, not malaria. But there is ample evidence that malaria-carrying mosquitoes respond similarly to DDT. Several malaria-carrying species are even more sensitive to DDT’s repellent effects.

When we sprayed the huts with either dieldrin or alphacypermethrin, in contrast, all the test mosquitoes entered. Alphacypermethrin acted as a contact irritant, and it killed others that lingered on a treated surface. Dieldrin worked only as a poison — a powerful one, killing 92 percent of mosquitoes that made contact with it, far more than alphacypermethrin or DDT.

But dieldrin’s strong toxicity means that mosquitoes quickly develop resistance to it. Its use against malaria was short-lived, ending in the 1950s, because it so quickly became powerless.

Alphacypermethrin and others like it in the family of so-called pyrethroid insecticides are viewed as environmentally friendly, so they are used heavily in agriculture, in Africa and elsewhere. They are also used for treating bed nets and in indoor spraying programs to control malaria. But these multiple uses, combined with fact that the insecticide must make contact with the insect in order to work, have made pyrethroid resistance a large and growing problem for pest control programs in Africa.

DDT’s spatial repellency, by keeping mosquitoes from making physical contact, reduces the likelihood that the insects will develop resistance. Even those mosquitoes already resistant to poisoning by DDT are repelled by it.

It would be a mistake to think we could rely on DDT alone to fight mosquitoes in Africa. Fortunately, research aimed at developing new and better insecticides continues — thanks especially to the work of the international Innovative Vector Control Consortium. Until a suitable alternative is found, however, DDT remains the cheapest and most effective long-term malaria fighter we have.

Donald Roberts is an emeritus professor of tropical medicine at the Uniformed Services University of the Health Sciences and a board member of the nonprofit health advocacy group Africa Fighting Malaria.

http://www.nytimes.com/2007/08/20/opinion/20roberts.html?_r=1&oref=slogin

October 22, 2007 at 5:31 am

Louise,

I agree that the judicious and locally selective use of DDT would be a good thing. It is nice to have another insecticide available in the arsenal, particularly one as cost-effective as DDT. The only problem with a strategy that relies on long-term, intensive use of any insecticide is that efficacy is gradually, and sometimes suddenly lost as selection proceeds, favoring mutations and genetic structures that protect mosquitoes from the effects of a particular insecticide. Selection can also influence behavior leading to vectors biting outdoors and earlier in the evening. Excito-repellency can also induce this effect directly, causing mosquitoes to deliver more infective bites outdoors than they would otherwise have intended. Though mosquitoes may not be entering huts as much, they still participate in the transmission cycle.

Dr. Roberts article, which is for the most part accurate, nevertheless has some glaring errors in it’s logic (or phrasing?). For example: “DDTs spatial repellency, by keeping mosquitoes from making physical contact, reduces the likelihood that the insects will develop resistance.” This is misleading, maybe only because it is poorly phrased. Excitorepellency might reduce the rate in which resistance develops, but not the “likeliihood”. It remains quite likely that resistance will always develop to an insecticide and the speed at which this happens is directly correlated with the breadth and intensity of coverage with the insecticide. There are many examples in nature as well as mathematical models that support this phenomenon. If excito-repellency is so protective against resistance, how does Dr. Roberts explain the scores of mosquito species and populations that have become resistance to DDT already? Pyrethroids also induce excito-repellency, yet resistance is building against these insecticides as well.

“Do you think you know more about fighting malaria than these organizations (WHO etc) and the author, Donald Roberts?”

Dr. Roberts is an accomplished scientist and a very nice man to boot. But I am very displeased with the tactics that have become the conventional “wisdom” promoted by “these organizations.”

I may not be an emeritus professor, but I am no slouch. I have >25 years of experience in fighting vector-borne tropical diseases in Thailand, Liberia, Uganda, Ethiopia, Equatorial Guinea and Peru.

October 23, 2007 at 8:24 am

See: http://www.deanesmay.com/posts/1193075082.shtml
For a synthesis of the ideas presented here. Thanks TonyK for the education.

