The latest stunt from Africa Fighting Malaria is a petition advocating policies that would cripple the United States efforts against malaria. The petition asks that Congress and the President
- Ensure that at least 2/3 (two-thirds) of annual Congressional appropriations for malaria control are earmarked for insecticidal and medicinal commodities – with up to half of such monies targeted to the treatment and cure of infected patients.
- Specifically direct such funds to the actual purchase and deployment of: (1) DDT, or any other proven, more cost-effective insecticide/repellent, for Indoor Residual Spraying (IRS) in any given malarial locality; and (2) of ACTs, or other equally effective and durable drugs, for treatment of malaria patients and reduction in transmission rates.
- Require that this 2/3 formula be mirrored in the annual malaria control spending by any agency receiving US malaria control monies – such as US Agency for International Development, World Health Organization, World Bank, UNICEF and Global Fund to Fight AIDS, Malaria and Tuberculosis.
This is an absolutely dreadful way to run an anti-malaria program. The goal should be to reduce malaria and you should let the experts figure out the best way to do this. It should not be to spray DDT. In the map below (source) green dots mark resistance to pyrethroids, blue resistance to DDT, and red is resistance to both DDT and pyrethroids.
The only concession that the petition makes for problems like widespread DDT resistance is this passage:
- Direct that this 2/3 proportion will be subject to reduction ONLY if replaced by corresponding expenditures for any malaria control measure (such as larvaciding) that has been proven equally or more cost-effective in reducing malaria morbidity and mortality rates in specific localities – as certified, in advance of such expenditure and replacement, by the directors of the US Centers for Disease Control, Uniformed Services University of the Health Sciences or similar independent agency, based on controlled epidemiological studies in the field.
But why don’t they require epidemiological evidence that DDT is more effective before spraying it? In any case, the studies on the effectiveness have already been done and led to WHO concluding in 1994 that DDT was no longer the insecticide of choice for vector control. Furthermore, the evidence that the petition presents in favour of DDT does not follow the standard that they require for alternatives. For example, they dismiss all the evidence in favour of insecticide-treated nets not with epidemiological studies, but with hand waving:
Insecticide-treated nets certainly help to a limited degree. However, they often get torn. They only protect one person at a time. People often don’t use them, because the insecticide irritates their skin – or they forget kick them off when it gets too unbearably hot under the net to sleep don’t have enough for every family member have no way to hang them up properly or are still doing homework or housework when mosquitoes arrive.
But somehow nets seem to work. It’s a shame that this petition would prevent their use to save lives from malaria…
I hope that the US government rejects the appallingly bad policies advocated by this petition, because if they are followed more African children will die from malaria.