DDT gone from Bangladesh?

Bangladesh said they have gotten rid of DDT and residuals in the nation, a singular achievement in pollution control.

Interesting claim; good news that even one site was cleaned up. Because these international sources tend to disappear from the web in my experience, here is the full text of the story, from IANS, who say they are India’s largest independent news organization.

Photo of a garbage dump in Bangladesh, probably a stock photo. From IANSLive news service.

IANSLive

Dhaka, Jan 9 (IANS) Bangladesh has been declared free from dangerous Dichlorodiphenyltrichloroethane pesticide, commonly known as DDT pesticide.

Bangladeshi Environment, Forest and Climate Change Minister, Md. Shahab Uddin made the announcement at a press conference on Sunday.

The press briefing came after Bangladesh’s successful removal of 500 tons of DDT from a medical sub-depot in Chattogram city, nearly 242 km southeast of the capital Dhaka, in December 2022.

According to the World Health Organisation, DDT is a persistent organic pollutant (POP), a chemical that can have significant negative effects on both human health and the environment, Xinhua news agency reported.

Bangladesh imported 500 metric tons (500,000 kg) of the pesticide in 1985 to control malaria-carrying mosquitos. Upon arrival, it was put into a government compound in the Agrabad district in Chattogram city. Over the years, many of the boxes and bags have disintegrated, leaving exposed piles of the white DDT powder.

In 1991, Bangladesh imposed a DDT ban, but the huge consignment remained.

Under a project titled “Pesticide Risk Reduction in Bangladesh,” the toxic substance was completely exported to France for incineration, according to the Ministry.

–IANS
int/khz/

Update: 09-January-2023

Typewriter of the moment: Rachel Carson’s Royal, investigated by her cat

Beinecke Library at Yale is a repository for Rachel Carson’s papers, and much more.

Including this beguiling photo of Rachel Carson’s cat investigating the typewriter on which she wrote Silent Spring.

Maybe the cat is trying to find where all those beautifully-crafted words came from. Even decades before the internet, cats tortured their humans in the humans’ offices. Royal Typewriter in Rachel Carson’s Maryland house.

Researchers into Rachel Carson should check the on-line holdings of the Beinecke Library.

Tip of the old scrub brush to Yale’s Beinecke Library on Twitter.

Seminal DDT source: Cottam’s 1946 monograph on harms of DDT, USFWS “Circular 11”

Cover of 1946 USFWS publication, Circular 11, “DDT: Its Effect on Fish and Wildlife”

Rachel Carson knew Clarence Cottam, Assistant Director of the U.S. Fish and Wildlife Service (USFWS) and an active researcher. Cottam and Elmer Higgins, Chief of the Division of Fishery Biology at USFWS published a monograph in 1946 on the harms of the then-new insecticide DDT, with suggestions on how to use it more safely. It was an early publication from USFWS, indicated by the title, Circular 11.

Dr. Clarence Cottam, USFWS Assistant Director

This was one of the earliest publications to document harms from DDT across the spectrum of DDT use and the spectrum of wildlife.

Finding the publication in libraries now is difficult. Funding cuts at many libraries encouraged them to throw away materials not heavily used, and this one was not the most popular in most libraries who may have had it.

So when I ran into a .pdf of the circular on a NOAA site, I downloaded it, and I make it available to you here.

In the introduction Cottam and Higgins explain why the monograph was published:

Most organic and mineral poisons are specific to a degree; they do not strike the innumerable animal and plant species with equal effectiveness; if these poisons did, the advantage of control of undesirable species would be more than offset by the detriment to desirable and beneficial forms. DDT is no exception to this rule. Certainly such an effective poison will destroy some beneficial insects, fishes, and wildlife.

The circular said when DDT was used, deaths resulted in mammals, amphibians, birds and fish.

DDT history revisionists are fond now of saying DDT is “harmless” and “safe.” This 1946 publication makes clear that neither is true. While it may take a large dose to cause acute harm to large mammals, like cattle and humans, it is quite deadly to smaller wildlife in all branches.

Cottam and Higgins recommended caution, reducing does of DDT in use, and careful monitoring after use.

Use DDT only where it is needed. Wherever it is applied by airplane, provide careful plane-to-ground control to insure even cover–age and to prevent local overdosage.

In forest-pest control, wherever feasible, leave strips untreated at the first application to serve as undisturbed sanctuaries for wildlife, treating these strips at a later time or in succeeding seasons if necessary.

In the control of early appearing insect pests, apply DDT, if possible, just before the emergence of leaves and the main spring migration of birds; for late appearing pests, delay applications, whenever practicable, past the nesting period of birds. Adjust crop applications and mosquito-control applications so far as possible to avoid the nesting period.

Because of the sensitivity of fishes and crabs to DDT, avoid as far as possible direct application to streams, lakes, and coastal bays.

Wherever DDT is used, make careful before and after observations of mammals, birds, fishes, and other wildlife.

Wildlife scientists were not working blind with DDT after 1946.

Full text of USFWS Circular 11, by Clarence Cottam and Elmer Higgins, 1946.

World Malaria Day was April 25: WHO’s fact sheet

Preparing for World Malaria Day the World Health Organization (WHO) put out a fact sheet on malaria and status of current work to fight it. Technically it’s nothing new — but much of the material is news to the general public who get the politicized versions of the stories.

World Malaria Day 2021 logo from Roll Back Malaria via BioMed Central

WHO’s analysis shows malaria declines, but the rates of decline are not so steep as desired. Developed nations get distracted in providing funds to fight malaria. 2020 was an outstanding year of distraction of the malaria fight, now complicated by spread of COVID-19 viruses.

Notable:

• No call for DDT; pesticide resistance remains a problem, but it’s a problem DDT cannot solve.
• Malaria remains near all-time lows in humans, with 229 million cases worldwide.
• Malaria still kills kids predominantly, and African kids make up most of those deaths.
• 15 years ago there was hope of eradicating malaria from many countries by 2020; that goal will be missed in several nations.

The fact sheet:

Key facts

• Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
• In 2019, there were an estimated 229 million cases of malaria worldwide.
• The estimated number of malaria deaths stood at 409 000 in 2019.
• Children aged under 5 years are the most vulnerable group affected by malaria; in 2019, they accounted for 67% (274 000) of all malaria deaths worldwide.
• The WHO African Region carries a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of malaria cases and deaths.
• Total funding for malaria control and elimination reached an estimated US$ 3 billion in 2019. Contributions from governments of endemic countries amounted to US$ 900 million, representing 31% of total funding.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called “malaria vectors.” There are 5 parasite species that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest threat.

In 2018, P. falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region 50% of cases in the WHO South-East Asia Region, 71% of cases in the Eastern Mediterranean and 65% in the Western Pacific.

P. vivax is the predominant parasite in the WHO Region of the Americas, representing 75% of malaria cases.

Symptoms

Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.

Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ failure is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

Who is at risk?

In 2019, nearly half of the world’s population was at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk.

Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances.

Disease burden

According to the latest  World malaria report, released on 30 November 2020, there were 229 million cases of malaria in 2019 compared to 228 million cases in 2018. The estimated number of malaria deaths stood at 409 000 in 2019, compared with 411 000 deaths in 2018.

The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of all malaria cases and deaths.

In 2019, 6 countries accounted for approximately half of all malaria deaths worldwide: Nigeria (23%), the Democratic Republic of the Congo (11%), United Republic of Tanzania (5%), Burkina Faso (4%), Mozambique (4%) and Niger (4% each).

Children under 5 years of age are the most vulnerable group affected by malaria; in  2019  they accounted for 67% (274 000) of all malaria deaths worldwide.

Transmission

In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species bite between dusk and dawn. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of fresh water, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries.

Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world’s malaria cases are in Africa.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Prevention

Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.

WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

Insecticide-treated mosquito nets

Sleeping under an insecticide-treated net (ITN) can reduce contact between mosquitoes and humans by providing both a physical barrier and an insecticidal effect. Population-wide protection can result from the killing of mosquitoes on a large scale where there is high access and usage of such nets within a community.