FYI the Wife just got back from Tanzania where she worked as a physician in the Kilimanjaro region for a month. She reports many fat, healthy babies. That’s good news.

October 23, 2007 at 6:15 pm

TonyK,
Since you’ve worked in the field of malaria control for 25 years, I’d like to ask you some questions:

1. During your 25 years of combating malaria, how many years were you allowed to use DDT?

2. Are you aware of the lies, distortions, etc in Rachel Carson’s book, Silent Spring? Dr. J. Gordon Edwards, a well-known entomologist, documented in his article, “The Lies of Rachel Carson”, some of the misstatements in Carson’s Silent Spring, the 1962 book that poisoned public opinion against DDT and other pesticides.
The entire article can be read at: http://www.21stcenturysciencetech.com/articles/summ02/Carson.html

3. Are you aware of the following DDT success story? The following is from the Center for disease control at: http://www.cdc.gov/malaria/control_prevention/vector_control.htm.
IRS (Indoor Residual Spraying) refers to applying insecticides to the interior walls of homes to control mosquitoes and reduce the spread of malaria.

“…the recent success of IRS in reducing malaria cases in South Africa by more than 80% has revived interest in this malaria prevention tool. It has also reignited the debate over whether or not DDT should have a place in malaria control. With support from the Global Fund to fight AIDS, Tuberculosis and Malaria as well as the President’s Malaria Initiative, several countries have initiated IRS programs—many using DDT in their arsenal of insecticides—for the control of malaria…

4. http://www.fightingmalaria.org has an abundance of information about malaria and DDT. In 2000 environmentalists made an effort to ban DDT worldwide, but scientists and doctors who were fighting malaria successfully stopped the environmentalists efforts to totally ban DDT. Were you involved in the effort to keep DDT from being banned worldwide?

For Africans, methods of fighting DDT during the past 25 to 30 years were like trying to fight a forest fire with a garden hose.

During 1958-1960 when I traveled in Asia, Africa, and South America, malaria wasn’t a problem. After Rachel Carson’s book of lies, and the subsequent banning of DDT, malaria cases exploded and there are now epidemics in many of the places I once traveled safely.

5. Do you think Rachel Carson’s book of lies should be exposed and her “ban DDT” followers held accountable for the 50+ million deaths in Africa that could have been prevented?

October 23, 2007 at 8:17 pm

1. Yes. In Ethiopia, where I do most of my work, DDT has been used almost continuously over the last 40 years for IRS. The few interruptions have come mainly during times of revolution and war. It has not made much of a dent in the malaria situation there and resistance, if not absolute, is certainly ubiquitous. The Ministry of Health continues to use DDT to this day, obtaining it from a state-run factory in Admai Tulu.

2. That article by J.G. Edwards, who is so well known that I have never heard of him is rather lame. He over-exaggerates a few mis-statements and imprecisions from Silent Spring, or criticizes suppositions that she made for which definitive evidence had not been available at the time of writing. What specific statements of hers from that book do you take issue with?

3. They used DDT along the border in South Africa due to pyrethroid resistance, but they’re beginning to run into problems with DDT resistance there as well (Hargreaves et al. 2003). Their success seems to have been temporary.

4. Yes, I was, in fact. I still believe that DDT should be allowed to be used for indoor residual spraying in areas where it remains effective.

5. If people like you keep trying to distract and hijack the malaria control movement in order to feed your obsessions with DDT and anti-environmentalism, we might have to hold you accountable for wasting lives that could have been saved with a more pragmatic and less ideological approach.

October 24, 2007 at 9:44 pm

Hi TonyK,
I appreciate you taking the time to answer my questions. I’ve put your answers in quotes and put my latest questions in (** *)

“Dr. Roberts is an accomplished scientist and a very nice man to boot. But I am very displeased with the tactics that have become the conventional “wisdom” promoted by “these organizations.”
(*** what are the “tactics” that displease you?)

“I may not be an emeritus professor, but I am no slouch. I have >25 years of experience in fighting vector-borne tropical diseases in Thailand, Liberia, Uganda, Ethiopia, Equatorial Guinea and Peru.”
(*** what is your educational background?)

