Holding the line in battle against malaria

Richard Tren & Donald Roberts | 26 Apr 2023
Business Day (South Africa) Raising global awareness for public health problems is never easy, especially during periods of financial crisis. Yesterday, the United Nations, donor agencies and their affiliates marked World Malaria Day. However, the fact that most South Africans are ignorant of this day is not something to be lamented. It is a precisely because of SA's sound, evidence-based public health policies that malaria poses a minimal threat to South Africans.

However, environmental activism puts these policies at risk.
Malaria control in SA has been so effective that the government now has elimination in sight. Along with insecticides such as DDT, investment in health systems allows public health professionals to treat malaria cases effectively and to monitor outbreaks.

Two key elements to the success of malaria control in SA have been consistent and adequate funding from the national fiscus, and the strong domestic science base that shapes policy.

Since the government has funded its own malaria programme, it has not been forced to comply with the demands of foreign aid donors. As a consequence, it has set policies as determined by its own scientists. SA has funded interventions such as indoor residual spraying (IRS) with DDT, when most donors balked at any insecticide spraying.

Consistently demonstrating that its policies are sound, safe and deliver impressive results has not kept SA's programme out of activists' cross hairs. Recently, some scientists have gone public with claims against DDT as a cause of birth defects in boys. The fact that DDT was used in wealthy western countries for decades without ever causing birth defects is ignored.

Several US-based environmental groups lobby against public health insecticides and shamelessly promote research papers that suggest harm from insecticides while ignoring many other studies that refute or disprove their claims.

Environmental activists propose alternative, noninsecticidal methods of malaria control that are exceptionally naive and often severely lacking in evidence of efficacy. But then their motivation is to halt any insecticide use, not to control malaria. Whether these activists are motivated by a belief that public health insecticides are harmful or by the corporate interests of their sponsors in the profitable organic food industry, their actions harm malaria control and cost lives.

Luckily, the government is not alone in implementing malaria control policies based on sound science. The US government changed policies on insecticide use and now the President's Malaria Initiative (PMI) has been funding malaria control in 15 countries that relies on effective vector control , good treatment and diagnosis, and building local expertise and institutional capacity. Despite this, the PMI has also been targeted with harsh criticism from extremists such as the Pesticide Action Network (PAN).

The government and those truly interested in ridding the world of malaria have a tough task in defending the small arsenal of effective and safe insecticides. They also have to encourage companies to develop new insecticides, as resistance to the current suite of newer chemicals is already spreading and will only worsen. With little profit incentive in this small, specialised market, any whiff of organised activist pressure will scare off companies and potential investors.

If PAN and other insecticide fear- mongers get their way, malaria could well spread again in SA. Perhaps then World Malaria Day will mean something; until then, let's be grateful the government is holding the line on DDT and evidence-based malaria control.

https://www.businessday.co.za/articles/Content.aspx?id=107205