In 2019, an estimated 46% of all people at risk of malaria in Africa were protected by an insecticide-treated net, compared to 2% in 2000. However, ITN coverage has been at a standstill since 2016.Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is another powerful way to rapidly reduce malaria transmission. It involves spraying the inside of housing structures with an insecticide, typically once or twice per year. To confer significant community protection, IRS should be implemented at a high level of coverage.

Globally, IRS protection declined from a peak of 5% in 2010 to 2% in 2019, with decreases seen across all WHO regions, apart from the WHO Eastern Mediterranean Region. The declines in IRS coverage are occurring as countries switch from pyrethroid insecticides to more expensive alternatives to mitigate mosquito resistance to pyrethroids.

Antimalarial drugs

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends at least 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

Since 2012, WHO has recommended seasonal malaria chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Since 2000, progress in malaria control has resulted primarily from expanded access to vector control interventions, particularly in sub-Saharan Africa. However, these gains are threatened by emerging resistance to insecticides among Anopheles mosquitoes.  According to the latest  World malaria report, 73 countries reported mosquito resistance to at least 1 of the 4 commonly-used insecticide classes in the period 2010-2019. In 28 countries, mosquito resistance was reported to all of the main insecticide classes.

Despite the emergence and spread of mosquito resistance to pyrethroids, insecticide-treated nets continue to provide a substantial level of protection in most settings. This was evidenced in a  large 5-country study coordinated by WHO between 2011 and 2016.

While the findings of this study are encouraging, WHO continues to highlight the urgent need for new and improved tools in the global response to malaria. To prevent an erosion of the impact of core vector control tools, WHO also underscores the critical need for all countries with ongoing malaria transmission to develop and apply effective insecticide resistance management strategies.

Diagnosis and treatment

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).

WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 30 minutes or less. Treatment, solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the third edition of the “WHO Guidelines for the treatment of malaria”, published in April 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum malaria parasites to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.

Protecting the efficacy of antimalarial medicines is critical to malaria control and elimination. Regular monitoring of drug efficacy is needed to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance.

In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong subregion (GMS), a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.

At the World Health Assembly in May 2015, WHO launched the  Strategy for malaria elimination in the Greater Mekong subregion (2015–2030), which was endorsed by all the countries in the subregion. Urging immediate action, the strategy calls for the elimination of all species of human malaria across the region by 2030, with priority action targeted to areas where multidrug resistant malaria has taken root.

With technical guidance from WHO, all countries in the region have developed national malaria elimination plans. Together with partners, WHO is providing ongoing support for country elimination efforts through the Mekong Malaria Elimination programme, an initiative that evolved from the ERAR

Surveillance

Surveillance entails tracking of the disease and programmatic responses, and taking action based on the data received. Currently, many countries with a high burden of malaria have weak surveillance systems and are not in a position to assess disease distribution and trends, making it difficult to optimize responses and respond to outbreaks.

Effective surveillance is required at all points on the path to malaria elimination. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

In March 2018, WHO released a  reference manual on malaria surveillance, monitoring and evaluation, monitoring and evaluation. The manual provides information on global surveillance standards and guides countries in their efforts to strengthen surveillance systems.

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required once eradication has been achieved.

Globally, the elimination net is widening, with more countries moving towards the goal of zero malaria. In 2019, 27 countries reported fewer than 100 indigenous cases of the disease, up from 6 countries in 2000.

Countries that have achieved at least 3 consecutive years of 0 indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Over the last two decades, 11 countries have been certified by the WHO Director-General as malaria-free: United Arab Emirates (2007),  Morocco (2010), Turkmenistan (2010), Armenia (2011), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019), Argentina (2019) and El Salvador (2021). The WHO Framework for malaria elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination. In January 2021, WHO published a new manual, Preparing for certification of malaria elimination, with extended guidance for countries that are approaching elimination or preparing for elimination certification.

Vaccines against malaria

RTS,S/AS01 (RTS,S) is the first and, to date, the only vaccine to show that it can significantly reduce malaria, and life-threatening severe malaria, in young African children. It acts against P. falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria over a 4-year period.

In view of its public health potential, WHO’s top advisory bodies for malaria and immunization have jointly recommended phased introduction of the vaccine in selected areas of sub-Saharan Africa. Three countries – Ghana, Kenya and Malawi – began introducing the vaccine in selected areas of moderate and high malaria transmission in 2019. Vaccinations are being provided through each country’s routine immunization programme.

The pilot programme will address several outstanding questions related to the public health use of the vaccine. It will be critical for understanding how best to deliver the recommended 4 doses of RTS,S; the vaccine’s potential role in reducing childhood deaths; and its safety in the context of routine use.

This WHO-coordinated programme is a collaborative effort with Ministries of Health in Ghana, Kenya and Malawi and a range of in-country and international partners, including PATH, a non-profit organization, and GSK, the vaccine developer and manufacturer.

Financing for the vaccine programme has been mobilized through a collaboration between 3 major global health funding bodies: Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid.

WHO response

WHO Global technical strategy for malaria 2016-2030

The WHO  Global technical strategy for malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:

• reducing malaria case incidence by at least 90% by 2030;
• reducing malaria mortality rates by at least 90% by 2030;
• eliminating malaria in at least 35 countries by 2030;
• preventing a resurgence of malaria in all countries that are malaria-free.

This Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States.

The Global Malaria Programme

The  WHO Global Malaria Programme coordinates WHO’s global efforts to control and eliminate malaria by:

• setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
• keeping independent score of global progress;
• developing approaches for capacity building, systems strengthening, and surveillance; and
• identifying threats to malaria control and elimination as well as new areas for action.

The Programme is supported and advised by the Malaria Policy Advisory Committee (MPAC), a group of global malaria experts appointed following an open nomination process. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy-setting process.

“High burden high impact approach”

At the World Health Assembly in May 2018, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, called for an aggressive new approach to jump-start progress against malaria. A new country-driven response – “  High burden to high impact” – was launched in Mozambique in November 2018.

The approach is currently being driven by the 11 countries that carry a high burden of the disease (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania). Key elements include:

1. political will to reduce the toll of malaria;
2. strategic information to drive impact;
3. better guidance, policies and strategies; and
4. a coordinated national malaria response.

Catalysed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be prevented and diagnosed, and that is entirely curable with available treatments.

World Malaria Report 2020: Governments fell short of pledges, malaria poised to make a comeback.

World Malaria Report 2020 carries bad news. Despite remarkable progress against malaria, despite being on the verge of beating the disease and eradicating it from the planet, governments stopped supporting anti-malaria work.

Malaria is poised to come roaring back to kill millions.

COVID-19 complicates fighting malaria. But the real enemy of the fight against malaria is apathy, neglect and ignorance.

Cover of World Malaria Report 2020, WHO’s annual accounting of the fight to eradicate malaria.

Below, the full press release from the World Health Organization (WHO) on the 2020 accounting of the war against malaria.

____________________________

WHO calls for reinvigorated action to fight malaria

Global malaria gains threatened by access gaps, COVID-19 and funding shortfalls

30 November 2020

News release

Reading time: 6 min (1645 words)

The World Health Organization (WHO) is calling on countries and global health partners to step up the fight against malaria, a preventable and treatable disease that continues to claim hundreds of thousands of lives each year. A better targeting of interventions, new tools and increased funding are needed to change the global trajectory of the disease and reach internationally-agreed targets.

According to WHO‘s latest World malaria report, progress against malaria continues to plateau, particularly in high burden countries in Africa. Gaps in access to life-saving tools are undermining global efforts to curb the disease, and the COVID-19 pandemic is expected to set back the fight even further.

“It is time for leaders across Africa – and the world – to rise once again to the challenge of malaria, just as they did when they laid the foundation for the progress made since the beginning of this century,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Through joint action, and a commitment to leaving no one behind, we can achieve our shared vision of a world free of malaria.”