“Yes. In Ethiopia, where I do most of my work, DDT has been used almost continuously over the last 40 years for IRS. The few interruptions have come mainly during times of revolution and war. It has not made much of a dent in the malaria situation there and resistance, if not absolute, is certainly ubiquitous. The Ministry of Health continues to use DDT to this day, obtaining it from a state-run factory in Admai Tulu.”
(***How long have you worked in Ethiopia? What do you do there? Is Ethiopia anywhere near eradicating malaria? In your first post on this thread, you seemed to feel that eradicating malaria worldwide wasn’t possible. Since malaria has been eradicated in the USA and many other countries, why are you so negative about the possibility of eventual worldwide eradication?)

“2. That article by J.G. Edwards, who is so well known that I have never heard of him is rather lame. He over-exaggerates a few mis-statements and imprecisions from Silent Spring, or criticizes suppositions that she made for which definitive evidence had not been available at the time of writing. What specific statements of hers from that book do you take issue with?”
(*** I’m guessing that you must be about 50 years old which means you were quite young when J.G. Edwards was actively campaigning against the banning of DDT, so you probably never heard of him. Unfortunately Edwards wasn’t successful in his efforts to stop the banning of DDT. I “take issue” with all the false statements that Rachel Carson used that led to the banning of DDT and the preventable deaths of millions. Read Edwards paper if you are really interested.)

“3. They used DDT along the border in South Africa due to pyrethroid resistance, but they’re beginning to run into problems with DDT resistance there as well (Hargreaves et al. 2003). Their success seems to have been temporary.”
(*** Even if their success is temporary, if your life was one of the lives saved you might be grateful)

“4. Yes, I was, in fact. I still believe that DDT should be allowed to be used for indoor residual spraying in areas where it remains effective.”
(*** I congratulate you on being one of those who stopped the effort to totally ban the use of DDT worldwide, and at least made it available for medical purposes. What do you think of those who tried to get DDT totally banned worldwide?)

“5. If people like you keep trying to distract and hijack the malaria control movement in order to feed your obsessions with DDT and anti-environmentalism, we might have to hold you accountable for wasting lives that could have been saved with a more pragmatic and less ideological approach.”
(*** I believe that it is important to expose those who got DDT banned in the USA and effectively banned in much of the rest of the world, thus causing millions of preventable deaths. I think my concerns about those who banned DDT is vindicated by the announcement that WHO, USAID, and the Sierra club now support the use of DDT as a tool in the fight against malaria.)

October 25, 2007 at 4:59 am

(*** what are the “tactics” that displease you?)

Relying on too few interventions approaches applied too universally.

(*** what is your educational background?)

B.S. in entomology, Masters in entomology, Doctorate in Tropical Public Health

(***How long have you worked in Ethiopia? What do you do there? Is Ethiopia anywhere near eradicating malaria? In your first post on this thread, you seemed to feel that eradicating malaria worldwide wasn’t possible. Since malaria has been eradicated in the USA and many other countries, why are you so negative about the possibility of eventual worldwide eradication?)

Going on 8 years now. I’ve done various kinds of activities there, from helping the Government right grants for malaria control, trying to determine ways to predict malaria epidemics, and developing new intervention methods. Ethiopia is not anywhere near eradicating malaria. In fact, things seem to be getting worse there. Malaria is appearing in highland areas like Bure, where there had previously been no transmission. I am negative about worldwide eradication because of the complexity of malaria ecology and because of the resilience of malaria vectors and parasites in the face of interventions. The US had it much easier in eradicating malaria because of the characteristics of our main vector, Anopheles quadrimaculatus, whose larval habitat is confined to the shores of ponds, lakes and rivers and has a strong tendency to feed on animals.

(*** I’m guessing that you must be about 50 years old which means you were quite young when J.G. Edwards was actively campaigning against the banning of DDT, so you probably never heard of him. Unfortunately Edwards wasn’t successful in his efforts to stop the banning of DDT. I “take issue” with all the false statements that Rachel Carson used that led to the banning of DDT and the preventable deaths of millions. Read Edwards paper if you are really interested.)

