World Malaria Day is upon us and there is much to celebrate. Following a substantial increase in global spending since 2005, most of it thanks to the generosity of U.S. taxpayers, malaria cases and deaths have been declining. But these hard-won gains can easily be undone and history has demonstrated that malaria can come roaring back.
A critical cornerstone of past success, and future ambitions to eradicate this age-old disease, are effective insecticides to control malaria spreading mosquitoes. But environmentalist hysteria has deterred investment into new insecticides and Roll Back Malaria (RBM), a UN-sponsored global partnership of public health and donor agencies dedicated to combating malaria, adds to this problem by deftly avoiding the topic.
RBM recently issued talking points for anti-malaria advocates. The talking points include some sensible and unobjectionable calls to action, such as regional collaboration and sustained funding. Our concern, however, relates to what is omitted.
Among RBM’s statements is the following: “The continued development of new solutions and strategies – including next-generation drugs, diagnostics, and vaccines – is critical if we are to further accelerate gains and mitigate the threat of drug and insecticide resistance.”
RBM’s fear of the environmental lobby is obvious in its failure to call for the urgent need of new insecticides. RBM only mentions insecticides in the context of resistance. Everyone can agree that we need new drugs, diagnostics, and vaccines, and billions of both public and private dollars have been invested for decades in search of these essential new tools. Indeed, those research endeavors are entrenched and will continue with or without RBM’s plea.
Those searching for new insecticides have been less fortunate. For years insecticide research has received a mere fraction of the total malaria research investment, whether from public or private sources. While the Gates Foundation, in partnership with some chemical companies, has been investing in the search for new insecticides, much more must be done.
Malaria is an insect-borne disease and successful efforts to eliminate it have relied heavily on insecticides. Europe and the United States along with many other countries enjoyed spectacular successes against malaria in the 1940s and 50s thanks to the use of DDT.
Other insecticides have now been introduced and are either used to treat mosquito bed nets or are sprayed on the inside walls of houses, where they kill or repel deadly mosquitoes. Yet, these newer insecticides were all developed for agricultural use, and later adapted for public health. There hasn’t been a largely public health insecticide since DDT.
When RBM glosses over the need for insecticides it caters to the environmental lobby and does a disservice to the long-term fight against malaria and other insect-borne diseases. Interestingly, RBM mentions the emergence and spread of Zika Virus, arguing that improved malaria control will help in its control. However, RBM fails to mention that the mosquito that spreads Zika, Aedes aegypti, which is different to the malarial mosquito, was mostly eradicated from Latin America by the early 1950s as part of yellow fever control. It was DDT that eliminated the mosquito and halted the spread of disease.
Those mosquito control and eradication efforts were abandoned due to anti-insecticide environmentalist campaigns. After that, the mosquito re-emerged, leading to the current Zika crisis.
Similar anti-insecticide campaigns led to a re-emergence of malaria globally in the 1980s and 90s that is only now being controlled with tens of millions of dollars in spending and a massive global effort.
New insecticides are critical to sustaining the fight against malaria and other insect-borne diseases. RBM’s failure to advocate for new insecticides is unhelpful, and the environmentalist movement does further harm by actively advocating against them. For instance, the Global Environment Facility, a World Bank-run agency established to support “green” projects, along with the UN Environment Program have peddled the lie that malaria can be controlled by clearing vegetation around houses and keeping dirty clothes outside. This is dangerous nonsense, yet few in the public health community have spoken out against it.
The same is true of failures to denounce environmental campaigns based on false claims of harm from insecticides while simultaneously ignoring the very real benefits from careful and judicious insecticide use.
It is past time for RBM to start advocating for new insecticides, just as it does for other tools and it, along with others in the public health community, must start to stand up to the dangerous campaigns against public health uses of insecticides.
Jasson Urbach is the director of Africa Fighting Malaria, a public health advocacy group based in South Africa.