April 25 is World Malaria Day. It is a day for everyone to learn more about this devastating disease, which has plagued humankind since the beginning of recorded history and continues to be a significant threat to over half the world’s population in 109 countries across the globe. Despite the fact that malaria is both preventable and curable, every year it kills almost 1 million people – mainly women and children in sub-Saharan Africa. It is a major cause of anaemia, low birth weight, premature birth, infant mortality and maternal deaths.
The World Health Organisation (WHO) estimates that malaria claims a child’s life every thirty seconds and those who survive an episode of severe malaria are likely to suffer from learning impairment or brain damage. Often forgotten in the myriad statistics on cases and deaths is the psychological impact on families of the loss of a loved one or the long-term commitment of having to care for someone who has been brain damaged by this awful disease.
Most people in this world will never experience the debilitating effects of malaria, thanks mainly to the eradication campaign adopted at the eighth annual World Health Assembly meeting in 1955. Although the campaign was eventually abandoned and considered a failure, it registered resounding successes in wiping out malaria from large regions of the globe. The successful application of an insecticide commonly referred to as DDT on the inside walls of houses, coupled with the effectiveness of antimalarial treatments such as chloroquine formed the cornerstones of the programme. However, Africa was largely overlooked in the ‘global’ eradication effort because the continent lacked the necessary infrastructure to conduct a successful campaign.
Today, African nations do have the tools to control the disease. Although chloroquine has now been rendered completely useless, there are new, highly effective anti-malarial treatments called artemisinin based combination therapies. DDT remains the most cost effective insecticide, but despite the remarkable results of malaria control programmes across the globe, a great deal of misinformation surrounds its use for public health. Much of this misinformation stems from the roots of the environmental movement sparked by Rachel Carson’s book, The Silent Spring. Carson raised the suspicion that DDT was responsible for the decline of some bird species in the United States. After careful scientific analysis, it was revealed that the decline in bird populations was due to changing land uses which destroyed their natural habitats, as well as increased poaching and the sport of falconry.
In fact, DDT has a remarkably safe track record. Millions of people have been coming into direct contact with the chemical over many years, and, although certain researchers have asserted that DDT is harmful to human health, after voluminous research, the evidence of harm they presented does not comply with the most basic epidemiologic criteria established to prove cause and effect and remains exceedingly weak. The WHO and the Endangered Wildlife Trust endorse the limited and restricted use of small quantities of DDT for malaria vector control, but some politicians and environmentalists are determined to eliminate it. To flatly deny the use of something as highly effective as DDT which has made it possible for a countless number of individuals to live and prosper because of unproven, hypothetical risks is irresponsible.
When used for malaria control programmes, a tiny amount of DDT is sprayed on the inside walls of houses. This protects the occupants of the house for up to one year from the deadly bite of the malaria spreading mosquitoes. When combined with effective antimalarial treatments, successful malaria vector control strategies provide the one-two punch necessary to knock out the disease. This sounds simple enough, but the obstacles to a successful control programme today are similar to those that existed during the eradication campaign of 1955 — weak infrastructure, bureaucratic hurdles and the stark reality of millions of poor individuals who can barely sustain themselves, let alone spend money on personal measures to control and treat the disease.
History demonstrates that countries that developed and grew wealthy, eradicated malaria most rapidly and, subsequently, have kept it at bay. From the late 1800s, malaria declined in most of Europe and the US because mosquito-breeding areas were drained for farmland. People could afford better housing with windows, screens and shutters, all of this happened before anyone realised that mosquitoes transmitted the disease.
If the required economic development does not take place in targeted countries and no domestic commitment to a sustainable control programme is made, it is difficult to envision how the problem will be solved. There is a long, hard road to travel and, today, in Sub-Saharan Africa, it looks as if the successful implementation of an eradication programme will have more to do with politics and economics than with specific technologies.
World Malaria Day provides the opportunity to raise the profile of the disease and the search for what works in its control. DDT is certainly not a magic bullet, but when used in the appropriate settings and according to the strict guidelines as set out by the WHO, it is a highly effective malaria control intervention. Malaria control programmes and malaria scientists should be able to choose to use DDT. Effective control of this dreadful disease demands that strong political support is given to malaria control managers and malaria scientists. Above all, malaria control policies must be guided by scientific evidence and it is incumbent on leaders to ensure that political considerations do not trump science.
Author: Jasson Urbach is a director of the Health Policy Unit and of Africa Fighting Malaria. This article may be republished without prior consent but with acknowledgement to the authors. The views expressed in the article are the authors’.
Note: Africa Fighting Malaria will be launching its book The Excellent Powder: DDT’s Political and Scientific History on 28 April at Sandton Sun, Johannesburg from 09:00 until 10:30. If you would like to attend please RSVP by April 16 to firstname.lastname@example.org or phone (031) 206 1416
HPU Feature Article / 16 April 2010