1.0               Introduction:  WHO  liberalises DDT use in Africa.

 

1.1              After years of uncertainty about the fate of DDT use in Malaria control, the statement on 22/06/06 by the WHO liberalizing the use of DDT in Africa has taken the world, certainly Africa, by surprise. The statement “calls upon countries (in the African Region) to build or strengthen relevant capacities to plan,  implement, monitor and evaluate appropriate Malaria  vector interventions, including IRS with DDT” 1

 

1.2            It will be recalled that since the USA banned the Agricultural use of DDT in 1972 2 and the Stockholm convention placed DDT among the dirty 12 persistent organic pollutants, 3 the use of DDT in Malaria Control has been controversial and uncertain. Countries like South Africa which could fund it beneficially used DDT at their own expense 4, Donor agencies like the USAID, DFID refused to give support to poor countries which insisted on DDT use 5. It is worth noting however that the WHO had never banned the use of DDT in Malaria control and indeed praised the South African Malaria control policy which involved Indoor Residual Spraying of DDT 6. The New Director of the WHO Global Malaria Control Programme, Dr. Araka Kochi, deserves to be congratulated by all who care about the lives of Black Africans who are the worse victims of Malaria illness today.

 

 

2.0               Incidence of Malaria

 

2.1             It is often recited without much thought that 1.5-2.7 million people die of Malaria annually 7, that 90% of these deaths occur   in tropical Africa and that most of the deaths occur among women and children (as if these were disposable commodities)  and that 60% of clinic attendances in Nigeria is due to Malaria.

 

2.2             Malaria was endemic throughout much of Europe, Asia and Africa as early as historians could trace 8. Though there were mosquitoes in the Americas, malaria was introduced there by African slaves and their slavers, there having been no record of Malaria in the “Medical Books” of the Mayans and Aztecs before then 9. So up to 1951, Malaria was endemic in parts of every continent of the World. But in 1952, the USA declared itself Malaria free! 8

 

3.0             The first (American) Malaria Eradication Effort

 

3.1            This declaration was possible because shortly after World War II, between 1947 and 1952, the USA decided to eradicate Malaria from its territory by sheer determination backed by enough money to fight mosquitoes with DDT and treat Malaria with chloroquine 8. The need to eradicate Malaria was paramount because the USA appreciated the devastating effects of Malaria on its military personnel during its Civil War and the debilitating effects of Malaria on its work force and economy. In the 18th century a major Malaria epidemic had spread as far North as Montreal in temperate Canada.8

 

 

3.2            The American determination to eradicate Malaria was a product of its genuine concern for the welfare of its people and not pay lip service to matters that affect its strategic interests, matters that affect the lives of its citizens and its economy. The rapidity with which the USA converted the discovery of the insecticidal properties of DDT by Dr Paul Muller of Switzerland in 1939 to its beneficial use, first to rid its soldiers  of Typhus in Italy in 1944 10 and  then Malaria eradication from its territory between 1947 to 1952, bears witness to this view.

 

 

4.0                    The Second (WHO) Malaria Eradication Effort

 

4.1            The USA experiment to eradicate Malaria was so successful that the WHO decided to copy the method. In 1955, the WHO declared an Eight-year Global Malaria Eradication Campaign8 that saved 500 million human lives that would otherwise have been lost due to Malaria 10. DDT was praised in superlative terms by the American National Academy of Science 3 and declared a miracle pesticide2. But its very success was to become its doom. Such saving of so many lives in such a short time in the developing countries became a problem to the Malthusians 12. Whereas DDT was beneficially used in parts of Europe, Asia and Latin America where Malaria was endemic, only three Sub Saharan African countries were selected for the purpose 11. Clearly the vast majority of the 500 million lives saved were not   Africans. This discriminatory use of DDT explains why 90% of   all Malaria illness in the World now occurs in Black Africa.

 

5.0            The fight against DDT use.

 

5.1            The declaration of the ban on the use of DDT  in America in 1972 2, twenty years after America was declared Malaria free, was clearly due to its Agricultural use which was responsible for the depopulation of birds which in turn inspired the writing of the then popular book, Silent Spring by Rachel Carson in 1962 13. The importance of this book is that it gave birth to the environmental groups13 who joined forces with the Malthusians to fight against the use of DDT and created unprecedented menticide of generations of people against DDT use to this day 12. Black Africans in Africa who oppose DDT use are clearly victims of this menticide.

