Deja Vu all over again: The Preview to Anti-GMO activism, DDT

DDT's return is a good thing. Really
23.sep.06
Globe and Mail
Margaret Wente

Columnist Wente writes that malaria is the leading killer of African kids under 5, a curable, preventable disease that carries off the very young, and leaves adults too sick to work. In Tanzania, malaria kills more people than AIDS and every other infectious disease combined. Worldwide, malaria kills a million people a year -- most of them in sub-Saharan Africa -- and infects 500 million more. Most victims are young children.

Among the most effective ways to control malaria is indoor spraying with DDT. It can reduce malaria transmission by up to 90 per cent and, when used properly, is safe for both humans and the environment. Yet, for many years, DDT has been taboo. African nations dismantled their spraying programs because donors wouldn't fund them, even though spraying indoors never was dangerous.

Last week, all this began to change, when the World Health Organization announced a major policy reversal. From now on, it will aggressively promote the use of DDT to fight malaria. "Extensive research and testing has demonstrated that well-managed, indoor, residual house-spraying programs using DDT pose no harm to wildlife or to humans," said Dr. Arata Kochi, director of the WHO's Global Malaria Department. He challenged environmental groups: "Help save African babies as you are saving the environment."

The story of DDT in Africa is a monumental tragedy. It is the story of how the misguided environmental fears of well-meaning Westerners denied the world's poorest people access to one of the most effective disease-prevention tools.

Amir Attaran, a committed environmentalist, knows the story all too well. It's partly owing to his efforts that the WHO finally reversed itself.

"Every day, the number of kids dying of malaria equals seven Boeing 747s going down," he said from his Ottawa office. "There's a massive constituency for other diseases, but malaria? It kills African kids, so nobody gives a damn."...

Mr. Attaran is no stranger to Canada. In the late 1990s, he landed his dream job with the Sierra Legal Defence Fund in Vancouver. There, he helped win an important case on toxic-waste law before the Supreme Court of Canada. In the summer of 1998, he attended a UN conference in Montreal, negotiating a global treaty on eliminating 12 chemicals known as persistent organic pollutants. Eleven of those 12 had no merit. The 12th was DDT.
"I knew from my time studying infectious diseases that DDT was awfully useful to control malaria," he says. "I have a deep commitment to the environment. But I'm also a scientist. I want to see the data. And I'm not about to sell African kids down the river."

Working in his spare time, Mr. Attaran fought to get the ban softened.
"My view was, let us ban DDT for all uses other than health, and carve out an exception for that." With the assistance of a small international group called the Malaria Foundation, he drafted an open letter making the case for DDT. He e-mailed it to colleagues and circulated it on the Internet. In a few months, he got 400 leading doctors and scientists from around the world, including several Nobel Prize winners, to sign it. Eventually, a compromise was negotiated (he drafted it), and the final treaty made an exception for DDT when used for public health.

"By this time, the environmentalists hated me," he recalls. "I'd just driven a stake through their aspirations to ban DDT once and for all." Although his boss was supportive, his stance on DDT eventually cost him his job....

Although Western donors wouldn't fund it, some African nations kept using DDT for malaria control. Among them was South Africa. In 1995, it finally bowed to pressure and stopped using the chemical. In 1996, it was struck by one of its worst malaria epidemics ever. Malaria cases soared tenfold: By 2000, there were more than 60,000. Meantime, just across the border, Swaziland continued spraying with DDT. Malaria did not increase.

Despite the global treaty's compromise on DDT, leading aid agencies (including the World Bank, USAID and Canada's CIDA) refused to fund its use. So Mr. Attaran doggedly persisted with his campaign. "All the agencies who are supposed to help the poor were hurting them," he says. "The WHO responded by hiding from the issue."
Other critics are less kind. Among them is James Shikawati, co-ordinator of the Africa Resource Bank. DDT policies, he argues, are "evidence of how developed countries' intellectuals inadvertently contribute to deaths in poor countries." Malaria "has wrecked the continent for over 30 years, simply because some policy-makers thought it wrong to kill mosquitoes using chemicals."

Instead of spraying with DDT, many aid agencies (including CIDA) have endorsed the use of treated bed nets to combat malaria. Bed nets have their place. But they only work when people are under them. And mosquitoes don't only bite at night. In Mr. Attaran's view, the wrangling over bed nets versus spraying is stupid. "It's like having a debate over whether you should use chemotherapy or radiation to treat cancer. You need both. You need everything you've got."
The WHO's new policy is a major breakthrough. It means Western governments and donor agencies will start to fund DDT spraying programs.

But Mr. Attaran's battle isn't over. Bizarrely, the anti-DDT lobby includes major African agricultural producers, who are worried that DDT might contaminate their crops and ruin their export markets. In Uganda, the ministry of trade has threatened to take the ministry of health to court if it goes ahead and uses DDT.
Then there's the matter of persuading Western aid agencies to change their policies.


Pundits Comment:
The Tide has turned. And Mr Amir Attaran is one of David Tribe's Heroes.

WHO gives indoor use of DDT a clean bill of health for controlling malaria
WHO promotes indoor spraying with insecticides as one of three main interventions to fight malaria

15 SEPTEMBER 2006 | WASHINGTON, D.C. -- Nearly thirty years after phasing out the widespread use of indoor spraying with DDT and other insecticides to control malaria, the World Health Organization (WHO) today announced that this intervention will once again play a major role in its efforts to fight the disease. WHO is now recommending the use of indoor residual spraying (IRS) not only in epidemic areas but also in areas with constant and high malaria transmission, including throughout Africa.