In 2000, African leaders signed the landmark Abuja Declaration pledging to reduce malaria deaths on the continent by 50% over a 10-year period. Robust political commitment, together with innovations in new tools and a steep increase in funding, catalyzed an unprecedented period of success in global malaria control. According to the report, 1.5 billion malaria cases and 7.6 million deaths have been averted since 2000.

A plateau in progress

In 2019, the global tally of malaria cases was 229 million, an annual estimate that has remained virtually unchanged over the last 4 years. The disease claimed some 409 000 lives in 2019 compared to 411 000 in 2018.

As in past years, the African Region shouldered more than 90% of the overall disease burden. Since 2000, the region has reduced its malaria death toll by 44%, from an estimated 680 000 to 384 000 annually. However, progress has slowed in recent years, particularly in countries with a high burden of the disease.

A funding shortfall at both the international and domestic levels poses a significant threat to future gains. In 2019, total funding reached US $3 billion against a global target of $5.6 billion. Funding shortages have led to critical gaps in access to proven malaria control tools.

COVID-19 an added challenge

In 2020, COVID-19 emerged as an additional challenge to the provision of essential health services worldwide. According to the report, most malaria prevention campaigns were able to move forward this year without major delays. Ensuring access to malaria prevention – such as insecticide-treated nets and preventive medicines for children – has supported the COVID-19 response strategy by reducing the number of malaria infections and, in turn, easing the strain on health systems. WHO worked swiftly to provide countries with guidance to adapt their responses and ensure the safe delivery of malaria services during the pandemic.

However, WHO is concerned that even moderate disruptions in access to treatment could lead to a considerable loss of life. The report finds, for example, that a 10% disruption in access to effective antimalarial treatment in sub-Saharan Africa could lead to 19 000 additional deaths. Disruptions of 25% and 50% in the region could result in an additional 46 000 and 100 000 deaths, respectively.

“While Africa has shown the world what can be achieved if we stand together to end malaria as a public health threat, progress has stalled,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “COVID-19 threatens to further derail our efforts to overcome malaria, particularly treating people with the disease. Despite the devastating impact COVID-19 has had on African economies, international partners and countries need to do more to ensure that the resources are there to expand malaria programmes which are making such a difference in people’s lives.”

WHO response

A key strategy to reignite progress is the “High burden to high impact” (HBHI) response, catalyzed in 2018 by WHO and the RBM Partnership to End Malaria. The response is led by 11 countries – including 10 in sub-Saharan Africa – that account for approximately 70% of the world’s malaria burden.

Over the last 2 years, HBHI countries have been moving away from a “one-size-fits all” approach to malaria control – opting, instead, for tailored responses based on local data and intelligence. A recent analysis from Nigeria, for example, found that through an optimized mix of interventions, the country could avert tens of millions of additional cases and thousands of additional deaths by the year 2023, compared to a business-as-usual approach.

While it is too early to measure the impact of the HBHI approach, the report finds that deaths in the 11 countries were reduced from 263 000 to 226 000 between 2018 and 2019.  India continued to make impressive gains, with reductions in cases and deaths of 18% and 20%, respectively, over the last 2 years. There was, however, a slight increase in the total number of cases among HBHI countries, from an estimated 155 million in 2018 to 156 million in 2019.

Meeting global malaria targets

This year’s report highlights key milestones and events that helped shape the global response to the disease in recent decades. Beginning in the 1990s, leaders of malaria-affected countries, scientists and other partners laid the groundwork for a renewed malaria response that contributed to one of the biggest returns on investment in global health.

According to the report, 21 countries eliminated malaria over the last 2 decades; of these, 10 countries were officially certified as malaria-free by WHO. In the face of the ongoing threat of antimalarial drug resistance, the 6 countries of the Greater Mekong subregion continue to make major gains towards their goal of malaria elimination by 2030.

But many countries with a high burden of malaria have been losing ground.  According to WHO global projections, the 2020 target for reductions in malaria case incidence will be missed by 37% and the mortality reduction target will be missed by 22%.

Note to editors

WHO’s work on malaria is guided by the Global technical strategy for malaria 2016-2030 (GTS), approved by the World Health Assembly in May 2015. The strategy includes four global targets for 2030, with milestones along the way to track progress. The 2030 targets are: 1) reducing malaria case incidence by at least 90%; 2) reducing malaria mortality rates by at least 90%; 3) eliminating malaria in at least 35 countries; and
4) preventing a resurgence of malaria in all countries that are malaria-free.

Near-term GTS milestones for 2020 include global reductions in malaria case incidence and death rates of at least 40% and the elimination of malaria in at least 10 countries. According to the report, the 2020 milestones for malaria case incidence and mortality rates will be missed:
– Case incidence:  WHO projects that, in 2020, there were an estimated 56 malaria cases for every 1000 people at risk of the disease against a GTS target of 35 cases. The GTS milestone will be missed by an estimated 37%.
– Mortality rate: The estimate for globally projected malaria deaths per 100 000 population at risk was 9.8 in 2020 against a GTS target of 7.2 deaths. The milestone will be missed by an estimated 22%.

WHO African Region – Since 2014, the rate of progress in both cases and deaths in the region has slowed, attributed mainly to the stalling of progress in several countries with moderate or high transmission. In 2019, six African countries accounted for 50% of all malaria cases globally: Nigeria (23%), the Democratic Republic of the Congo (11%), United Republic of Tanzania (5%), Niger (4%), Mozambique (4%) and Burkina Faso (4%). In view of recent trends, the African Region will miss the GTS 2020 milestones for case incidence and mortality by 37% and 25%, respectively.

 “High burden to high impact” (HBHI) – Launched in November 2018, HBHI builds on the principle that no one should die from a disease that is preventable and treatable. It is led by 11 countries that, together, accounted for approximately 70% of the world’s malaria burden in 2017: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania. Over the last two years, all 11 HBHI countries have implemented activities across four response elements: 1) political will to reduce the toll of malaria; 2) strategic information to drive impact; 3) better guidance, policies and strategies; and 4) a coordinated national malaria response

Malaria elimination – Between 2000 and 2019, 10 countries received the official WHO certification of malaria elimination: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Kyrgyzstan (2016), Sri Lanka (2016), Uzbekistan (2018), Paraguay (2018), Argentina (2019) and Algeria (2019). In 2019, China reported zero indigenous cases of malaria for the third consecutive year; the country recently applied for the official WHO certification of malaria elimination. In 2020, El Salvador became the first country in Central America to apply for the WHO malaria-free certification

In the six countries of the Greater Mekong subregion – Cambodia, China (Yunnan Province), Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – the reported number of malaria cases fell by 90% from 2000 to 2019, while P. falciparum (Pf) cases fell by 97% in the same time period. This accelerated decrease in Pf malaria is notable in view of the threat posed by antimalarial drug resistance in the subregion.

A call for innovation – Eliminating malaria in all countries, especially those with a high disease burden, will likely require tools that are not available today. In September 2019, the WHO Director-General issued a “malaria challenge,” calling on the global health community to ramp up investment in the research and development of new malaria-fighting tools and approaches. This message was further reinforced in the April 2020 report of the WHO Strategic advisory group on malaria eradication.

Ruckelshaus, Sweeney and DDT – rescued from the archives, for the record

Years ago Jim Easter tracked down the actual decision document from EPA’s Administrative Law Judge Edmund Sweeney, in which detailed his findings from the months of hearings at EPA on whether to pull registration as a pesticide from DDT.

Masthead and first few sentences of Jim Easter’s late, lamented blog Some Are Boojums, and his 2007 post on EPA Administrative Law Judge Edmund Sweeney’s decision on DDT labels after several months and 9,000 pages of hearings.

It was great sleuthing, taking him through several EPA regional libraries, for a document that just falls into the cracks of most history of environmental law, DDT and regulation.

Jim posted the document at his blog, Some Are Boojums, and linked to his .pdf of the document. A great historical record.

Then his blog went out of commission, then it came back. And now, it’s gone again.

Meanwhile, I’d linked to the post, and have over the years sent a few hundred people to the old blog to find the .pdf and read Jim’s write-up of EPA’s hearings, findings and effects.

