During his State of the Union address on Jan. 31, 2006, President Bush mentioned malaria twice. This probably took most Americans by surprise as the disease was banished from the States in the early 1950s. But as Bush and his administration established the ambitious President’s Malaria Initiative (PMI), the disease would soon feature fairly high on the political and popular agenda. So it should — the disease claims the life of an African child almost every 30 seconds.
Funding for malaria control and treatment and malaria advocacy activities have increased dramatically since 2006. Whereas before most Americans hardly knew what malaria was, now Ashton Kutcher and Anderson Cooper tweet for malaria and P. Diddy, aka Ditty Dirty Money held a White Party in LA to raise awareness about the disease.
The PMI’s efforts appear to be paying off with declining malaria cases and deaths in the 15 highly malarial African countries in which they operate. Before the 2006 State of the Union address, the US government’s anti-malaria efforts were far less impressive. Thanks in part to the fact that the PMI now funds indoor spraying with insecticides including DDT, the chemical that environmentalists love to hate, malaria cases have declined rapidly.
Pre-PMI malaria control refused to put any funding into this highly effective intervention. To its eternal credit, USAID, which manages the PMI, shook off its fear of offending environmental groups, listened to what malarial countries wanted and started to procure life-saving DDT. Using DDT is sensible because it is cheap and safe and because it is only sprayed inside houses, does not harm the environment.
Ever since Rachel Carson’s publication of Silent Spring in 1962, great fears have persisted about DDT. The received wisdom has been that DDT was devastating to bird populations and harmful to human health. The reality is that if DDT ever did harm bird populations, such harm was minor and at the margins; the main and most serious threats to wildlife were from human beings directly through hunting, trapping, poisoning and land-use changes. And to this day, after over 60 years of almost continual use of DDT and thousands of scientific studies, there is no convincing evidence that environmental exposure to DDT is a source of harm to human health.
But while DDT is safe and effective and has an unrivaled record in saving lives, some extremist groups such as Pesticide Action Network continue to campaign against it, even attacking the laudable efforts of the PMI. Were these groups to campaign against life-saving medicines or vaccines, they would be roundly condemned and viewed with the same contempt reserved for those who ignore science and campaign against anti-retroviral AIDS medicines. Yet so successful have been the fear campaigns against chemicals, a legacy of Rachel Carson, that PAN are not dismissed as cranks, but sit on UN committees overseeing the use of DDT and even hold events in the US Congress.
Not content only with campaigning against DDT, environmental extremists also rail against all insecticide use. These groups lobbied the World Health Assembly, the agenda setting body of the World Health Organization, to pass a resolution in 1997 against insecticide use in disease control altogether. This was done at a time of rising dengue infections and re-emerging malaria and without any credible non-insecticide means of controlling insect borne diseases. Instead of insecticides, extremist groups promote ideas of environmental control that are unproven and naïve. These so-called solutions would be laughable if the implications of actually using them weren’t so harmful and life-threatening to some of the most vulnerable people on earth.
While DDT remains effective and safe, we need alternative chemicals. Yet in spite of the limited arsenal of public health insecticides, public and private investment in this area has been minimal, and scurrilously trivial compared to the large and consistent flow of public funds in the search for a malaria vaccine and in developing new medicines. The public health insecticide market is small and unprofitable compared to the large and profitable agricultural sector. Furthermore the private sector are wary of the onerous and expensive regulatory hoops they would have to jump through to bring a product to market and remain skittish thanks to the attacks from environmental groups.
The contributions from Kutcher, Cooper and other celebrities are of course to be welcomed and celebrated. Fighting malaria is known to be a good public health investment and so keeping the disease at the forefront of the political and popular agenda is important. But while celebrities may provide a level of glamour that is rare among medical entomologists, malaria advocacy must now evolve urgently. Beyond tweets and glamorous parties, we must start addressing serious policy issues that threaten US investments.
Surely these celebrity champions have been briefed on malaria and therefore they must realize that the risks posed by deadly mosquitoes are far greater than the miniscule and unproven risks posed by public health insecticides. So in addition to raising awareness about the disease, they can and should help to push back against the deadly anti-insecticide bias. Insecticides like DDT save lives every day. Young children living in rural malarial areas without a voice need champions in the West to push back against the unscientific and biased bully tactics of extremist groups. Champions for these children could begin by getting the World Health Assembly to rescind the 1997 resolution against use of insecticides to protect children from malaria and other diseases.
Complex and contentious issues feature prominently in public health, most particularly with HIV/AIDS. Celebrities have shown that they are capable of tackling these issues to the benefit of AIDS control and treatment – now is the time to tackle malaria’s complex and compelling issues and not to shy away from them.
Mr. Tren is the director of Africa Fighting Malaria, and Dr. Roberts is professor emeritus of tropical public health at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Their book “The Excellent Powder: DDT’s Political and Scientific History,” will be published this month by Africa Fighting Malaria and launched at the National Press Club, Washington, DC, April 21 at 9:00am.