Letter to IVCC: Please correct history of DDT (repost)

May 21, 2015

[WordPress is misbehaving, or the programmers have put in some new wrinkle that haven’t mastered. This piece I posted this morning shows up back on May 11; I repost it here, now, to get it where it belongs.]
Screen capture of IVCC's introductory film, explaining benefits of mosquito bednets and the need for new pesticides to replace those now in use, to which mosquitoes have developed resistance and immunity.

Screen capture of IVCC’s introductory film, explaining benefits of mosquito bednets and the need for new pesticides to replace those now in use, to which mosquitoes have developed resistance and immunity.

Text of an e-mail I sent to the non-profit vector control group IVCC at the Liverpool School of Tropical Medicine. “Vector” is the fancy name for “disease-carrying arthropod,” usually an insect.

Dear IVCC,

Generally your website is very useful. I am happy to recommend it for most people, for most purposes.

However, I’ve discovered errors in history you need to correct. On this page: Highlights of vector-borne disease history | IVCC

You say:

1962: Rachel Carson publishes Silent Spring; a powerfully written book arguing that DDT is not safe. The reaction is immediate in several US states: DDT is banned. A nation-wide ban follows ten years later.

When Rachel Carson’s book Silent Spring hit the shelves, it caused outrage.

Carson’s engaging and populist style meant the book appealed to many ordinary people, not just scientists. Carson used the scientific evidence of many researchers to argue that DDT can kill animals, cause bird populations to decline and lead certain pests to proliferate. Workers who handled the chemical suffer health problems and exposed fish got liver cancer. She also found evidence of DDT in mother’s breast milk and in the bodies of babies. Several US states immediately banned the use of DDT as a pesticide and for crops. In 1972, the USA banned it outright.

But there was a problem. DDT was and is the most effective means of reducing malaria incidences, particularly in developing countries. DDT is cheap, effective, easily stored and transported and relatively safe for the person spraying. It does not have to be applied very often and provides the best means of protection possible. But how could the USA promote DDT through its aid programmes if DDT was a banned chemical at home?

In 2000, a worldwide ban on DDT nearly ensued but it was stopped at the last minute. Today, DDT is still produced in China and India and available globally for use uniquely in anti-malarial efforts.

I find that to be an inaccurate history, and one that falsely contributes to the idea that scientists, the World Health Organization, and African malaria fighters are fools.

In 1972, the U.S. Environmental Protection Agency issued an order banning DDT from use on crops. The order specifically worked around then-current U.S. law which would have required an absolute ban on DTT, or “outright” as you call it. But the U.S. action was not “outright.”

EPA Administrator William Ruckelshaus fully appreciated the utility of DDT for fighting insect vectors of disease. The regulation banned ONLY crop use, and specifically exempted from ban the use of DDT to fight insect vectors — in the U.S., as well as world wide. See this article, and follow the links for the actual text of the regulation: Oh, look: EPA ordered DDT to be used to fight malaria in 1972!

You can see EPA’s action also did not ban manufacturing in the U.S. Many scientists in the U.S. saw this as a bow to chemical manufacturers who would have lost money invested in manufacturing plants. Production of DDT in the U.S. continued, almost exclusively for export, until 1984. In 1984, there were exports of 300 tons of DDT from the U.S.

DDT remains a deadly toxin, one that kills indiscriminately in the wild. It is not at all clear to me that the POPs Treaty negotiations were speeding to a complete ban on the stuff — but in any case, a special carve out was created to allow DDT use to continue, to fight disease. That amendment was proposed first in early negotiations — not a “last-minute” change of mind.

DDT was never “the most effective means of reducing malaria incidences;” it was a key part of WHO’s eradication program, precisely because it is so toxic, and precisely because it is long-lasting, the two key features that make it a “persistent organic pollutant.” DDT only works when coupled with a program of medical care to cure humans of the disease while mosquito populations are temporarily knocked down — a point you recognize at other places on your website. Alone, DDT sets a stage for malaria to come roaring back, as soon as the DDT effectiveness wears off due to wall washing, painting or time, and when the mosquitoes come roaring back resistant to DDT, they will spread any malaria left in the population of humans.

I hope you can make corrections. There is a widespread, well-funded effort to claim DDT is perfectly harmless to humans, that evil scientists and environmentalists prevailed on WHO and nations to stop using DDT, that the complete cessation of DDT use led to a massive expansion of malaria, and that therefore we should ignore scientists, environmentalists, NGOs and anyone else like the Liverpool School of Tropical Medicine, who advocate doing anything other than massive DDT spraying campaigns to fight malaria.