Some time in the late-Bush/early-Obama years EPA posted a copy of Judge Sweeney’s decision. That disappeared with the Trump administration, and I’ve not found it anywhere.

So to defend myself, make linking easier, and to aid any stray researchers who are having difficulty finding Judge Sweeney’s real decision, perhaps to debunk the pro-DDT lobbyists’ shouting that Sweeney said DDT is perfectly safe and should be used to bath every newborn, I’ve recaptured Jim Easter’s post from Some Are Boojums, and put it all here.

Warning: I’ve not rejiggered any links. I suspect many of them have gone sour. I may come back to fix a few, but you should know that at one time they all worked well.

Comments were quite lively, but I haven’t quite figured out how to post them; that may come later, or it may not.

Judge Sweeney’s decision? Full text here: Sweeney decision.

After all that ado, here’s Jim Easter’s post:
______________________________________________________________

Ruckelshaus, Sweeney and DDT

On June 2nd, 1972, William D. Ruckelshaus, Administrator of the Environmental Protection Agency, issued an order effectively ending the agricultural use of DDT in the US.

Thirty-five years later, that order is still the subject of fierce controversy.

One claim often made by proponents of renewed DDT use is that Ruckelshaus’ decision was capricious and unsupported by the evidence — specifically, that he acted in willful disregard of his own hearing examiner’s findings. For example, in a post co-authored^[1] with the late J. Gordon Edwards, Steven Milloy states that Ruckelshaus “ignored the decision of his own administrative law judge.”^[2]

Milloy’s distortion of the history and science surrounding DDT is shameless, and deserves to be the subject of a separate post. But let’s stick with the Ruckelshaus order for now.

Did Ruckelshaus ignore the conclusions of his hearing examiner? You’d think, since this claim is made so relentlessly by DDT advocates, that we could find the relevant document somewhere on the Web. But it’s not that easy. Ruckelshaus’ order itself is readily available (see below for a more readable copy), but the hearing examiner’s findings … not so much. The document is sometimes cited as “Sweeney, E.M., 1972. ‘EPA Hearing Examiner’s Recommendations and Findings Concerning DDT Hearings,’ April 25, 1972. 40 CFR 164.32.” — which helps a bit, but only a bit, since “40 CFR 164.32″ is just the Federal Regulation governing administrative hearings at EPA. Anyone who offers that to you as an actual cite for the opinion is blowing smoke. A better cite is the one given in the order, viz.: “Stevens Industries, Inc. et al., I.F&R. Docket Nos. 63 et al. (Consolidated DDT Hearings)”. But even that will not get you anything online. EPA does give its Decisions and Orders online, but only back to 1989. A good deal of fruitless searching convinced me that the Sweeney opinion would not be mine with the click of a mouse; it was old-school or nothing. After several weeks, a dozen or so phone calls and the help of some very nice university librarians, I was able to get my hooks on all 173 glorious manually typewritten pages of Edmund M. Sweeney’s “Recommended Findings, Conclusions and Orders.”

Here it is. (56 Mb pdf!) EPA’s librarians indicated that they would not post it online, because of the wretched quality. I’m not so picky. While we’re at it, here is a (slightly) more readable copy of Ruckelshaus’ order.
(UPDATE: See ^[4] below.)

The following are some of the more notable things we can observe if we look at both documents:

Did Sweeney’s findings generally support the Petitioners (DDT registrants)?

Yes. Sweeney found no evidence to indicate that DDT causes mutations or birth defects in humans, considered the evidence for DDT’s carcinogenicity in humans to be inconclusive, and, though he found that DDT is harmful to wildlife, he deemed that harm to be outweighed by DDT’s value as a pesticide. Sweeney’s findings of fact are summarized in pages 91-92, and his conclusions of law in pages 93-94. Milloy quotes (#17) part of those conclusions:

The EPA hearing examiner, Judge Edmund Sweeney, concluded that “DDT is not a carcinogenic hazard to man… DDT is not a mutagenic or teratogenic hazard to man… The use of DDT under the regulations involved here do not have a deleterious effect on freshwater fish, estuarine organisms, wild birds or other wildlife.”

That partial quote is misleading. Sweeney also found (p. 92) that

20. DDT can have a deleterious effect on freshwater fish and estuarine organisms when directly applied to the water.

21. DDT is used as a rodenticide.

22. DDT can have an adverse effect on beneficial animals.

23. DDT is concentrated in organisms and can be transferred through food chains.

It is not true that Sweeney found no harm caused by DDT. Rather, he found that, using a “preponderance of the evidence” test, DDT users and USDA had shown that DDT’s usefulness to agriculture outweighed the demonstrated harm.

Did Ruckelshaus ignore Sweeney’s opinion?

No, but he disagreed with substantial portions of it. Ruckelshaus quotes extensively from Sweeney’s opinion, including the findings of fact and conclusions of law noted above. He repeats arguments made by the petitioners, and describes how he differs. Choosing one example:

Group Petitioners and USDA argue that the laboratory feeding studies, conducted with exaggerated doses of DDE and under stress conditions, provide no basis for extrapolating to nature.
They suggest that the study results are contradictory and place particular emphasis on documents which were not part of the original record and the inconsistencies in Dr. Heath’s testimony as brought out during cross-examination. Group Petitioners also contend that the observed phenomenon of eggshell thinning and DDE residue data are tied by a statistical thread too slender to connect the two in any meaningful way.

Viewing the evidence as a total picture, a preponderance supports the conclusion that DDE does cause eggshell thinning. Whether or not the laboratory data above would sustain this conclusion is beside the point. For here there is laboratory data and observational data, and in addition, a scientific hypothesis, which might explain the phenomenon.

This is exactly the kind of language that sent J. Gordon Edwards ballistic (detailed discussion reserved for another post). Then as now, DDT advocates felt that the existence of studies with negative results created enough doubt that a ban could not be justified. Ruckelshaus felt just the opposite — that the bulk of the evidence supported a ban — and explained why. For eggshell thinning, 35 years of research have shown that Ruckelshaus was right. A follow-up report issued in 1975 cited 179 studies related to eggshell thinning alone (pp. 69-81). Today, a quick check of PubMed for “ddt eggshell” turns up 50 papers since 1969, and it is clear from the abstracts that the association of thinning and DDT is well established. Bald eagle populations have rebounded since the DDT ban, so successfully that they are now delisted as threatened, a result accepted matter-of-factly by wildlife biologists as a benefit of the DDT ban.

How did Ruckelshaus’ order differ from Sweeney’s recommendation?

One word: cotton. Sweeney ruled on six separate applications for DDT registration, affirming the cancellations for two, vacating the cancellations for three, and allowing a sixth to start the application process. Two of the cases where Sweeney restored the DDT registration were for public health uses: Wyco’s for treatment of mosquito larvae and Eli Lilly’s for use against body lice. Ruckelshaus permitted both applications, as well as public health use of DDT generally, but required a label restricting it to that use. As to DDT’s application worldwide against malaria (the topic of so much dispute nowadays), Ruckelshaus took pains to say that he was not restricting it:

It should be emphasized that these hearings have never involved the use of DDT by other nations in their health control programs. As we said in our DDT Statement of March, 1971, “this Agency will not presume to regulate the felt necessities of other countries.” (p. 26)

The remaining case in which Sweeney vacated the cancellation of DDT registration, permitting its use, was a biggie: USDA and Group Petitioners (31 users of DDT). These had argued collectively that DDT was “essential” for economical production of various crops and control of pests such as the spruce budworm. Of these applications, by far the most important was cotton production, accounting for at least half of all DDT consumption in the US^[3]. Other crops were discussed, with sweet peppers in the Delmarva peninsula used as an example. In his order, Ruckelshaus carved out specific exceptions for several crops where DDT was considered the only acceptable alternative, and said that

… if these users or registrants can demonstrate that a produce shortage will result and their particular use of DDT, taken with other uses, does not create undue stress on the general or local environment, particularly the aquasphere, cancellation should be lifted.

