TCS Daily


Health in the Balance

By Paul Driessen - September 20, 2004 12:00 AM

News flash! New artemisinin-based combination therapies (ACT drugs) will, and pesticides (including DDT) may, henceforth play greater roles in the global battle against malaria. Thus spoke World Health Organization and U.S. Agency for International Development officials at a September 14 hearing before the House Subcommittee on Africa.

The declarations may represent significant progress, and exceptionally good news for millions in developing countries -- if the agencies really mean what they said (there are serious doubts), and Congress is willing to hold them to their commitments.

Consider what's at stake:

HIV/AIDS affects over 45 million people worldwide. Two-thirds are in sub-Saharan Africa, but the disease is spreading rapidly in China, India and elsewhere. It is complex in origin, constantly mutating and extremely hard to cure, especially in the face of political hostility to ABC programs (Abstain, Be faithful, use a Condom). By damaging victims' immune systems, it makes them far more vulnerable to the many other diseases that also plague these nations.

Malaria infects at least 300 million people and kills up to 2.7 million a year -- 90 percent in sub-Saharan Africa, and half of them children. Spread by infected mosquitoes, it rapidly incapacitates victims and kills more quickly than AIDS -- often within days, rather than years.

Tuberculosis continues to kill another 2 million people a year. Over 2 billion may be infected with the TB bacillus; 9 million have the infectious variety; and some new strains are resistant even to multi-drug treatments.

Those not actually killed by malaria and infectious TB are often left too sick to work, cultivate fields, go to school, or survive dysentery, typhus, intestinal parasites and other diseases. Tens of millions more must care for sick patients or family members, rather than being engaged more productively.

Nine of ten child malaria victims survive the disease. However, many get cerebral malaria, become brain-damaged, unable to function as normal adults, and die early. Those who survive advanced tuberculosis are often permanently disabled.

Not surprisingly, the worst malaria, TB and AIDS areas are also the most destitute regions on Earth. Their almost nonexistent healthcare systems cannot possibly cope with malaria alone, much less all these diseases simultaneously. Until at least one is dramatically reduced, economic growth is impossible. Where to start?

Devoting more attention to properly managed first-tier drug interventions can dramatically reduce infectious tuberculosis, before treatable TB becomes multi-drug resistant.

Abundant, reliable, affordable electricity (via hydroelectric, fossil fuel and nuclear facilities) will energize modern homes, clinics, hospitals, schools and industries.

But reducing malaria should be a top priority. South Africa slashed its malaria rates by 91 percent in just three years. It began with DDT in indoor spraying programs, cutting malaria by 80 percent, and then employed Coartem (a powerful artemisinin-based drug) to treat far fewer severe malaria cases -- while still continuing to use DDT and bed nets.

These three actions would prevent hundreds of thousands of deaths annually. Populations would be healthier and more productive, and nations would be able to build modern transportation, healthcare and manufacturing infrastructures, free up more people and other resources to fight AIDS -- and ensure that progress in that battle comes much more swiftly.

Unfortunately, since the WHO launched its vaunted Roll Back Malaria campaign in 1998 -- pledging to cut disease and death rates in half by 2010 -- the rates have actually increased by over 10 percent. A principal reason is that government agencies, NGOs and charitable foundations have long resisted the use of pesticides, especially DDT. Some have threatened to withhold financial support from any country that uses DDT. Many often promoted and funded only two interventions to prevent malaria:

  • bed nets, which many countries accepted as the only available option when donors would not fund pesticide spraying, says tropical disease expert Professor Donald Roberts; and

  • drug treatments that generally did not include modern drugs like Coartem, and frequently relied on drugs that fail up to 80 percent of the time (chloroquine and SP), because malaria parasites have become resistant to them.

Taking these drugs repeatedly or for extended periods of time may be risky, especially for children and pregnant women -- infinitely more so than having trace amounts of DDT in their bodies. Repeated use also increases drug resistance, especially when patients stop using them once they begin to feel better.

That's why many other countries want to use DDT. However, they are not yet as wealthy or politically powerful as South Africa, and thus cannot ignore anti-pesticide pressure. Hundreds of thousands of children and parents thus die every year who might live, if their countries could emulate South Africa.

The WHO and World Bank spend hundreds of millions of (largely American) taxpayer dollars every year on malaria. But they have released few figures specifying where and how funds are actually used. USAID spends $65 million a year on malaria, but nothing to buy drugs or insecticides, and only a tiny amount to coordinate programs that help people buy bed nets. Apparently, over $60 million is spent on education, research and delivery of programs by US consultants. UNICEF spends just $3.7 million a year on malaria, and just $1 million on ACT drugs.

Congress should insist on knowing how tax dollars are being spent, notes Dr. Roger Bate, director or Africa Fighting Malaria, a health NGO, and visiting fellow at the American Enterprise Institute. It should analyze scientific and health claims regarding pesticide, bed net, drug and other programs; judge agencies by their success in reducing disease and death, rather than by the number of bed nets or reports they distribute; and hold the directors of agencies, NGOs and foundations accountable when their programs fail.

It should also consider modifying the current economic incentive structure to encourage drug companies to develop new, faster-acting malaria, TB and AIDS medicines, and make them more accessible to poor people in countries wracked by these diseases.

The mere fact that many of these issues were directly and honestly addressed at a congressional hearing marks a watershed moment. The real test, however, will be whether WHO and USAID finally change their longstanding policies and actually implement comprehensive disease control programs that put pesticides and ACT drugs on equal footing with bed nets, to bring Africa's greatest scourge under control. The lives of millions, and the future health and prosperity of dozens of nations, hang in the balance.

Paul Driessen is the author of Eco-Imperialism: Green Power · Black Death (www.Eco-Imperialism.com), senior fellow for the Committee For A Constructive Tomorrow, and senior policy advisor for the Congress of Racial Equality (CORE). Niger Innis is national spokesman for CORE (www.CORE-online.org), which has consultative status with the United Nations and participated in the Geneva and Bangkok health conferences.


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