 

 

5.2           The environmentalist groups gradually took over control of the WHO Global Malaria Programme and created the Panel of Experts on Environmental Management, PEEM 3. PEEM gradually but progressively changed the WHO Vector Biology Control policy which favoured Malaria Eradication by moving Malaria control to the Primary Health Care System3 which favoured Malaria treatment over Eradication. Environmental Care thus became more important than public Health, malaria treatment became more important than Malaria Eradication and the yardstick for measuring success was changed from incidence of Malaria illness to incidence of deaths due to Malaria. All this was in spite of the well known Public Health Axiom that Prevention is better than cure. This is the genesis of Roll Back Malaria Initiative which was created by a partnership of WHO, World Bank, UNEP, and UNICEF in 1998 14. This policy was adopted wholesale and helplessly by African countries at its conference in Abuja in April 2000. Over the years, Africa had been treating Malaria with herbs, herbal steam baths and other methods and the fittest survived. No efforts were made to Eradicate Malaria. Roll Back Malaria favours treatment over eradication so we must go back to where we were, to our roots, not make progress!

 

 

5.3              A look at the Newspaper summary15 of the 2007 budget of the Federal Ministry of Health vindicates this point absolutely. The budget provides funds for the purchase of new antimalaria drugs and Insecticidal Treated Bed Nets, not a kobo for larvicidal or other methods of eradication. Yet it is generally known that the ITNs provided are not being widely used and their use is not enforceable. Are we paying lip service to Malaria control? Are we not determined like the Americans to fight malaria? Are we merely interested in the business of Malaria control? Spending 60% of the National Health Insurance Funds on Malaria alone? Recurrently?

 

6.0              Third (African) Malaria Eradication Effort.

 

6.1              As of today, ten African countries, mainly in East and South Africa and adjacent Central Africa, are using IRS with DDT in an attempt to eradicate Malaria from their territory. Politically stable North Africa is largely free from Malaria. Only West Africa and adjacent Central Africa are not using DDT Indoor Residual Spraying. The pyrethroid insecticides being used to treat bed nets are up to twenty times dearer than DDT. So we waste our scarce resources voluntarily whereas India had to be compelled to do so in 1997 3

 

 

6.2              Malaria Eradication or its reduction to insignificance in Africa is possible. What is lacking is determination, not even funding. With the creation of the Suez Canal, Africa is merely an island, albeit a Giant Island. Unless West Africa and adjacent Central Africa also use cheap, safe, tested, sustainable DDT to fight Malaria, it will constitute itself into a breeding ground for reinfesting the rest of Africa and the World as it did to the Americas. With all the available experience at our disposal, endless experimentation at Local Government or State level is merely cutting corners.

 

 

6.3                      Funding

 

               As mentioned earlier, Funding problems are surmountable. The DFID assured me in writing that once the policy decision to use DDT is made and the WHO agrees, as it has now done, it will donate funds16. I believe that other donor agencies will do the same. Indeed the Millennium Development Goals demand their cooperation. Further, I believe that the environmentalists will come round to support IRS with DDT once agricultural use can be controlled. Besides, it is in the interest of Europeans and Americans to rid Africa of Malaria. REID, et al 7 report that many English visitors to Tropical Africa return home to suffer from kidney complications, die or be treated at great costs. Africa is the continent of the future and the world cannot do without Africa.

 

6.4                              At the country level, it will be a sad day for Africa if Nigeria with its size and influence refuses to use DDT when others do so. Nigeria cannot be isolated from the rest of Africa.

 

 

7.0            Prescription for success of the Africa Malaria Eradication Effort

 

7.1          True friends of Africa and the Scientific Community are invited to sincerely fight Malaria here on this planet as they find their way to Mars. The fear of population growth should not deter them. Let Africa use the same methods of population control as the rest of the World.

 

 

7.2        The United Nations must go further to make the use of DDT in Malaria control an African Union policy 17 and not leave it to the financial constraints or whims and caprices of each country. African Malaria eradication programme needs to be centrally funded and organized just as the WHO World Eradication Campaign was. African Malaria eradication success will lead to World Eradication success as envisaged in 1955.

 

 

                  Appreciation

 

                  Lastly, Africa owes a debt of gratitude to all individuals and groups who have campaigned ceaselessly for the return of DDT use in Malaria Control.  Africa congratulates Dr. Araka Kochi for his humanity and sensitivity to the efforts and pleas of all these people.

 

 

                 I thank you

 

 

                References

 

1.                 Final statement on the use of DDT for Indoor Residual spraying in the African Region. 22/6/2006, Brazzaville, Republic of Congo

 

2.                 US Environmental Protection Agency, DDT Ban Takes Effect. Press Release 31/12/1972

 

 

3.                 Roberts Donald R, DDT and Malaria Control, Past, Present and Future. 21st Century Science and Technology Magazine 2002,

            21st Centurysciencetech.com/articles/Fall02/DDT.html

 

4.                 Tren, Richard; Bate, Roger: South Africa’s War Against Malaria, Lessons for the developing world. Policy Analysis No. 513. 25/3/2004.  Cato Institute, www.cato.org.