Actually, later, when I looked up Edwards’ work, I did recall hearing about him, particularly the stories of him eating a teaspoon of DDT as a demonstration of its low human toxicity.

(*** Even if their success is temporary, if your life was one of the lives saved you might be grateful)

One problem with temporary success is that people lose immunity, so rebounds can occur. So instead of dying in infancy, children die a few years later.

(*** I congratulate you on being one of those who stopped the effort to totally ban the use of DDT worldwide, and at least made it available for medical purposes. What do you think of those who tried to get DDT totally banned worldwide?)

Personally, I don’t think it would have made such a huge difference if it had been banned completely. But it would have been a waste of a tool that remains effective in many areas. I certainly would not want DDT used again in outdoor applications because its effects on certain kinds of wildlife are quite destructive. So I can sympathize with those who wanted it banned. I don’t think they realize how indoor applications have little risk of producing environmental contamination.

(*** I believe that it is important to expose those who got DDT banned in the USA and effectively banned in much of the rest of the world, thus causing millions of preventable deaths. I think my concerns about those who banned DDT is vindicated by the announcement that WHO, USAID, and the Sierra club now support the use of DDT as a tool in the fight against malaria.)

I think the potential impact of DDT on public health is exaggerated. I’m glad its available and it’s certainly useful in many places, but to me its just another insecticide. With each year that passes, it becomes less useful due to resistance. I just wish people would advocate more locale-appropriate approaches that employ a complementary array of interventions. It would help if aid organizations could listen better to local malaria control experts instead of trying to impose methodologies that may not be appropriate for certain situations.

October 26, 2007 at 12:28 am

Hi TonyK,

When I asked, “What do you think of those who tried to get DDT totally banned worldwide?, you answered:
“Personally, I don’t think it would have made such a huge difference if it had been banned completely. But it would have been a waste of a tool that remains effective in many areas. I certainly would not want DDT used again in outdoor applications because its effects on certain kinds of wildlife are quite destructive. So I can sympathize with those who wanted it banned. I don’t think they realize how indoor applications have little risk of producing environmental contamination.”

(***If it would have been a “waste of a tool that remains effective in many areas”, why wouldn’t it have made a “huge difference” if DDT had been banned completely?)
(*** How can you “sympathize with those who wanted DDT banned” because you “don’t think they realize how indoor applications have little risk of producing environmental contamination”? What kind of person actively works to totally ban DDT without doing enough research to discover DDT was very useful for indoor applications in the fight against malaria and was of little risk for environmental contamination? I would save my sympathy for the potential malaria victims that the anti-DDT types wanted to deprive of DDT.)

You wrote, “I think the potential impact of DDT on public health is exaggerated. I’m glad its available and it’s certainly useful in many places, but to me its just another insecticide. With each year that passes, it becomes less useful due to resistance. I just wish people would advocate more locale-appropriate approaches that employ a complementary array of interventions. It would help if aid organizations could listen better to local malaria control experts instead of trying to impose methodologies that may not be appropriate for certain situations.”

(*** Perhaps you are right that the potential impact of DDT on public health is exaggerated, and perhaps you are wrong. Certainly DDT was dramatically useful in reducing malaria deaths recently in South Africa. Perhaps DDT may become less useful due to resistance, but in the meantime it may save millions from death and many more millions from a terrible illness until new tools are developed for the fight against malaria.)

(***How is your work in Ethiopia funded? Is most of it funded by WHO or USAID and do they control how the funds are used? If you had the responsibility and the funds, how would you try to control malaria in Ethiopia? What would it take to eradicate malaria in Ethiopia? I read somewhere that one of the richest men in the world is an Ethiopian. Has he offered to help in the battle against malaria? Who built and paid for the DDT plant in Ethiopia? Who runs the plant? I thought I read somewhere that currently only India and China had working DDT plants. Does Ethiopia sell DDT to other African countries? I gather you aren’t in Ethiopia now. How much of your time do you spend there? Has the civil termoil in Ethiopia made it impossible to have a consistant attack against malaria? It seems like irregular use of DDT would develope DDT resistent mosquitoes. What do you think Bill Gates could do that would help the most in the fight against malaria? I looked at a world map yesterday that showed the areas of the world most affected by malaria. Africa is certainly the major battlefield, but so many other countries that were safe in 1958 to 1960 are no longer safe. If you don’t think the US ban on DDT is responsible for the current malaria epidemics, what do you think is responsible?)

