THIS week, the Southern African Development Community commemorates malaria week and, coincidentally, the US congress is debating appropriations for malaria control to be spent by the US Agency for International Development (USAID). Unless congress insists on wide-ranging changes to the way malaria control is conducted, most of the money appropriated will be wasted and Africans will continue to mourn their children, mothers and fathers for years to come.
USAID has become a magnate of malaria control by virtue of its deep pockets — but has little to show for the millions it spends. According to the World Health Organisation's Roll Back Malaria Partnership (RBM), malaria in Africa has increased or remained the same since 1998. Malaria has risen sharply in several African countries despite endless technical advice from USAID, RBM and other donors.
This is because these organisations single-mindedly focus on mosquito nets as a prevention strategy. USAID claimed, for example, that the distribution of insecticide-impregnated mosquito nets in Togo and Zambia effectively protected 90% of the recipient population (a few thousand children). This figure is a product of many convenient assumptions: that people stay under the nets from dusk until dawn; that nets are never torn or misused; that the nets are annually re-impregnated with insecticide by their owners, etc. However, only one net per household was given and USAID admits (in a footnote) that only 56% of those were being used.
Mosquito nets alone are insufficient. DDT, a chemical insecticide which kills mosquitoes, was used to eradicate malaria from the US and western Europe by the mid-20th century, saving untold numbers of human lives. In 1971, the US banned DDT based largely on unsound science and scaremongering. Largely for this reason, DDT is absent from USAID control strategies despite its proven success. Where DDT was used in Zambia to target malarial mosquitoes, reported cases of the disease plummeted 75% in two years. In SA, DDT was removed from national malaria control strategies in 1996 to appease environmental interest groups. Cases had increased tenfold by 2000, when the government promptly reintroduced the chemical and watched the malaria burden drop nearly 80%.
Yet DDT continues to be demonised. Its use in public health programmes is limited to spraying tiny amounts of the chemical inside houses — not aerial spraying of agricultural fields as opponents would have you believe. Spraying it on the inside walls once a year is sufficient not only to destroy mosquitoes coming into contact with the chemical, but also to stop mosquitoes from entering the house. Moreover, DDT has not been linked to a single case of human cancer in five decades of use. Perhaps DDT's adversaries would relent if they, like many African children, were bitten every night by deadly insects.
DDT remains the cheapest and most effective means of combating malaria. The US has the money to buy DDT and the political might to rebrand its image. This is why a coalition of public health experts and political leaders has signed a declaration to "Kill Malarial Mosquitoes NOW!", demanding that 66% of the house foreign appropriations funding for malaria control be used to buy DDT. The declaration is being actively circulated, and has so far been signed by Archbishop Desmond Tutu, a former US Navy surgeon general, the Congress of Racial Equality chairman, a cofounder of Greenpeace and the Association of American Physicians and Surgeons president among others.
If the coalition has its way and USAID reforms itself, many lives will be saved. The fact is Africa desperately needs DDT. USAID should buy it.
Coticelli is a researcher and Tren is a director of the health advocacy group Africa Fighting Malaria.
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