TCS Daily


Where DDT Works

By Richard Tren - April 26, 2004 12:00 AM

LUSAKA, Zambia - "Malaria Day" was on April 25 and, four years into the World Health Organisation's (WHO) Roll Back Malaria (RBM) programme, WHO has little to celebrate. A partnership between WHO, UNICEF, the World Bank and others, RBM aims to halve malaria deaths by 2010. Yet malaria cases and deaths have increased since the start of the RBM programme. If RBM continues with its malaria control strategy, it stands little chance of reducing malaria cases by 5% let alone 50% by 2010. Yet there is hope for malarial control and several success stories if only the bureaucrats in Geneva and Washington would sit up and pay attention.

After decades of disastrous economic policies and misrule, Zambia is one of the world's poorest countries. It is also one of the least healthy countries: preventable and curable diseases such as malaria and diarrhoea claim tens of thousands of lives. In the 1960s and 70s, malaria was well under control in Zambia and declining in incidence, but economic failure caused Zambia to abandon malaria control programmes in the 1980s. Unchecked, the disease clawed its way back and now accounts for more hospital admissions and deaths than any other.

In 2000, however, the tide started to turn. The newly privatised copper mines on Zambia's northern border re-started their malaria control programmes with spectacular success. The Konkola Copper Mines (KCM) started indoor residual spraying (IRS) with insecticides such as DDT and saw a 50% reduction in cases in 1 year. They saw a further 50% reduction in the second year and for the past 3 years have recorded no deaths from malaria. Their programme has been so successful that the Global Fund to fight AIDS, TB and Malaria (GFATM) is funding its expansion. The Zambian government is now re-starting its IRS programmes in other parts of the country using its own and GFATM money.

IRS programmes (which spray tiny amounts of insecticide on the inside walls of houses where mosquitoes rest) have been the cornerstone of successful malaria control programmes in many southern African countries. South Africa, Swaziland and Mozambique have recorded equally outstanding results against malaria. South Africa and Zambia have also introduced new malaria treatments -- artemisinin based combination therapies (ACTs) -- which are essential given the rise of drug resistance to the alternatives. By promoting the correct mix of interventions, success over malaria once again seems achievable.

Given these successes, one would have thought that the WHO, its Roll Back Malaria partners and donors such as USAID would be falling over themselves to fund similar programmes elsewhere in Africa. Yet it seems that UN agencies and most donors have little interest in what actually works and great interest in what is politically correct.

No national donor agency will fund IRS programmes, and few are funding the new and highly effective ACT medicines. Donor agencies, many of whom take their cue from the WHO, prefer to promote insecticide treated bed nets (ITNs) to the exclusion of IRS. Last year the WHO released its Africa Malaria Report, which it promoted as a comprehensive assessment of malaria and malaria control on the continent. Yet in all 112 pages it mentions IRS only 4 or 5 times and then instructs African countries to reduce reliance on IRS. This comes despite the fact that more African countries (such as Uganda and Kenya) want to restart their IRS programmes in light of the successes in Zambia, Mozambique and elsewhere.

ITNs can be effective, but promoting them to the exclusion of IRS is dangerous and costs lives. ITNs do not provide the same kind of protection that IRS does. To date, no country has been able to replicate the successes of IRS with ITNs. Yet the WHO and donors feel that ITNs are more 'sustainable' than IRS. Perhaps they feel this way because they sustain ITNs by funding their purchase and distribution, while the dramatically successful, but supposedly "unsustainable" IRS programs look in vain for sustaining donors.

To date the only thing that the WHO's single minded ITN policy sustains are malaria deaths and misery in Africa. Perhaps the WHO, USAID and others don't promote IRS because they are frightened of upsetting environmentalists (who irrationally oppose the use of insecticides) or perhaps they are simply too arrogant to pay attention to the scientists and Ministers of Health from Africa. No matter the cause, it's high time they started paying attention to what actually control malaria and supporting those successful strategies. Malaria is preventable and entirely curable. No one need die from it or the revolting bureaucratic inertia, arrogance and fear in Geneva and Washington DC that kills Africans in record numbers.

Tren is a director of the health advocacy group Africa Fighting Malaria and a regular contributor to TechCentralStation.


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