The fact that a few loopholes were left open for a while does not change the fact that Ruckelshaus intended to eliminate use of DDT on crops in the US, and his order did have that effect. Even for the “essential” uses, alternatives were found and DDT was dropped. The largest impact of the order was on cotton production. And this is where it gets even more interesting. One of Sweeney’s conclusions of law (p. 94) was that

13. The use of DDT in the United States has declined rapidly since 1959.

The EPA’s 1975 report gives a table (p. 149) that I’ve represented graphically below.

Although exports, and overall production, continued to rise until 1963, US consumption of DDT peaked in 1959, before any significant restrictions were placed on its use, and declined steadily thereafter. A reasonable person might wonder why that would be. Guess what? The boll weevil and the bollworm were becoming resistant to DDT. Sweeney refers to this fact (p. 86) and observes that

While the evidence convinces me that the use of DDT on cotton is declining and should be reduced as soon as effective replacement means of controlling pests are developed, I do not feel that the evidence to date permits any conclusion to the effect that DDT should be banned for use on cotton at this time.

Ruckelshaus disagreed. With his order, use of DDT on cotton pests became history. The economic impact on cotton growers was significant but far from catastrophic: costs to cotton producers were estimated at $7.75 million nationally, and for consumers at 2.2 cents per capita per year (p. 193).

Even in the one arena where the DDT ban was argued to be unbearably burdensome, its use was already declining, the hearing examiner recommended that it be reduced further in favor of alternative methods, and in the event, the ban’s effects were easily absorbed. Well, then — did it have any impact that we should care about?

Glad you asked.

Returning to Steven Milloy’s DDT FAQ, cited above, we find a pearl. Robert Desowitz’ The Malaria Capers is quoted (#8):

“There is persuasive evidence that antimalarial operations did not produce mosquito resistance to DDT. That crime, and in a very real sense it was a crime, can be laid to the intemperate and inappropriate use of DDT by farmers, especially cotton growers. They used the insecticide at levels that would accelerate, if not actually induce, the selection of a resistant population of mosquitoes.”

That’s right. The 1972 DDT ban did nothing to restrict the chemical’s use against malaria, but had the effect of eliminating the single most intense source of selection pressure for insecticide resistance in mosquitos. As the rest of the world followed suit in restricting agricultural use of DDT, the spread of resistance was slowed dramatically or stopped.
By this single action, William Ruckelshaus — and, credit where it’s due, Rachel Carson — may well have saved millions of lives.

Steven Milloy is invited to add that to the DDT FAQ any time it’s convenient.

_____________________________________________________________

^[1] A footnote explains that the post is “largely drawn from materials compiled by J. Gordon Edwards, professor of entomology at San Jose State University.” How much actual collaboration took place, if any, is not stated.

^[2] Technically, it’s not a “decision”, but an opinion stating “recommended findings, conclusions and orders.” A fine point, to be sure, but it makes a difference.

^[3] “It has been estimated that two-thirds of the DDT that is used in the United States is used in agriculture, and that 75% of the DDT that is used on agricultural crops is used on cotton.” (Sweeney, p. 83). According to the 1975 report, cotton’s share had increased to 80% by 1971-1972.

^[4] UPDATE: EPA has now posted its DDT archives, complete with the Sweeney opinion, here. You can now download a better-quality copy of the opinion at a fraction of the size, so do that. If my copy is adding no value, I’ll probably take it down eventually. I see that the EPA page was last updated September 25th, roughly a month after this post. I’d like to think that my prodding was a factor, but there’s no way to know.

_____________________________________________________________

(Hat tips are due Ed Darrell, for the best historical coverage, Bug Girl, for the best scientific coverage, and Tim Lambert, for the best overall coverage of this issue.)

 

This entry was posted on Sunday, August 26th, 2007 at 6:25 pm and is filed under General. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

World Malaria Report 2018: Quick blueprint for action, no standing still

No standing still with malaria, fighting the disease must continue or progress can be quickly lost. Still from WHO film on World Malaria Report 2018 call to action.

World Health Organization’s (WHO) World Malaria Report 2018 dropped on November 19, a month earlier than usual (but about the same time as 2017). With an additional few weeks to plug it, it still sank without big ripples in world media.

WHO adds a shorter version, an “executive version” — that still doesn’t get the attention it should.

This is prelude to a tragedy if industrialized and wealthy nations of the world pay no heed, and continue to cut budgets to fight malaria for whatever bad reason some crabby, brown Earth policy maker invents.

Ever optimistic, WHO gives a plan for action to continue to reduce malaria deaths and infections, even with reduced funding. None of the proposed actions involves more DDT to poison poor people in poor countries, however, so it is unlikely to find favor with the crabby policy people now in charge of fixing world problems in the increasingly isolationist West (including the U.S.).

Please watch the video. What is your country doing to eradicate malaria? How can you prod politicians to do more?
2,616

More:

• World Malaria Report 2018, full report in English
• World Malaria Report 2018 “at a glance”

World Malaria Report 2018: World looks away as malaria bounces back

Covers of the last four World Malaria Reports. World Health Organization (WHO)

It’s a common tale but true: In any period when nations collaborate to defeat or eradicate malaria, funders of the programs get board and cut funding.

Malaria roars back.

This cycle has nothing to do with pesticides or medicines, mostly. Especially it’s not a problem that can be fixed with more DDT.

When a nation focuses on beating malaria, progress occurs. When nations lose their focus, malaria strikes back.

After great progress reducing malaria infections and malaria deaths between 1999 and 2017, nations including the U.S. lost focus. International donors failed to contribute enough money to keep the fight going.

World Malaria Report 2018 notes the striking back by malaria.

One other thing we can be quite sure of: Almost all mass media will ignore this report.

What will you do to change things?

You can help by donating $10 to a charity that delivers bednets to people who need them in Asia and Africa. You can help by writing letters to your local newspapers, to your Congressional representatives, and to the President. Every little bit helps.

Here’s the press release on World Malaria Report 2018, which was released by the World Health Organization (WHO) on November 19, 2018.

WHO and partners launch new country-led response to put stalled malaria control efforts back on track

19 November 2018
News Release

Maputo/Geneva

Reductions in malaria cases have stalled after several years of decline globally, according to the new World malaria report 2018. To get the reduction in malaria deaths and disease back on track, WHO and partners are joining a new country-led response, launched today, to scale up prevention and treatment, and increased investment, to protect vulnerable people from the deadly disease.

For the second consecutive year, the annual report produced by WHO reveals a plateauing in numbers of people affected by malaria: in 2017, there were an estimated 219 million cases of malaria, compared to 217 million the year before. But in the years prior, the number of people contracting malaria globally had been steadily falling, from 239 million in 2010 to 214 million in 2015.

“Nobody should die from malaria. But the world faces a new reality: as progress stagnates, we are at risk of squandering years of toil, investment and success in reducing the number of people suffering from the disease,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We recognise we have to do something different – now. So today we are launching a country-focused and -led plan to take comprehensive action against malaria by making our work more effective where it counts most – at local level.”

Where malaria is hitting hardest

In 2017, approximately 70% of all malaria cases (151 million) and deaths (274 000) were concentrated in 11 countries: 10 in Africa (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania) and India. There were 3.5 million more malaria cases reported in these 10 African countries in 2017 compared to the previous year, while India, however, showed progress in reducing its disease burden.

Despite marginal increases in recent years in the distribution and use of insecticide-treated bed nets in sub-Saharan Africa – the primary tool for preventing malaria – the report highlights major coverage gaps. In 2017, an estimated half of at-risk people in Africa did not sleep under a treated net. Also, fewer homes are being protected by indoor residual spraying than before, and access to preventive therapies that protect pregnant women and children from malaria remains too low.

High impact response needed

In line with WHO’s strategic vision to scale up activities to protect people’s health, the new country-driven “High burden to high impact” response plan has been launched to support nations with most malaria cases and deaths. The response follows a call made by Dr Tedros at the World Health Assembly in May 2018 for an aggressive new approach to jump-start progress against malaria. It is based on four pillars:

• Galvanizing national and global political attention to reduce malaria deaths;
• Driving impact through the strategic use of information;
• Establishing best global guidance, policies and strategies suitable for all malaria endemic countries; and
• Implementing a coordinated country response.

