It’s time for all-out war on malaria

If an accident kills wildlife or people, punishment is meted out and restitution made. A host of regulators, lawyers, judges, activists, journalists and politicians help bring the wrongdoers to justice.

But when it comes to policies and programmes that sicken and kill millions of parents and children a year, these ethics cops and eco-warriors are not just silent. They refuse to hold government agencies and activist groups to the same honesty and accountability standards they apply to for-profit companies. They even oppose programmes that would reduce disease and save lives.

More than two billion people worldwide are at risk of getting malaria, and 350-500million contract it every year, mostly in Sub-Saharan Africa. The disease kills up to a million African children annually, making it the continent’s greatest executioner of children under age five. In Uganda alone, 60million cases of malaria caused 110,000 deaths in 2005 (1). In its Apac District, a person is likely to be bitten 1,560 times a year by mosquitoes infected with malaria parasites. The disease also perpetuates poverty (sick people can’t work) and increases deaths from HIV/AIDS, tuberculosis, diarrhoea and malnutrition.

Controlling and eradicating this serial killer ought to be a global priority. But far too many organisations fail to take sufficient measures, while others actively oppose critically needed interventions.

UNICEF partners with Malaria No More to raise money from donors, distribute educational materials and long-lasting insecticide-treated bednets (LLINs), provide anti-malarial drugs, and save lives. ‘Sometimes’ they organise teams to spray insecticides on the inside walls of houses, to ‘kill the female mosquito after she feeds on a person’ (and frequently infects him or her). Under ‘some special circumstances’, they support treating mosquito-breeding sites, if the larvacides are ‘environmentally friendly’.

All these interventions will help reduce disease and death tolls. They will garner plaudits from environmental activists. But these limited measures will not result in No More Malaria. Unless and until their programmes include regular use of larvacides and insecticides to control mosquitoes, and DDT in selected cases to keep the flying killers out of houses, UNICEF and MNM will not even come close to reducing malaria cases and deaths to what a moral person would deem tolerable levels: close to zero – not 50 per cent or even 25 per cent of current levels.

Kenya claims widespread distribution of insecticide-treated nets cut malaria deaths in half, in the short run anyway, when regular compliance was monitored. But that means 15,000 people are still dying each year. For Uganda, a 50 per cent reduction via nets would mean 30million cases of malaria and 55,000 deaths. Uganda’s Ministry of Health recently studied 410 children who had been given LLINs and instructed in how to use them. Within two to three weeks, 52 per cent of the children were again infected with malaria. ‘The use of nets relies greatly on behavioral change and compliance, while indoor spraying eliminates that factor and protects everyone in the sprayed house’, noted malaria programme director John Rwakimari.

And yet misguided aid agencies, radical environmentalists and pseudo ethicists are telling African nations they should be happy with nets, use of limited insecticides ‘sometimes’, and a 50 per cent reduction in malaria cases and deaths – because these activists in malaria-free countries dislike chemicals.

Equally unacceptable, 60 per cent of African child malaria victims are still being ‘treated’ with chloroquine, which no longer kills African plasmodium parasites. The typical justification is that chloroquine is much less expensive than Artemisia-based combination therapies (ACT drugs) that do work. In other words, medical malpractitioners are saying it is better to give millions of children cheap drugs that don’t work, and let thousands of them die, than it is to give fewer children more expensive drugs that work, and ensure that they live. By failing to support chemical mosquito killers and repellants, they are also guaranteeing tens of millions of needless malaria cases every year, continued shortfalls of effective medicines, and countless unnecessary deaths.

That is unforgivable, unconscionable and immoral.

To achieve moral levels of malaria, countries need comprehensive, integrated programmes that include every weapon in the arsenal. None is appropriate in all places, at all times. But all must be available, so that they can be employed at the proper time and place. That is why the US Agency for International Development, the US President’s Malaria Initiative and the World Health Organisation determined that these chemical weapons are vital in the war on malaria, and safe for people and the environment.

Larvacides, insecticides and DDT – in conjunction with nets and other interventions – can reduce the number of malaria victims dramatically, and ensure that people who still get malaria can be treated with ACT drugs like Coartem. These truly integrated strategies have enabled South Africa, Botswana, Swaziland and Zanzibar to largely eradicate malaria.

Uganda, where I just spent a week on an anti-malaria mission, is using larvacides, insecticides, nets and other interventions. It has sprayed 95 per cent of households in the Kabale District (with the pesticide Icon) – and slashed the prevalence of malaria parasites in residents from 30 per cent before spraying to 3 per cent afterwards.

Three other districts have also been sprayed, and Uganda’s Ministry of Health plans to spray another 15 highly endemic areas in 2008, including the Apac District. In January, it will add DDT to its programme, for indoor residual spraying that will keep at least 70 per cent of mosquitoes from entering homes for up to eight months, with a single application.

Radical environmentalists are trying to stir up opposition to DDT and other spraying programmes, and some people in USAID and WHO continue undermining efforts to utilise chemical interventions. However, Uganda is adamant about ending the needless slaughter of its children and parents. President Yoweri Museveni, director general of health services Sam Zaramba and other leaders know DDT will save lives.

Anti-pesticide activists claim insecticide spraying is not sustainable. They are wrong – on financial, practical, public health and moral grounds. What are not sustainable are nothing-but-nets programmes that require constant monitoring to ensure daily use and moderate success – while raising the risk that mosquitoes will become resistant to pyrethroid pesticides that impregnate the nets, and parasites will become resistant to drugs that by default become the primary weapon in the war on malaria.

What are truly not sustainable are unconscionable malaria tolls that result from politically correct policies that are best described as lethal experimentation on African children.

Paul Driessen is senior policy adviser for the Congress of Racial Equality and Committee For A Constructive Tomorrow, and author of Eco-Imperialism: Green Power, Black Death.

(1) See, for example, Uganda: Malaria – 320 Die Daily, Monitor, republished on Africa Fighting Malaria, 13 September 2007