Mozambique and DDT

In debunking this DDT myth nonesense there is one aspect that is rarely or never discussed. Malaria was almost eradicated in the early 1960s--from the whole earth. The number of cases registered by health authorities were at a historic low and eradication seemed within our grasp. This was done largely without pesticides, through careful monitoring, early diagnosis and rapid treatment of detected cases and general sanitation measures (cleaning up sources of stagnant water such as old tires, tin cans and other garbage in marginal communities). It was an exemplary international program that got local people heavily involved.

Pesticides were added to these measures in the late fifties, and may have contributed, but probably they were not necessary. If the policies had only continued for a few years more as they were being applied, malaria would be history. It is an eradicale disease as it has no animal reservoirs.

However, in the late 1960s international policy changed and it was decided to rely primarily on pesticides to finish the eradication job, and reduce or discontinue the funds spent on community-based monitoring and environmental measures. Of course, we know who benefited greatly from this decision. But who lost are the over 2 million people who now die every year from malaria, and the 100s of thousands who get sick or are at high risk. Because practically the first year after the new policy was implemented, the number cases began to increase again worldwide as they have done every year ever since then. Besides the usual venality of chemical companies, this story is a major moral and political failure on the part of the world public health establishment, which is why it is never told.

Now no one mentiones 'eradication' as a goal anymore. Who have killed millions are the pesticide companies and others who pushed for this mistaken policy that has utterly failed to control the disease. Malaria is completely out of control and will get worse as things heat up. Spraying, bed nets and now vaccinations are simply admissions of a major failure to eradicate this terrible disease when we had the chance.

Alicia Colon's stuff is more than rubbish. It is a criminal cover up.

Ron -You are generally on target in saying that a multi-pronged attack on malaria was making rapid progress until the 1960s, when it slowed dramatically. But we should be cautious about saying that total victory was just around the corner. In my view, it would be more accurate to say that part of the problem was (as you point out) a naive and overly optimistic belief in the enduring power of DDT, but also that another, very important part was that we had already won most of the easy battles. Gordon Harrison describes, in Mosquitoes, Malaria and Man, how the protean nature of the Anopheles mosquito stymied attempts to use a single breeding control strategy worldwide. The damn pesky critters just come in so many varieties, with a different behavior for each, that what works in Borneo is worthless in Bangladesh. Where the local malaria vector prefers to lay its eggs in (for example) wheel ruts and rainbarrels, the odds are excellent that you can mobilize the town and interrupt the breeding cycle. But where the mozzies would rather breed in the swamp and come to town on holidays, you face a much more difficult fight. The hard-won wisdom of the last fifty years is that any successful strategy against malaria must take into account all the local variables, and use a combination of targeted methods against Plasmodium and its vector. The CDC summed up our present state with a bit of determined pessimism:

With the success of DDT, the advent of less toxic, more effective synthetic antimalarials, and the enthusiastic and urgent belief that time and money were of the essence, the World Health Organization (WHO) submitted at the World Health Assembly in 1955 an ambitious proposal for the eradication of malaria worldwide. Eradication efforts began and focused on house spraying with residual insecticides, antimalarial drug treatment, and surveillance, and would be carried out in 4 successive steps: preparation, attack, consolidation, and maintenance. Successes included eradication in nations with temperate climates and seasonal malaria transmission. Some countries such as India and Sri Lanka had sharp reductions in the number of cases, followed by increases to substantial levels after efforts ceased. Other nations had negligible progress (such as Indonesia, Afghanistan, Haiti, and Nicaragua). Some nations were excluded completely from the eradication campaign (most of sub-Saharan Africa). The emergence of drug resistance, widespread resistance to available insecticides, wars and massive population movements, difficulties in obtaining sustained funding from donor countries, and lack of community participation made the long-term maintenance of the effort untenable. Completion of the eradication campaign was eventually abandoned to one of control.

HTH,
Jim

Tim Lambert's endless sniffing out and lambasting of those who claim somewhat inaccurately that DDT has been banned worldwide (instead of just de jure in the USA and de facto elsewhere) whilst himself demanding that there should be a ban seems more than a little perverse. Lambert has also claimed that the attempt by Roger Bate's Africa Fighting Malaria to secure a commitment by the USA to spend at least a third of its Malaria budget on use of DDT amounts to genocide of African infants, but using that kind of persiflage one might as well claim that Lambert's advocacy of just bednets as a sufficient panacea against malaria also amounts to genocide of adult African who do not spend all night in bed.