Before DDT was banned in the USA, and the use of DDT effectively banned in most of the rest of the world, malaria was eradicated in the USA and many other nations. After DDT was banned has any other country in the world been able to eradicate malaria? What do you think are the most important things that need to happen in order to eradicate malaria in all the countries that would be willing to do whatever is necessary to accomplish such a goal?

If the USA had NOT eradicated malaria before DDT was banned, how long do you think DDT would have stayed banned?

October 26, 2007 at 1:40 am

Hi TonyK,
I just finished rereading previous posts and wondered how many of the following suggestions for fighting malaria (suggestion made in your Oct 19 post) you were able to implement in Ethiopia. You wrote that, “None of these sorts of things are currently being done anywhere despite the fact that they are sustainable by empowering those most at risk of acquiring malaria.”, so it sounds like you weren’t able to implement any of the suggested actions in Ethiopia. Is that true? If so, why? Does Ethiopia need a different set of actions?

1. Targeted focal manipulation or elimination of larval breeding sites with simple hand tools
2. Make modest enhancements to home construction that render homes refractory to mosquito entry
3. Promote stabilized earth methods of construction that are compatible with local construction methods, but reduce the need for replastering, thus reducing the production of borrow pits that are the most productive breeding sites for malaria vectors.
4. Space the planting of maize fields in relation to other crops such that the maize pollen does not nourish larval anophelines producing more, larger and longer-lived female mosquitoes.
5. Use low cost repellents to enhance the efficacy of bednets by driving more mosquitoes to insecticide treated surfaces while protecting people from bites that would occur outdoors or earlier in the evening when they are not under the protection of nets.

October 26, 2007 at 5:56 am

I’m just a bit player. I don’t have much influence over what gets done in Ethiopia or anywhere else. I work on the basis of small research grants from various organizations, usually as a member of a team led by another principal investigator. My latest project on repellents is being funded by a tiny non-profit foundation in collaboration with private industry. I’m also involved in several small projects in West Africa.

It’s not that Ethiopia needs a “different” set of actions as much as it needs an “integrated” set of complementary actions. For one thing, bednet utilization rates after distribution is very poor, despite IEC, thus they won’t get the kind of morbidity reductions they seek unless they combine bednets with other measures.

IRS in Ethiopia is targeted in particular against transmission in high risk areas, to prevent epidemics. However, there are some places where Anopheles pharoensis maintains transmission cycles outdoors (such as near Lake Ziway and other parts of the Rift Valley). Thus, outdoor biting mosquitoes are not affected by either IRS or bednets.

I also worry about resistance because, although people rarely measure it, whenever they do, they find it to be rather intensive.

I wouldn’t have missed DDT that much if it had been banned completely because there are alternative insecticides that cost a little more but work almost as well. Deltamethrin, for example, needs to be applied in many places only on an annual basis.

I believe that the DDT plant in Admai Tulu is run by the government, similarly to some other state-run industries including a sugar plant near Wonjji. They had been getting their DDT from China previously, but their local DDT production came on line in 2001.

October 26, 2007 at 11:21 pm

Hi TonyK,
You wrote,
“It’s not that Ethiopia needs a “different” set of actions as much as it needs an “integrated” set of complementary actions. For one thing, bednet utilization rates after distribution is very poor, despite IEC, thus they won’t get the kind of morbidity reductions they seek unless they combine bednets with other measures.”
(***Do groups fighting malaria have a website where they can discuss improvements to the process of fighting malaria? Do they rotate the insecticides they use to spray interiors of homes to keep the mosquitoes from building up resistence? I’m NOT surprised that bednet utilization rates are very poor, and yet bednets seem to have been the primary tool of choice for many groups. I hope you, and other people with extensive experience, will send suggestions to Bill Gates to help his program develope more “integrated” and effective actions.)