“The scientific and programmatic evidence clearly supports this reassessment,” said Dr Anarfi Asamoa-Baah, WHO Assistant Director-General for HIV/AIDS, TB and Malaria. "Indoor residual spraying is useful to quickly reduce the number of infections caused by malaria-carrying mosquitoes. IRS has proven to be just as cost effective as other malaria prevention measures, and DDT presents no health risk when used properly.”

WHO actively promoted indoor residual spraying for malaria control until the early 1980s when increased health and environmental concerns surrounding DDT caused the organization to stop promoting its use and to focus instead on other means of prevention. Extensive research and testing has since demonstrated that well-managed indoor residual spraying programmes using DDT pose no harm to wildlife or to humans.

"We must take a position based on the science and the data," said Dr Arata Kochi, Director of WHO’s Global Malaria Programme. “One of the best tools we have against malaria is indoor residual house spraying. Of the dozen insecticides WHO has approved as safe for house spraying, the most effective is DDT.”

Indoor residual spraying is the application of long-acting insecticides on the walls and roofs of houses and domestic animal shelters in order to kill malaria-carrying mosquitoes that land on these surfaces.

“Indoor spraying is like providing a huge mosquito net over an entire household for around-the-clock protection,” said U.S. Senator Tom Coburn, a leading advocate for global malaria control efforts. “Finally, with WHO’s unambiguous leadership on the issue, we can put to rest the junk science and myths that have provided aid and comfort to the real enemy – mosquitoes – which threaten the lives of more than 300 million children each year.”

Views about the use of insecticides for indoor protection from malaria have been changing in recent years. Environmental Defense, which launched the anti-DDT campaign in the 1960s, now endorses the indoor use of DDT for malaria control, as does the Sierra Club and the Endangered Wildlife Trust. The recently-launched President’s Malaria Initiative (PMI) announced last year that it would also fund DDT spraying on the inside walls of households to prevent the disease.

“I anticipate that all 15 of the country programs of President Bush’s $1.2 billion commitment to cut malaria deaths in half will include substantial indoor residual spraying activities, including many that will use DDT,” said Admiral R. Timothy Ziemer, Coordinator of the President’s Malaria Initiative. “Because it is relatively inexpensive and very effective, USAID supports the spraying of homes with insecticides as a part of a balanced, comprehensive malaria prevention and treatment program. “

Programmatic evidence shows that correct and timely use of indoor residual spraying can reduce malaria transmission by up to 90 percent. In the past, India was able to use DDT effectively in indoor residual spraying to cut dramatically the number of malaria cases and fatalities. South Africa has again re-introduced DDT for indoor residual spraying to keep malaria case and fatality numbers at all-time low levels and move towards malaria elimination. Today, 14 countries in Sub-Saharan Africa are using IRS and 10 of those are using DDT.

At today’s news conference, the World Health Organization also called on all malaria control programmes around the world to develop and issue a clear statement outlining their position on indoor spraying with long-lasting insecticides such as DDT, specifying where and how spraying will be implemented in accordance with WHO guidelines, and how they will provide all possible support to accelerate and manage this intervention effectively.

“All development agencies and endemic countries need to act in accordance with WHO’s position on the use of DDT for indoor residual spraying,” said Richard Tren, Director of Africa Fighting Malaria. “Donors in particular need to help WHO provide technical and programmatic support to ensure these interventions are used properly.”

Indoor residual spraying is one of the main interventions WHO is now promoting to control and eliminate malaria globally. A second is the widespread use of insecticide-treated mosquito nets. While the use of bed nets has long been encouraged by WHO, the recent development of “long-lasting insecticidal nets” (LLINs) has dramatically improved their usefulness. Unlike their predecessors, the long-lasting nets need not be re-dipped in buckets of insecticide every six months as they remain effective for up to five years without retreatment.

Finally, for those who do ultimately become sick with malaria, more effective medicines are increasingly becoming available. Unlike previous antimalarials that have been rendered useless in many regions due to drug resistance, Artemisinin Combination Therapies (ACTs) are now recommended. These lifesaving medications are becoming more widely available throughout the world. In January of this year, WHO took stringent measures to help prevent future resistance to antimalarial medicines by banning the use of malaria monotherapy. An example of the negative consequences of drug resistance is apparent in the threat it poses to intermittent preventive treatment in pregnancy (IPTp), a crucial strategic intervention to protect pregnant women from the consequences of malaria.

Potential funding to scale up the availability of all three of these strategic interventions has dramatically increased over the past few years through the inception of the Global Fund to Fight AIDS, TB and Malaria, World Bank plans to significantly increase its funding for malaria, and the launch of the President’s Malaria Initiative.

“With serious money finally becoming available to fight malaria, it is more imperative than ever that WHO provides sound technical guidance and programme assistance to ensure timely and effective use of these resources,” said Dr Kochi.

Each year, more than 500 million people suffer from acute malaria, resulting in more than 1 million deaths. At least 86 percent of these deaths are in sub-Saharan Africa. Globally an estimated 3,000 children and infants die from malaria every day and 10,000 pregnant women die from malaria in Africa every year. Malaria disproportionately affects poor people, with almost 60 percent of malaria cases occurring among the poorest 20 percent of the world’s population.

For more information contact:

In Washington, DC:
Jim Palmer at 1 (202) 262-9823

In Geneva:
Ed Vela at +41 22 791-4550 or Shiva Murugasampillay at +41 22 791-1019


See also:
The Hidden Cost of Saying No