But to try and inject some economics into the pros and cons of DDT usage for wall spraying vis vis bednets treated with some other insecticide, the following data derived from the Report of the UN Secretary General's Millennium Project's Malaria Task Force (Coming to grips with malaria in the new millennium, Awash Teklehaimanot, foreword by Jeffrey Sachs, Earthscan, London and Sterling, Va.) seem pertinent. The data is for two vector control programs in Ethiopia, one to protect about 30 million people who are 60% of the total population at risk in unstable transmission areas, and the other to protect just 15 million persons "eligible" for bednets (by virtue of age and weight, i.e. infants) out of the total population at risk of 49.7 million in the program's "unstable" area. The cost for house-spraying for the 30 million in this program is US$108 million, or $3.62 per capita; the cost of bednets for the eligible children of all 49.7 million people in the project area is $28 million, or $1.89 per child. Harsh money talk, as 40% of parents of children with bednets as well as all their non-eligible children will not be protected by house spraying. Surely the humane and ethical approach is to aim for total coverage by both spraying and bednets? Bednetted children whose parents die of malaria will not have an easy start in life.

As a footnote, check out Roger Bate et al in Lambert's favourite medical journal, The Lancet, as summarised by Roger at TCS 26 April 06, where he exposes the dishonesty of the World Bank's own malaria program, when it could if it chose easily provide well directed funding along the lines noted above to ensure 100% coverage by spraying and bednetting.

The UN's Malaria Taskforce Report cited above also notes (p.28) the use of DDT in the Lebombo areas of eastern South Africa and Mozambique to combat the resistance of A. Funestus to pyrethroids (Deltoid's insecticide of choice!)

Tim Lambert's endless sniffing out and lambasting of those who claim somewhat inaccurately that DDT has been banned worldwide (instead of just de jure in the USA and de facto elsewhere) whilst himself demanding that there should be a ban seems more than a little perverse.

Excuse me, just out of curiosity, could you please quote Tim Lambert's "demand" for a DDT ban?

In case anyone is fooled by Tim Curtin: I have never advocated a ban on DDT and I do not think that bed nets are the only thing that should be used. I think that the malariologists should be allowed to choose what works best. Just published April 26 in Malaria Journal

Malaria is a huge public health problem in Africa that is responsible for more than one million deaths annually. In line with the Roll Back Malaria initiative and the Abuja Declaration, Eritrea and other African countries have intensified their fight against malaria. This study examines the impact of Eritrea's Roll Back Malaria Programme: 200-2004 and the effects and possible interactions between the public health interventions in use.MethodsThis study employed cross-sectional survey to collect data from households, community and health facilities on coverage and usage of Insecticide-Treated Nets (ITNs), Indoor Residual Spraying (IRS), larvicidal activities and malaria case management. Comparative data was obtained from a similar survey carried out in 2001. Data from the Health Management Information System (HMIS) and reports of the annual assessments by the National Malaria Control Programme was used to assess impact. Time series model (ARIMA) was used to assess association.ResultsIn the period 2000-2004, approximately 874,000 ITNs were distributed and 13,109 health workers and community health agents were trained on malaria case management. In 2004, approximately 81% households owned at least one net, of which 73% were ITNs and 58.6% of children 0-5 years slept under a net. The proportion of malaria cases managed by community health agents rose from 50% in 1999 to 78% in 2004. IRS coverage increased with the combined amount of DDT and Malathion used rising from 6,444 kg, in 2000 to 43,491 kg, in 2004, increasing the population protected from 117,017 to 259,420. Drug resistance necessitated regimen change to chloroquine plus sulfadoxine-pyrimethamine. During the period, there was a steep decline in malaria morbidity and case fatality by 84% and 40% respectively. Malaria morbidity was strongly correlated to the numbers of ITNs distributed (SZ=-0.125, p<0.005) and the amount (kg) of DDT and Malathion used for IRS (SZ =-2.352, p<0.05). The correlation between malaria case fatality and ITNs, IRS, population protected and annual rainfall was not statistically significant.ConclusionEritrea has within 5 years attained key Roll Back Malaria targets. ITNs and IRS contributed most to reducing malaria morbidity.

As I recall, on March 27th Tim Curtin remarked that

Tim Lambert [referred to this report], which clearly he regards as one of those tablets brought down to Moses/Mohammed.

then launched into a hilariously misinformed comment accusing GISS of neglecting the UHI effect.

A day later, he objected to

... the cavalier way issues of life and death are dealt with by Tim Lambert and others here - as a computer scientist he seems too quick to warrant eg that all non-DDT pesticides are non-toxic and that thimeresol has no side-effects or risks.

and posted several requests for readily available information he hadn't bothered to look up himself.