“IRS in Ethiopia is targeted in particular against transmission in high risk areas, to prevent epidemics. However, there are some places where Anopheles pharoensis maintains transmission cycles outdoors (such as near Lake Ziway and other parts of the Rift Valley). Thus, outdoor biting mosquitoes are not affected by either IRS or bednets.”
(***Is there nothing they can do about the outdoor biting mosquitoes? They can’t drain the lake. Can they spray with non-DDT insecticides? )

(*** I asked you the following question in a previous post, but you didn’t answer. I’m still interested in knowing your answer to this question:
If the USA had NOT eradicated malaria before DDT was banned, how long do you think DDT would have stayed banned?)

October 27, 2007 at 9:56 am

(***Do groups fighting malaria have a website where they can discuss improvements to the process of fighting malaria? Do they rotate the insecticides they use to spray interiors of homes to keep the mosquitoes from building up resistence? I’m NOT surprised that bednet utilization rates are very poor, and yet bednets seem to have been the primary tool of choice for many groups. I hope you, and other people with extensive experience, will send suggestions to Bill Gates to help his program develope more “integrated” and effective actions.)

I don’t know of any such web-site. The Columbia Earth Institute hosts a site that is supposed to allow malaria program managers in different African countries to communicate with each other but it seems quite empty when I’ve visited it. This exchange is the first time I’ve ever attempted to communicate about malaria control on-line.

Rotation does occur in some places, but not yet in Ethiopia. There are places in West Africa where I’ve worked where they have switched from deltamethrin to bendiocarb. They have been waiting several years for the deltamethrin-resistance to wane, but so say it shows no signs of fading. The advantage of deltamethrin, like DDT is that you only have to spray once a year. Bendiocarb is more hazardous to applicators and requires 2 sprayings per year (at least).

Another problem I see in the educational system, is the lack of support for field-based epidemiology. Former Departments of Tropical Public Health are being shut down and absorbed into departments with a high tech, basic research focus aimed at long-term, perhaps unreachable goals. I fear that a goal of eradication will only encourage more of this “taking the eye off the ball.” More resources will be diverted to high-risk, low return research that will drain the coffers of those who would do something for malaria victims now.

(***Is there nothing they can do about the outdoor biting mosquitoes? They can’t drain the lake. Can they spray with non-DDT insecticides? )

Larval spraying can work if it’s done carefully but it can be tricky. Incomplete killls can paradoxically create larger, long-lived mosquitoes by reducing competition in a larval habitat. By releasing competition in overpopulated habitats, they can even allow more mosquitoes to develop into adults than if you had never sprayed at all. Outdoor chemicals are also fully exposed to the elements and sunlight so they break down quickly. Microbial larvicides like bti are more persistent, but expensive.

Habitat modification can be effective. THe conventional wisdom states that there is water, water everywhere and you can’t remove all habitats, except maybe in urban areas. Anyone who has walked through an African village after rainy season however can see that only a small proportion of surface water collections (aka puddles) harbor anophelines, and even some of those are not suitable for development to adulthood due to instability or nutritional deficits. The bottomline is, environmental management can be very effective if it is carefully targeted on habitats most likely to support mosquito development.

(*** I asked you the following question in a previous post, but you didn’t answer. I’m still interested in knowing your answer to this question:
If the USA had NOT eradicated malaria before DDT was banned, how long do you think DDT would have stayed banned?

I’m not sure. I suppose that DDT might have been allowed, in that case, for indoor use. I certainly would have supported such an application.

October 27, 2007 at 1:12 pm

Hi TonyK,
I found the following article at http://www.fightingmalaria.org. Have you check out the site? The article contains this comment, “The powerful insecticide (DDT) was decommissioned 30 years ago because of environmental fears but recent reports by specialists have found the risks to be exaggerated.” My comment: It didn’t take specialists 30 years to find the risks to be “exaggerated”. That information was available 30 years ago, it took them 30 years to accept that the risks were exaggerated and that their anti-DDT religion was a false religion. “Environmental Defense”, a group that takes credit at their website for the DDT ban in the USA, still hasn’t acknowledged that DDT risks were exaggerated, because they were involved in exaggerating the risks.

