Africa Fighting Malaria claims to be fighting malaria


In response to earlier analysis here, that Africa Fighting Malaria (AFM) does not appear to do much to fight malaria, Richard Tren wrote a comment to a post at TropIKA.

Tren is unlikely to respond here; I gather he does not want to answer questions.

I will comment more completely later — I’m still not sure just what AFM does to fight malaria.  It’s humorous that he calls my question an “ad hominem” attack; I ask the questions because Tren has led the fight in the unholy smear campaign against Rachel Carson, against the U.S. Fish and Wildlife Service, against dozens of other scientists and science itself, against saving the bald eagle, against wise use of pesticides, against bed nets, against fighting malaria other than poisoning Africa. Most recently, as Tren mentions, he published a book that repeats much of the inaccurate claims and hoaxes he has relied on before.  But he’s concerned about attacks on him personally, and not the substance.

Why am I concerned at all?  The AFM-led assault on the World Health Organization, Rachel Carson, malaria fighters in public health, scientists and environmentalists  has come at an extremely high cost in human life. It is impossible to know how many people have died needlessly from malaria, yellow fever, leishmaniasis, dengue fever and other insect-borne diseases in the absence of medical care or prevention programs in lieu of DDT, but it must be millions — many of them could have been saved but for policy-makers’ beliefs that an increase in DDT could poison these people to health quickly and cheaply.  The campaign in favor of DDT has hampered serious efforts to fight malaria especially, such as Nothing But Nets and USAID’s support for prophylactic measures to beat the disease.

Does Tren answer the question well, what does AFM actually do to fight malaria?

Help me find some substance here in Tren’s letter (unedited by me in any way):

Paul,

It’s hard to know whether or not to respond to this. To say that we are ‘under fire’ because of the sniping and ad-hominem attacks from a blogger who has, for some or other reason, decided to take issue with my organization is an exaggeration to say the least. However even though your post has so far received zero comments I’d like to make a few things clear for the record.

AFM was founded in South Africa in 2000 and we opened an office in the United States in 2003. We maintain an office and a presence in South Africa as well as an office in the Washington DC. You say that we have focused most of our attention on one issue – the desirability of using DDT in mosquito control programs. Actually we focus on malaria control programs, not mosquito control programs; but to an extent you are correct. We have focused on this issue because DDT continues to play an important role in malaria control in many southern African programs (and in some other countries) and over the years other countries, such as Uganda have attempted to use DDT but have been harshly criticized and domestic and international groups forcing DDT spraying programs to close down. AFM defends DDT because of its outstanding record in saving lives and because it is under attack. The scare stories and smear campaigns against this insecticide are so pervasive and the misunderstanding about it so widespread that it is vital for some group or individual to provide a counterbalance, based on sound science.

AFM was a critical voice in securing an exemption for the use of DDT in the Stockholm Convention, and our research and advocacy work helped to usher in far-reaching reforms to US support for malaria control. We recently published a major book on DDT and its role in malaria control – The Excellent Powder – see http://www.excellentpowder.org. Additionally, we have responded to several recent publications that seek to limit the use of DDT (and interestingly other insecticides such as pyrethroids), with letters in Environmental Health Perspectives, British Journal of Urology International and working papers published on our own website. We have publicly exposed and criticized the way in which anti-insecticide advocacy groups, like Pesticide Action Network, have lobbied against indoor residual spraying programs that are funded and maintained by the President’s Malaria Initiative (PMI). All of these letters and papers can be accessed from our website – if any of your readers have any difficulty in accessing them, I’d be happy to forward them.

A word on our critical review of a paper published in British Journal of Urology International. Several researchers from the University of Pretoria published a paper in late 2009 claiming that DDT use in IRS would increase the chance that a boy would be born with a urogenital birth defect by around 33%. This paper was widely covered in the media and caused considerable problems for the malaria control programs in southern Africa. One scientist in particular even claimed on a public TV program that DDT was linked to the case of intersex South African athlete, Caster Semenya; this was further promoted in the print media causing great concern among people living in malaria areas. As we documented in our review, the research paper was very deeply flawed and the conclusions of the authors were premature to say the least. Although it required a considerable investment of time and effort, we respond with a formal review of both the paper and the outrageous claims made in the media for which there was no scientific evidence. Our letter to the journal, which was co-authored by some senior malaria scientists from South Africa, was published in the journal. Although the authors of the paper were given ample opportunity to respond to our criticisms, they declined – which is telling.

You make the point that we have focused on DDT – true, we have done so because there is a need for someone to respond to the never-ending claims of harm. Someone has to stand up and defend the malaria control programs that are using DDT and implementing effective malaria control measures – perhaps if some of the other advocacy groups or individuals stepped up and helped to defend IRS and the use of public health insecticides, we wouldn’t have to spend so much of our time and energy doing it.

In addition to defending the use of public health insecticides, we strongly advocate for investments in new insecticides and against regulations and policies that may hamper access to insecticides or investment in new insecticides. For instance in 2008/9 we coordinated a response to proposed EU regulation of insecticides that could limit access to insecticides. (The various documents that I describe are available on our website) As an example of our work in this regard, we recently held a successful policy briefing on Capitol Hill (in Washington, D.C.) involving stakeholders from advocacy groups, donor agencies and the private sector. Again details of this are available on our website.

Aside from our advocacy and defense of public health insecticides, we have been successful in exposing the ongoing use of sub-standard malaria medicines as well as fake medicines in Africa. Our research studies have been published in Malaria Journal, PLoS One, and other journals. In order to maintain this project and to get safe and effective malaria medicines out to communities we have raised funds for malaria treatments and have focused on increasing access in Uganda. Again, details are available on our website.

Lastly AFM is involved in a research and advocacy program to remove import tariffs and non-tariff barriers from malaria commodities. As malaria programs are scaled up, it is increasingly important to ensure that barriers to access are removed – import tariffs and non-tariff barriers can be significant and AFM is very excited to be involved in this important area of research and advocacy. See http://www.m-tap.org for more details.

So, I hope that this helps to answer the questions about what we do. We are a policy and research group, we have never pretended to be anything else and our track record stands for itself.

Paul, if you want to have a discussion about our work, I’d be happy to correspond with you and your colleagues on a basis of cordiality and respect. I would be delighted to debate our work on DDT, public health insecticides, drug quality and import tariffs and non-tariff barriers, but let’s leave the sniping bloggers and their misleading and biased comments out of this.

Richard Tren

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