Catalyzed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be easily prevented and diagnosed, and that is entirely curable with available treatments.

“There is no standing still with malaria. The latest World malaria report shows that further progress is not inevitable and that business as usual is no longer an option,” said Dr Kesete Admasu, CEO of the RBM Partnership. “The new country-led response will jumpstart aggressive new malaria control efforts in the highest burden countries and will be crucial to get back on track with fighting one of the most pressing health challenges we face.”

Targets set by the WHO Global technical strategy for malaria 2016–2030 to reduce malaria case incidence and death rates by at least 40% by 2020 are not on track to being met.

Pockets of progress

The report highlights some positive progress. The number of countries nearing elimination continues to grow (46 in 2017 compared to 37 in 2010). Meanwhile in China and El Salvador, where malaria had long been endemic, no local transmission of malaria was reported in 2017, proof that intensive, country-led control efforts can succeed in reducing the risk people face from the disease.

In 2018, WHO certified Paraguay as malaria free, the first country in the Americas to receive this status in 45 years. Three other countries – Algeria, Argentina and Uzbekistan – have requested official malaria-free certification from WHO.

India – a country that represents 4% of the global malaria burden – recorded a 24% reduction in cases in 2017 compared to 2016. Also in Rwanda, 436 000 fewer cases were recorded in 2017 compared to 2016. Ethiopia and Pakistan both had estimated decreases of more than  240 000 in the same period.

“When countries prioritize action on malaria, we see the results in lives saved and cases reduced,” says Dr Matshidiso Moeti, WHO Regional Director for Africa. “WHO and global malaria control partners will continue striving to help governments, especially those with the highest burden, scale up the response to malaria.”

Domestic financing is key

As reductions in malaria cases and deaths slow, funding for the global response has also shown a levelling off, with US$ 3.1 billion made available for control and elimination programmes in 2017 including US$ 900 million (28%) from governments of malaria endemic countries.  The United States of America remains the largest single international donor, contributing US$ 1.2 billion (39%) in 2017.

To meet the 2030 targets of the global malaria strategy, malaria investments should reach at least US$6.6 billion annually by 2020 – more than double the amount available today.

Editors note

Download the WHO World malaria report 2018 app for an interactive experience with the report’s country data: App Store (iOS devices) | Google Play (Android devices).

Ban of DDT did not cause a rise in malaria, or malaria deaths

Time to put that old canard to bed.

Malaria distribution was greatly reduced in the 20th century, reversing centuries of spreading. But malaria persisted into the 21st century. DDT helped reduce malaria, but the U.S. ban on DDT did not cause a rise in malaria infections or deaths. From a paper by Michael Palmer, M.D,. at Waterloo University. Palmer’s source, Peter Gething in Nature.

The U.S. ban on DDT in 1972 did not cause millions of unnecessary deaths to malaria. In fact, the worldwide death toll to malaria dropped for at least 18 years after the ban, plateaued for most of a decade, and dropped from 1999 to 2017. Malaria deaths fell dramatically, after the U.S. banned DDT from U.S. farms.

Not sure why Dr. Palmer wrote his essay in 2013, but he got most of the major sources and got most of the history accurately, His title, “The ban of DDT did not cause millions to die from malaria.”

It’s a good paper to bookmark, because it doesn’t always show up in Google searches in the U.S. — Waterloo being a university in Canada, in Waterloo, Ontario

www.science.uwaterloo.ca/~mpalmer/stuff/DDT-myth.pdf

[Update, January 2023: If that link does not work, try the trusty old Wayback Machine: https://web.archive.org/web/20200625073336/http://www.science.uwaterloo.ca/~mpalmer/stuff/DDT-myth.pdf]

[And if that link doesn’t work well, Michael Palmer DDT-myth. Where did Palmer land after Waterloo? It appears he ran off his rails, began complaining about the COVID-19 policies of Waterloo University, and was fired (or had his contract not renewed). Sometime in 2021? Not sure if he’s still active; regret his papers were deleted from Waterloo U’s site. Palmer’s paper on DDT is easily verifiable with sources he cites well.]

Annals of DDT: When they sprayed DDT from airplanes to stop polio

March of Dimes Foundation photo: “Nurses tended to polio patients in iron lung respirators at the Robert B. Green Memorial Hospital polio ward in San Antonio in 1950. It was a common scene throughout the polio crisis that swept Texas.” From the San Antonio Express-News article on the history of polio in the city.

It didn’t work.

In a desperate move to stop polio epidemics, after World War II but before the Salk polio vaccine was available, some American towns authorized aerial spraying of DDT over their cities.

Of course, DDT doesn’t stop viruses, and polio is a virus. Polio virus is not spread by a vector, an insect or other creature which might have been stopped by DDT, as mosquitoes spread malaria parasites and West Nile virus.

Aerial spraying of DDT against polio did not one thing.

A podcast from the Science History Institute discussed these misdirected events recently, and someone there did a sharp, short video to explain the issue.

YouTube explanation:

An animation drawn from episode 207 of Distillations podcast, DDT: The Britney Spears of Chemicals.

The podcast is a short 15 minutes, and fun, “Distillations.”

Americans have had a long, complicated relationship with the pesticide DDT, or dichloro-diphenyl-trichloroethane, if you want to get fancy. First we loved it, then we hated it, then we realized it might not be as bad as we thought. But we’ll never restore it to its former glory. And couldn’t you say the same about America’s once-favorite pop star?

We had a hunch that the usual narrative about DDT’s rise and fall left a few things out, so we talked to historian and CHF fellow Elena Conis. She has been discovering little-known pieces of this story one dusty letter at a time.

But first our associate producer Rigoberto Hernandez checks out some of CHF’s own DDT cans—that’s right, we have a DDT collection—and talks to the retired exterminator who donated them.

I bring it up here because in recent weeks there’s been a little surge on Twitter, and probably on Facebook and other places, in people claiming DDT causes polio, or causes symptoms so close to polio that physicians could never tell the difference. A lot of anti-vaccine advocates pile on, claiming that this would prove that the polio vaccine doesn’t work.

That’s all quite hooey-licious, off course. Polio’s paralysis of muscles in almost no way resembles acute DDT poisoning, which causes muscle misfiring instead of paralysis. As with almost every other disease, acute DDT poisoning can cause nausea; but DDT poisoning either kills its victim rather quickly, or goes away after a couple of weeks.

Polio doesn’t do that.

In the podcast, you’ll hear the common story of kids running behind DDT fogging trucks, because people thought DDT was harmless. In the concentrations in the DDT fogs, it would be almost impossible to ingest the 4 ounces or so of DDT required to get acute poisoning.

In any case, it’s one more odd facet of a long story of human relations to DDT and diseases. It’s worth a listen for history’s sake. But in this case, it’s entertaining, too. You’ll hear stories of people who opposed government actions to spray DDT, and who thought the government was too lax in its regulation and use of DDT.

More:

• San Antonio’s remaining daily newspaper, The Express-News, has a 2017 story by Michael Knoop on the 1946 polio epidemic in San Antonio, against which DDT was deployed; great explanation and a good photo slide show.

San Antonio Express-News file photo. “A young boy gets polio vaccine in this undated photo.”

Tip of the old scrub brush to Science History Institute (@SciHistoryOrg on Twitter).

DDT was once sprayed over entire towns to protect people from polio. (Spoiler: DDT doesn’t protect people from polio.) Hear the whole story: https://t.co/n9mcC73b6K pic.twitter.com/p519I3fQNC

— Science History Institute (@SciHistoryOrg) December 16, 2017

Historic Deltoid: Indur Goklany on DDT, corrections from Tim Lambert

I’ll have to beg forgiveness from Tim Lambert, but in the interest of accuracy and good history, I have captured below the post Tim Lambert had on the old Deltoid blog (at the Seed Science Blogs site), dealing with Indur Goklany’s errors on DDT.