 

5.                 Bate Roger, How Good Intentions Kill. Banning the use of DDT would cost lives and wealth in the developing world. Africa fighting malaria 8/12/00; South Africa, http://www,malaria.org/bateftddt.html

 

 

6.                 Whippy Peter, DDT and Malaria Euro Chlor, Fact Sheet. 2002, http//www.eurochlor.org

 

7.                 Reid A.J.E, Whitty C.J.M, Ayles H.M, Jennings R.M, Bovill  B.A, Felton J.M. Malaria at Christmas: risks of prophylaxis versus risks of malaria British medical Journal. 1998; 317 1506-8, www.bmj.com

 

 

8.                  Pautian Timothy, The World-Wide Malaria Eradication Effort. Science Education 2000, http://www.bact.wisc.edu:81/ScienceEd/discuss/msgReaderS36

 

 

9.                 Desowitz Robert S. The History of Malaria. The Malaria Capers 1991; W.W Norton & Company, New York, http://www.idre.ca/books/reports/1996/01-05e.html

 

10.            Edwards J. Gordon, Mosquitoes, DDT  and Human Health, 21st Century Science and Technology Magazine. (Fall 2002),  http//www.21stcenturysciencetech.com/articles/Fall02/Mosquitoes.html

 

11.            Quoted in Grott, Gerald J, Reviewing DDT. (25/06/02), http://groups.Yahoo.com/group/waterforum/message/8807

 

 

 

12.            Hecht Marjorie Mazel. Bring Back DDT, and  Science with it (Editorial) 21st Century ScienceTechnology Magazine

  (Summer 2002), http//www.21stcenturysciencetech.com/articles/Summer02/DDT.html

 

 

 

13.            Vice President Al Gore, Introduction, Silent Spring by Rachel Carson 1994 xviii.

 

14.            Alnwick David, Meeting the Malaria Challenge. Africa Health 2001;23 (6) 18-19

 

15.            THISDAY Newspapers, 14/10/2006; 10.

 

16.            DFID, Personal Communication

 

17.            Offoboche, M; Eradicating Malaria by the use of DDT, 2004.                                                                                                                                                                                                    

                   Electronic Global Press Abuja

           htp://groups.msn.com/EradicationofMalaria/

 

M. O. Offoboche, OON,

MB, BCH, FRCOG, FICS, FWACS, FMOG

 


 

 

The Economist, America and Malaria

 

Dr. Arata Kochi’s admission of WHO Malaria “policy mess” is refreshing. He must be congratulated for his courage in addressing the “green opposition” to the use of DDT in malaria control in Africa. Since June 2006, Indoor Residual Spraying of DDT in Africa has been officially allowed under his watch. Governments and Donor Agencies should now freely support the widespread use of DDT in Africa. This has been the tested method of eradicating malaria from the USA and thirty-six other countries in the world. Its current successful re-run in South Africa and usage in parts of East and Central Africa testifies to this. Since stable North Africa is largely free of malaria, only West Africa and parts of Central Africa need to be supported in the use of IRS with DDT. It needs to be stated that DDT may be bad for America now but malaria has always been worse for Africa.

 

But malaria will not be eradicated from Africa till the insidious Malthusian opposition to malaria eradication from Developing Countries is addressed by the WHO. Indeed, apart from “green opposition”, the unspoken opposition by the Malthusians is probably another reason for the “WHO fault” mentioned by Dr. Kochi. It is also probably responsible for the diversion of huge donor funds to the purchase of mosquito bed nets the use of which is unpopular, unenforceable and less effective in the long run.

 

The business of Bed Nets is booming at the expense of malaria control, their purchase is more profitable than their usage. One technical leadership will be to support research into the Genetic modification of the DNA of the plasmodium-bearing mosquito so that it may self-destruct. Surely mosquitoes are nearer than Mars!

 

The use of non-governmental organizations rather than Government organs in the deployment of funds and project execution will render accountability more easily verifiable. The channel of Government organs, meaning a country-by-country approach, with policy inconsistencies and accountability challenges is doomed to fail. Since malaria eradication from an Island (e.g. Zanzibar) is relatively easy, Africa for this purpose must be regarded as a giant island under the control of one supervising NGO appointed by the WHO with supporting NGOs down the line to the villages and wards, from the Atlantic Ocean to the Pacific. Simultaneous Indoor Residual Spraying with DDT in all sub-Saharan African countries will give the mosquito no quarters and lessen the incidence of resistance. A ten-year programme of such activity will free Africa for universal business activities uninhibited by the fear of malaria illness. It will wipe out 90% of world malaria problem.

 

The personal interest shown by Mr. and Mrs. George Bush and others like Bill Gates means that there is hope yet for African malaria eradication.

 

I thank you.

 

Matthias Offoboche, OON

Abuja, Nigeria


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