West Africa: New Approach to Malaria Recommended
UN Integrated Regional Information Networks | October 24, 2007

A World Health Organization evaluation of West African countries’ progress in controlling malaria has recommended that donors allocate more funds to indoor spraying and to helping countries purchase the latest anti-malarial drugs.

“For the control of malaria vectors, we had previously recommended the use of mosquito nets,” said Stephan Tohon, WHO focal point on malaria in West Africa, speaking to IRIN on the sidelines of the UN agency’s malaria evaluation meeting in the Burkina Faso capital Ouagadougou.

“But today the experience of some countries in southern Africa with indoor house spraying - containing the once-banned insecticide DDT - has yielded positive results. This is very important to beat malaria and it is going to contribute to controlling mosquitoes not only in bedrooms, but in houses and verandas,” Tohon explained.

International donors to date have mostly focused on providing insecticide-treated bed nets. According to a report from the UN Children’s Fund (UNICEF) released on 17 October, annual production and distribution of nets more than doubled between 2004 and 2006.

According to WHO officials DDT is effective because it stays for a long time on the walls and kills mosquitoes efficiently. The powerful insecticide was decommissioned 30 years ago because of environmental fears but recent reports by specialists have found the risks to be exaggerated.

October 27, 2007 at 2:44 pm

Hi TonyK,

I believe that Environmental Defense needs to update their website with the following information:

(the quote below is from “WHO gives indoor use of DDT a clean bill of health for controlling malaria”, published Sept 15, 2006)

“…Views about the use of insecticides for indoor protection from malaria have been changing in recent years. Environmental Defense, which launched the anti-DDT campaign in the 1960s, now endorses the indoor use of DDT for malaria control, as does the Sierra Club and the Endangered Wildlife Trust. The recently-launched President’s Malaria Initiative (PMI) announced last year that it would also fund DDT spraying on the inside walls of households to prevent the disease…”

NOTE: In Oct. 2007, Environmental Defense still brags on their website that they got DDT banned, but about a year earlier, in Sept. 2006, Environmental Defense endorsed the indoor use of DDT for malaria control. I guess they now believe that DDT isn’t as bad as they claimed it was when they got DDT banned, but they aren’t willing to openly acknowledge on their website that they goofed. Maybe they are embarrassed that by getting DDT banned, they contributed to the malaria caused deaths of over 50,000,000 people during the past 30 + years. Maybe they are worried that some of their regular donors will quit donating money to them, because of Environmental Defense’s key role in getting DDT banned.

The entire WHO article quoted from above is at:
http://www.who.int/mediacentre/news/releases/2006/pr50/en/

Environmental Defense says the following about DDT at http://www.environmentaldefense.org/documents/2978_FactSheet_aboutus.pdf

“DDT BANNED. In 1967, a small group of scientists provided
scientific evidence that the pesticide DDT was harming
wildlife. Later they found DDT was tainting human mother’s
milk. They formed Environmental Defense and won a
nationwide ban on the pesticide, allowing bald eagles,
ospreys and other magnificent birds to rebound.”

AMAZING: In 1967 Environmental Defense claims that, “…DDT was tainting human mother’s milk…”, but in 2006 they, “…endorse the indoor use of DDT for malaria control…” Do you find this rather strange? If DDT was “tainting human mother’s milk”, why would they endorse the indoor use of DDT?

November 4, 2007 at 12:07 am

Some concerns about malaria eradication are found at the following site:

http://www.fightingmalaria.org/research.aspx?id=935

November 8, 2007 at 8:06 am

Hello Everyone,

This is a very interesting discussion related to malaria and thanks for the useful information.

One view of this issue hasn’t come up yet in this discussion (if I’ve read it carefully).
This is the larger issue of single focus health programs and the effects these “vertical” programs continue to have on health services in Africa. True, It is easier to get the donors and media excited about eradicating malaria, stopping TB or fighting HIV/AIDS. It is much harder to get them excited about an approach to health that helps people to be educated about how they can protect themselves from all preventable disease, the importance of clean water, maternal health services and effective management and leadership in the health sector - essentially an approach with the objective of health people and healthy families as the outcome.