A bit of other history: Anthony Watts despises my posts (me, too, probably) and I am banned from his site for various sins including calling him out for suggesting Rachel Carson and President John F. Kennedy had more than an occasional handshake personal relationship (a bizarre charge Christopher Monckton repeats and exaggerates on in slightly different ways). Watts and I disagree on what we should regard as facts; I take the old collegiate debate and Scout Law positions, he sides with the Heartland Institute parody/comedy/hoax troupe.

Watts was having none of my corrections. Tim Lambert, who has researched this particular area of pro-DDT hoaxing more than anyone else, was kind enough to respond.

This is borrowed from the Internet Archive’s Wayback Machine, until, and then maybe a supplement to, the reappearance of Deltoid’s archives at the new site. As of April 10, 2018, I have not checked the links. If links don’t work, please tell me in comments, and I’ll work to get a new link to the old information where possible.

You should also know that Sri Lanka today is certified to be malaria-free, without DDT.

Below, Tim Lambert’s post on Indur Goklany’s errors about DDT history:

 

Indur Goklany, DDT and Malaria

Posted by Tim Lambert on September 15, 2010

More »

Ed Darrell points to a WUWT post by Indur Goklany which promotes the use of DDT to fight malaria instead of more effective measures. As with most of the DDT promoters, Goklany carefully avoids mentioning the way mosquitoes evolve resistance to insecticides. For example, here’s what he has on Sri Lanka:

For instance, malaria incidences in Sri Lanka (Ceylon) dropped from 2.8 million in the 1940s to less than 20 in 1963 (WHO 1999a, Whelan 1992). DDT spraying was stopped in 1964, and by 1969 the number of cases had grown to 2.5 million.

Now compare this with what really happened in Sri Lanka:

With widespread resistance of A. culicifacies to DDT, malathion spraying was introduced in 1975 in areas of P.falciparum transmission affording protection to nearly one million people. Towards the end of 1976 DDT spraying was completely discontinued and during 1977 exclusively malathion was used as an adulticide.

Note that the scale for malaria cases is logarithmic, so there was a factor of ten reduction in the number of cases in a few years after DDT spraying was discontinued.

The misinformation about DDT and malaria that Goklany spreads is harmful and could kill people. DDT still has a place in the fight against malaria (because of insecticide resistance we need as many different insecticides as possible), but there are more effective means available, and by trying to undercut the use of the best methods for fighting malaria, Goklany will be responsible for people dying from malaria.

[End, quote from Tim Lambert’s old Deltoid blog]

Now, is it possible that the comments will copy as well as the blog post? There are some good ones in there.

Here’s a try at copying the comments, below the fold.

 

‘DDT has become harmless to mosquitoes today’

From India today, not news to anyone who follows the fight against malaria, and the fight to save a part of the planet to preserve human life.

DDT resistance prompted India to agree to stop production of DDT by 2020 — the last DDT factory remaining. India’s disease fighters tell of frustration trying to control malaria, because abuse of DDT has bred DDT resistant and immune mosquitoes. This is not news.

But India Today has a news hole to fill, and the continuing crises of vector-borne diseases force public health agencies to turn to “fourth generation” pesticides, as insects are now resistant to DDT and malathion.

The story out of New Delhi on March 13 almost adds some poetry to the issue. I repeat the story from India Today in full, partly because I love the lilt of Indian English, and because it tells the story of continuing attempts to get ahead of pesticide resistance in pests, attempts that just don’t seem to be doing the job.

Delhi’s civic agencies asked to use fourth generation pesticides to kill chemical-resistant insects

A small vehicle fogging streets of Delhi, India, with DDT, to fight mosquitoes. File photo from India Today, used to illustrate the story only.

Pesticides such as DDT and malathion, which were once super weapons in the fight against mosquitoes, now seem to have become harmless perfume-like sprays for the blood-sucking parasites.

Scientists at the National Vector Borne Disease Control Programme (NVBDCP), Delhi which is the central nodal agency for prevention of diseases like malaria, dengue, filariasis, kala-azar, Japanese encephalitis and chikungunya, etc, in India has now recommended municipalities in the Capital and other parts of the country to shift to the 4th generation of pesticides that is also the last in the row.

These constitute certain bio-larvicides and insect growth regulators that stop the synthesis of critical hormones in mosquito larvae to prevent them from becoming adult. Only after attaining maturity, do the female Anopheles and Aedes Aegypti mosquitoes suck blood to get protein nutrition to lay eggs.

Scientists explain that the first generation of pesticides was DDT, used since World War II on soldiers in 1940s up till now, as its a powerful poison against mosquitoes. Later, its environmental effects, specifically on birds like vultures, reduced its usage globally.

Then came malathion, which had to be applied in huge quantities, paving the way for 3rdgeneration pesticides like synthetic pyrethroids and temephos. But with reports of mosquitoes developing tolerance towards all of these gradually, scientists are now recommending mixed and increased usage of the fourth generation of pesticides that is also the last line of defence in this class.

Experiments are still going on with genetically modified mosquitoes and introducing batches of mosquitoes injected with wolbachia bacteria in the wild to produce sterile eggs. A senior scientist with the NVBDCP, Civil Lines, said, Just like humans develop resistance towards antibiotics, mosquitoes have also evolved over the past 20-30 years to grow natural defence against DDT, malathion, etc. We are still using these two in virgin areas like forests of northeast India, Odisha, etc. successfully. But we have begun getting reports that even temephos and synthetic pyrethroids have stopped receiving the desired results against mosquitoes.

A pesticide is said to be successful when it kills over 90 per cent of the targeted insect or pest population. Over 3,500 species of mosquitoes, which play host to a number of disease-causing vectors such as zika, yellow fever, west Nile virus, etc. are said to be the deadliest animal family in the world. They kill 700 million people annually world over.
In Delhi itself, at least 10 people died of dengue last year and 9,271 people were affected.

The numbers of malaria and chikungunya cases recorded in 2017 stood at 1,142 and 940. In 2016, at least 21 dengue deaths were reported from various city hospitals. And this year, an early onset of the deadly trio dengue, malaria and chikungunya is expected with summer-like weather conditions already.

High temperature and presence of clear water in desert coolers, flower pots, coconut shells, etc, act as excellent breeding sites for the menacing insects.

We have asked municipalities to even use the fourth generation of pesticides pirimiphos-methyl and diflubenzuron in a mix with the previous generation pesticides to delay mosquitoes developing tolerance towards this in the future, the scientist explained. He said, over the years, the pesticides must be rotated in use so that their effectiveness on hardy mosquitoes does not go down.

Dr Himmat Singh, senior scientist at the National Institute of Malaria Research (NIMR), Dwarka, said, The benefit with these two latest pesticides is that they are only hormone-inhibitors, not poisons, and specific to mosquitoes. So they wouldnt have any effect on other insects, birds, mammals, fishes, etc. They are categorised as non-hazardous by WHO. However, their cost has been prohibitive so far, he said.

Delhi municipalities have begun their use after a meeting of scientists and bureaucrats of NVBDCP, NIMR, ministry of health and family welfare and the Central Insecticide Board (CIB) authorised their application in January, sources said.

Dr NR Das, head of the department of Public Health in east MCD said, We have already procured diflubenzuron on NVBDCP directions and been using it for one month satisfactorily. However, we will be able to ascertain its degree of effectiveness only after two to three months.

For at least a decade, India has been the world’s largest producer of DDT, and the largest user, spraying more DDT than the rest of the world together. China and North Korea were the only two other nations making DDT at the end of the 20th century, but both cut off production. Counter to popular conceptions, India has struggled to control malaria, often being the only nation in the world to account increases in the disease from year to year, since 2001. Malaria increased despite increasing DDT application.

To fight malaria effectively DDT spraying should be limited to Indoor Residual Spraying (IRS), which leaves a fine coat of DDT on the walls of sleeping rooms, where malaria-carrying mosquitoes bite humans, then pause on the walls to squeeze water out of the blood they’ve fed on, to reduce weight to fly. Broadscale spraying of DDT only speeds development of resistance in all mosquito species, and many other pests.

India is catching up with the rest of the world on DDT.