Now, he accuses Tim L. of

... endless sniffing out and lambasting of those who claim somewhat inaccurately that DDT has been banned worldwide (instead of just de jure in the USA and de facto elsewhere) whilst himself demanding that there should be a ban ...

which would seem to anyone who has followed these threads to come from some alternate universe.

Is it just me, or is there a pattern emerging here? There is, after all, a difference between principled devil's advocacy and simple trolling.

More of this crap here -- which unfortunately made it into Carnival of the Vanities 188 -- which I read because one of you seed bloggers posted about it...

http://www.tmhbaconbits.net/2006/04/23/greens-passive-genocide/

"Greens Hate Blacks" is the preposterous title.

"DDT has been banned worldwide (instead of just de jure in the USA and de facto elsewhere)"

except for where it is in use, of course.

"whilst himself demanding that there should be a ban"

If one thinks there really is a ban, how can he perceive that somebody else is demanding that one be instituted?

>If one thinks there really is a ban, how can he perceive that somebody else is demanding that one be instituted?

You expect logic from someone who asserts there's a de facto ban then goes on to describe the results of a spraying program using the allegedly banned substance?

"You expect logic from someone who asserts there's a de facto ban then goes on to describe the results of a spraying program using the allegedly banned substance?"

I was recently debating on Wikipedia with someone who was deploring the DDT ban, and in response to my "what ban?", argued that there didn't have to be an official ban to restrict use, using as an example his restricting his food intake. I guess that would be another example of a de facto ban, then, on food. I confess, I just haven't got the intellectual capacity to grasp it.

http://www.nationalreview.com/comment/coticelli_schwab200604270701.asp

Thanks dumbcisco! I got 5 boxes in [DDT Ban Myth Bingo](http://timlambert.org/2005/12/ddt-ban-myth-bingo/) on your article, but alas, not four in a row.

Z: as I've said before, you can't buy penicillin over the counter withotu a prescription.

I wodner how many trillions of deaths that "de facto ban" has allegedly caused?

Do you reckon there's more money to be made from your angle of attack on modern times than from an environmentalist's, dumbcisco? That'd be nice work eh!

Hmmm - do you think snake oil salesmen and quacks have always made easier money than those honest folk who've struggled to disabuse the buying public of their ill-placed faith in the panaceas and nostrums of the charlatans? For that matter - has honest work ever paid as well as spinning for those big company bucks? "Hell no!" I'd think.

Ron says:

Malaria was almost eradicated in the early 1960s--from the whole earth. The number of cases registered by health authorities were at a historic low and eradication seemed within our grasp. This was done largely without pesticides

What are you talking about? This was precisely when people were using massive amounts of DDT.

Also, from Lambert's second link:

Fromom the outset, pyrethroids were identified as the insecticide to be used in the spraying component of the LSDI. However, with the discovery of high levels of pyrethroid resistance in An. funestus, meetings were held with the RMCC, national and international experts to recommend an alternative to the use of this family of insecticides. Based on scientific data, it was unanimously agreed the best course of action would be to use DDT. In the light of Mozambique not agreeing to the use of DDT, an alternative recommendation was that a carbamate such as Bendiocarb be used.

So. The unanimous scientific choice is to use DDT. But they don't, and instead go with a more expensive insecticide... now why would that be, I wonder?

tc:

So. The unanimous scientific choice is to use DDT. But they don't, and instead go with a more expensive insecticide... now why would that be, I wonder?

Why don't you tell us? I assume you have been in communication with the government of Mozambique in order to determine their rationale.

TC, Ron is referring to the fact that Malaria was elminated from most of Europe and most of North America prior to World War II and the introduction of World War II.

I would call the World Bank refusing to loan to countries who will not ban DDT a defacto ban. Wouldn't you? Many countries have banned the use of DDT. It's known to kill malaria-causing instects and has been shown by the WHO to be safe for use around humans. Are they in on the scam to get chemical companies rich, too? Ever hear of ALAR, folks? Perfectly safe, but banned because environmentalists freaked out that people were daring to use science and intelligence to raise better crops. We can't have that!

I would call your claim that the World Bank refuses to loan to countries that don't ban DDT a fabrication. In fact, the World Bank funds DDT use in [India, Madagascar and the Solomon Islands](http://timlambert.org/2005/08/ddt11/).

Belatedly refuting an old lie repeated above about Alar, this article describes how it's being used again recently in the general push to diminish government public health regulations.

July 2005, Vol 95, No. S1
American Journal of Public Health S81-S91
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.044818
PUBLIC HEALTH MATTERS
Regulatory Parallels to Daubert: Stakeholder Influence, "Sound Science," and the Delayed Adoption of Health-Protective Standards
http://www.ajph.org/cgi/content/full/95/S1/S81