I lived in East Africa for 13 years and have worked in Africa for 25 years. The “flavor of the month” single focused health approach has undermined an over all health and education approach with healthy people and health communities as the outcome. The over all primary health system in many countries in Africa are now dysfunctional. A lot of work is needed to get community health and family health back on track.

November 9, 2007 at 9:24 am

I agree that there are some very general, community-based aspects to health promotion that don’t get the attention that they deserve because they’re not as flashy as the “Big 3″. I don’t think it helps to set unrealistic, diversionary goals like “malaria eradication” that overemphasize long-term, high risk, low odds of success, “magic bullet” solutions.

However, with regard to how the “Big 3″ diseases are handled by international agencies, I think that the pendulum has already swung hard towards horizontal, clinical and community-based approaches. It certainly dominates the thinking and actions of WHO and many NGOs. Global Fund applications, for example, require that applicants describe explicitly how their proposal will benefit the general health system, and the degree to which this happens seems to weigh heavily in the the success of the proposal during review.

I would, however, ask for caution in not allowing the pendulum to to become stuck entirely on the “horizontal” side. Malaria (and other vector-borne diseases) are diseases of landscapes, requiring ecological expertise that cannot be expected to be mastered by those who have only clinical training. Good clinics are important, but there is only so much that can be done in those settings. I have spoken with many African clinicians who are well-versed in patient management, but whose knowledge of malaria vector ecology is comparatively absent. For example, one MD in Uganda insisted that malaria vectors derive from the water that collects in the axils of maize plants.

It is getting very difficult in certain countries to find young technicians and scientists who have training in the field aspects of malaria control, because it is deemed too specialized or “vertical”.

Community health and general clinical strengthening should be built into any activity that contains “vertical elements”. But to shift everything into the “horizontal” end of the spectrum, is just as dangerous as going completely “vertical”. We need to be aware of the natural human tendency to overcompensate for imbalances that end up creating a different imbalance.

November 15, 2007 at 12:48 pm

Bill Jobin
Blue Nile Associates

After 40 years working on control of tropical diseases in Africa and elsewhere, my concern for the Bill and Melinda Gates Foundation is that they are chasing the chimera of a malaria vaccine in hopes of the unattainable goal of eradication, to the neglect of reality in Africa. What is needed in Africa is a long-term field effort using all available methods to go after modest and sustainable reductions in transmission. That approach will save lives tomorrow, and can be sustained.

MInd you, eradication in the subtropics might be possible, as it was in the southern US, in Italy and in a few small islands. The anophelines in these subtropical regions have a lot against them from the beginning. But eradication in Africa - the perfect place for anophelines and for malaria transmission - is such a monumental and naive goal, it doesn’t deserve consideration by public health people.

Reports on malaria transmission worldwide show that is has increased since the great interest began in recent years. I think this is because of the refocus if global resources on research for a vaccine. About 1980 I attended one of the first debates on the possibilitiy of a malaria vaccine, given at the annual meeting of the ASTMH. Since that time only partially effective and cumbersome vaccines have been developed. Our efforts during those 27 years could better have been used on practical methods sustainable in Africa, in countries where government instability, wars, droughts and famines continually upset the applecart.

I would hope the global foundations, WHO and others interested in controlling malaria in Africa will adopt modest goals of slowly reducing transmission by patient and careful field work, rather than by pursuing the shiny attraction of vaccine research on a method which is unlikely to be successful against a disease with such a complicated transmission cycle..

June 11, 2008 at 10:37 am

(-_-#)

June 20, 2008 at 1:43 pm

(+_+)

July 7, 2008 at 12:58 am

(O,o)

July 13, 2008 at 1:13 am

()

July 13, 2008 at 12:43 pm

*^_^*

July 16, 2008 at 3:00 am

(-_-+)

July 20, 2008 at 7:38 am

(^_^)

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