Tip of the old scrub brush to India Today’s Twitter feed.

 

Pesticides such as DDT, malathion have become harmless for mosquitoes.
(via @mail_today)https://t.co/wq2UJtky6f

— IndiaToday (@IndiaToday) March 13, 2018

 

Sri Lanka declared malaria-free, without DDT

Chart from the India Foundation shows the ups and downs of fighting malaria in Sri Lanka in the 20th and 21st centuries. Sri Lanka is malaria-free since 2016.

Sri Lanka pushed malaria out of the country, and is certified by the World Health Organization (WHO) as malaria-free, as of September 2016.

If you follow the fight against malaria, this may not be news to  you. If you’re a victim of the pro-DDT, anti-WHO and anti-Rachel Carson hoaxes, you may be surprised.

Sri Lanka once got malaria to almost nothing, with heavy use of DDT in Indoor Residual Spraying. Then the budget hawks stopped the anti-malaria program (“Success!”) to save money. Malaria came roaring back as it will when vigilance relaxes — but by then the mosquitoes were mostly resistant to DDT, and a civil war kept the nation from mounting any public health campaigns in much of the country.

With the advent of new medicines, ABC therapy, and new methods to diagnose the disease, and using bednets and targeted pesticides other than DDT, Sri Lanka beat the disease. The news was carried in Britain’s The Guardian.

The World Health Organisation has certified that Sri Lanka is a malaria-free nation, in what it called a truly remarkable achievement.

WHO regional director Poonam Khetrapal Singh said in a statement that Sri Lanka had been among the most malaria-affected countries in the mid-20th century.

But, the WHO said, the country had begun an anti-malaria campaign that successfully targeted the mosquito-borne parasite that causes the disease, not just mosquitoes. Health education and effective surveillance also helped the campaign.

https://www.theguardian.com/society/2016/sep/05/sri-lanka-malaria-free-world-health-organisation

This is a blow to the anti-WHO pro-DDT forces. Sri Lanka has been a key story in their tales of how only DDT could fix malaria, stories told long after DDT stopped working. One more example shot down.

More:

• India Foundation, “Lessons from Sri Lankan success over malaria”
• ‘Big Success Story’: Sri Lanka Is Declared Free of Malaria, Donald G. McNeil, Jr., New York Times, September 12, 2016

Tip of the old scrub brush to The Guardian.

https://twitter.com/EdDarrell/status/898059767993831424

Bad news from World Malaria Report 2017: Malaria fight stalled

Cover of World Malaria Report 2017. The fight against malaria is at a crossroads, WHO reports.

This is the press release from the World Health Organization on the release of World Malaria Report 2017, on November 29, 2017:

Global response to malaria at crossroads

WHO report shows gains are levelling

News release

29 November 2017 | Geneva – After unprecedented global success in malaria control, progress has stalled, according to the World malaria report 2017. There were an estimated 5 million more malaria cases in 2016 than in 2015. Malaria deaths stood at around 445 000, a similar number to the previous year.

“In recent years, we have made major gains in the fight against malaria,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “We are now at a turning point. Without urgent action, we risk going backwards, and missing the global malaria targets for 2020 and beyond.”

The WHO Global Technical Strategy for Malaria calls for reductions of at least 40% in malaria case incidence and mortality rates by the year 2020. According to WHO’s latest malaria report, the world is not on track to reach these critical milestones.

A major problem is insufficient funding at both domestic and international levels, resulting in major gaps in coverage of insecticide-treated nets, medicines, and other life-saving tools.

Funding shortage

An estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally in 2016. That is well below the US $6.5 billion annual investment required by 2020 to meet the 2030 targets of the WHO global malaria strategy.

In 2016, governments of endemic countries provided US$ 800 million, representing 31% of total funding. The United States of America was the largest international funder of malaria control programmes in 2016, providing US$1 billion (38% of all malaria funding), followed by other major donors, including the United Kingdom of Great Britain and Northern Ireland, France, Germany and Japan.

The global figures

The report shows that, in 2016, there were an estimated 216 million cases of malaria in 91 countries, up from 211 million cases in 2015. The estimated global tally of malaria deaths reached 445 000 in 2016 compared to 446 000 the previous year.

While the rate of new cases of malaria had fallen overall, since 2014 the trend has levelled off and even reversed in some regions. Malaria mortality rates followed a similar pattern.

The African Region continues to bear an estimated 90% of all malaria cases and deaths worldwide. Fifteen countries – all but one in sub-Saharan Africa – carry 80% of the global malaria burden.

“Clearly, if we are to get the global malaria response back on track, supporting the most heavily affected countries in the African Region must be the primary focus,” said Dr Tedros.

Controlling malaria

In most malaria-affected countries, sleeping under an insecticide-treated bednet (ITN) is the most common and most effective way to prevent infection. In 2016, an estimated 54% of people at risk of malaria in sub-Saharan Africa slept under an ITN compared to 30% in 2010. However, the rate of increase in ITN coverage has slowed since 2014, the report finds.

Spraying the inside walls of homes with insecticides is another effective way to prevent malaria. The report reveals a steep drop in the number of people protected from malaria by this method – from an estimated 180 million in 2010 to 100 million in 2016 – with the largest reductions seen in the African Region.

The African Region has seen a major increase in diagnostic testing in the public health sector: from 36% of suspected cases in 2010 to 87% in 2016. A majority of patients (70%) who sought treatment for malaria in the public health sector received artemisinin-based combination therapies (ACTs) – the most effective antimalarial medicines.

However, in many areas, access to the public health system remains low. National-level surveys in the African Region show that only about one third (34%) of children with a fever are taken to a medical provider in the public health sector.

Tackling malaria in complex settings

The report also outlines additional challenges in the global malaria response, including the risks posed by conflict and crises in malaria endemic zones. WHO is currently supporting malaria responses in Nigeria, South Sudan, Venezuela (Bolivarian Republic of) and Yemen, where ongoing humanitarian crises pose serious health risks. In Nigeria’s Borno State, for example, WHO supported the launch of a mass antimalarial drug administration campaign this year that reached an estimated 1.2 million children aged under 5 years in targeted areas. Early results point to a reduction in malaria cases and deaths in this state.

A wake-up call

“We are at a crossroads in the response to malaria,” said Dr Pedro Alonso, Director of the Global Malaria Programme, commenting on the findings of this year’s report. “We hope this report serves as a wake-up call for the global health community. Meeting the global malaria targets will only be possible through greater investment and expanded coverage of core tools that prevent, diagnose and treat malaria. Robust financing for the research and development of new tools is equally critical.”

Details of DDT use in the past year usually show up in the bowels of the report.

Map showing decline in DDT use, 2000 to 2014

DDT use declining toward oblivion: UNEP caption – Source: DDT Expert Group. Report of the Effectiveness Evaluation on DDT Pursuant to the Article 16 of the Stockholm Convention Animation prepared by: UN Environment Chemicals and Health Branch 2016, with the latest information available and may not reflect the current status.

More than 180 nations signed the Persistent Organic Pollutants Treaty (POPs), often called the Stockholm Convention. The treaty pledges nations to voluntarily work to rid the planet of dangerous and toxic organic chemicals.

DDT is named in negotiation documents as one of the Dirty Dozen most toxic pollutants; however, because there was no alternative that performed exactly like DDT, the nations made a special addendum to the treaty to allow any nation to use DDT to fight disease vectors (insects that carry disease). The World Health Organization tracks use of DDT.

In 2001, 43 nations said they thought DDT would be useful. But by 2015, 33 of those nations gave up DDT, due to insects developing resistance and immunity.

India, the sole remaining nation where manufacture of DDT occurs, plans to stop all DDT production by 2020. India discovered that more DDT makes the insect pests more resistant faster, instead of beating disease carriers.

This map from the UN Environmental Program shows declining use of DDT, 2000 to 2014.  ][If that link doesn’t work, and it’s been iffy, try this one for information: https://www.unenvironment.org/explore-topics/chemicals-waste/what-we-do/persistent-organic-pollutants/alternatives-ddt]

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