Good news about malaria

The Washington Post reports:

Long-lasting, insecticide-treated mosquito nets should be distributed free, rapidly and widely in malaria-endemic areas, World Health Organization officials said here Thursday, setting new guidelines for fighting the mosquito-borne disease around the globe.

For years, a policy debate has raged not so much over the effectiveness of mosquito nets in preventing the disease, but over how best to distribute them. ...

Thursday's announcement "ends the debate" over which method is best, said Arata Kochi, director of WHO's global malaria program. "No longer should the safety and well-being of your family be based upon whether you are rich or poor," Kochi said in a statement. "When insecticide treated mosquito nets are easily available for every person, young or old, malaria is reduced." ...

The WHO announcement was paired with what Kochi called "impressive" findings by Kenyan health authorities that widespread, free distribution of mosquito nets can effectively save children's lives.

After several years of using a combination of free distribution and sales, the Kenyan government last year conducted a massive, almost military-style campaign to distribute without charge 3.4 million insecticide-treated mosquito nets over three days in 46 malaria-endemic districts across the country.

Among a monitored group of 3,500 children in four of those districts, the number sleeping under the nets increased nearly tenfold from 2004 to 2006, WHO said, citing Kenyan government figures. The result was 44 percent fewer deaths than among children not sleeping under nets.

In light of this and other new evidence, the WHO seems to have reversed the policy it adopted last year of indoor residual spraying (IRS) in high-transmission areas. They now say:

Use of ITNs is one of the most cost-effective interventions against
malaria. In a recent analysis of the cost of five ITN and two IRS
programmes in Africa, LLINs were found to be significantly cheaper to
use than conventionally treated nets. The cost per death averted and
the cost per DALY averted with LLINs lasting three years were less
than half the comparable costs using conventional ITNs. The findings
of the study also suggest that, in high-transmission areas where most
of the malaria burden occurs in children under five years, and
assuming it is possible to effectively target LLINs to this population
group, the use of LLINs is 4 to 5 times cheaper than IRS which cannot
be targeted to children only. Average annual cost per LLIN was US$
2.10 (1.48-2.64), equivalent to US$ 1.05 per person protected per
year, compared with US$ 3.60 per person protected per year for IRS
(calculated for the whole population) (Yukich, Lengeler et al.,
submitted)

Good news about malaria and a major change in policy from the WHO. But although they reported the WHO's policy change last year, the New York Times did not mention this at all. Instead, they've run an op-ed from Donald Roberts, pushing the use of 1940s technology, DDT. Roberts oversells his study on the repellent effects of DDT. He may be right that mosquitoes will develop resistance to more effective insecticides more quickly than they will to DDT, but the implication of this is not that DDT should be used first, but that the more effective insecticide should be used first and DDT kept as a backup.

The WHO is confident that we now have a way to drastically cut malaria rates and save millions of lives, but the NYT's fetish about DDT seems to have stopped them from mentioning this.