Please don’t contribute to that political and science hoax campaign.

Sincerely,

Ed Darrell
Dallas, Texas

We’ll see whether anyone is awake and tending the message box at IVCC in Liverpool. I hope the project is not dormant.

Fighting malaria requires accurate information if malaria fighters are to be able to outsmart malaria, which has outsmarted humans for a half-million years.

IVCC’s film of introduction:

More:


One billion nets to Africa

May 21, 2015

Malaria No More reports a billion mosquito nets in Africa produce great results in the fight against malaria.

Malaria No More reports a billion mosquito nets in Africa produce great results in the fight against malaria.

Interesting week.

All that, and the World Health Assembly 68 is meeting in Geneva, Switzerland.  Among top items on the agenda of the world’s top public health experts: What are the next steps in fighting malaria?

Malaria No More produced this short video in time for World Malaria Day, April 25, 2015 — but I just saw it this week.  It depicts the Ochieng family in Kenya, and the effects of malaria, and beating malaria, have on the family:

One Billion Nets to Africa

Description of the film:

Meet the Ochieng family. They are one of the families that received the #OneBillionNets to Africa and is now protected from malaria-transmitting mosquitoes because of this unprecedented global effort. See more at 1BillionNets.org

  • Music:  “Eyes Wide Open” by Tony Anderson

This film caught my interest on a personal scale.  One of my great students at Molina High School in Dallas was a Kenyan immigrant, named Ochieng.  Can’t help but wonder if there is a relation.

Bednets, and a concentrated, international campaign to prevent mosquito bites and cure infected humans of the disease, have cut malaria deaths from just over 1 million per year in 2000, to fewer than 600,000 per year in 2014.  This progress produces hope again that malaria can be beaten, though there are many more hurdles blocking the path.

You may have noted: The malaria fighters at Malaria No More make no plea for more DDT, nor do they claim any handicap from the U.S. having banned the use of DDT on agricultural crops in the U.S.  In saving lives, disease fighters don’t have time to deal with destructive hoaxes.

Tip of the old scrub brush to PMI, the President’s Malaria Initiative:
http://twitter.com/PMIgov/status/596689144618823680


Homestead Act of 1862: Socialist land giveaway that appealed to free-market Americans, then and now

May 21, 2015

We passed an important anniversary in American history this week.  I’m not sure anyone noted it.

I am constantly amazed at how much of our history gets ignored in conservative politics, especially with regard to the role the government played in stimulating development of the nation with subsidies and give-aways.  What would America be without the Homestead Act?

A family off to find and settle their homestead, 1886. Photo from the National Archives

A family off to find and settle their homestead, 1886. Photo from the National Archives

History and demographics of the United States were forever changed when the Homestead Act became law early in the administration of President Abraham Lincoln, on May 20, 1862.

With Congress paralyzed and unable to act to do even minor good things now, it’s astonishing to think how the Congress of 1862 could do so much to open the American west, in the middle of the American Civil War.  Perhaps Congress was able to act because legislators from the South were absent, and did not oppose progress.

In any case, the Homestead Act encouraged Americans who lacked property, or who wanted to go west, to strike out for the western territories and states, to make a new life, to found new towns, cities and farms, and fulfill the nation’s “manifest destiny.”

The bill that became the Homestead Act, H.R. 125, in the 37th Congress, 1862. Image from the U.S. National Archives

The bill that became the Homestead Act, H.R. 125, in the 37th Congress, 1862. Image from the U.S. National Archives

Here’s the history from the National Archives:

The notion that the United States government should give free land titles to settlers to encourage westward expansion became popular in the 1850s. During that time the U.S. House of Representatives passed numerous homestead bills but southern opposition in the Senate prevented enactment. In 1860, during the 36th Congress, the Senate narrowly passed a homestead act but President James Buchanan vetoed it and the Senate failed its override attempt.

When the 37th Congress convened for its brief summer session in 1861, now without members from seceded states, it was preoccupied with Civil War-related legislation. The House took up briefly the homestead issue in December but postponed further consideration of it until the following February. The House finally passed the Homestead Act on February 28, 1862 by the large margin of 107 to 16. The act worked its way through the Senate until May 6, 1862 when it passed easily by a vote of 33 to 7. After a few minor changes in conference committee—which both houses agreed to without controversy—Congress sent the final legislation to President Abraham Lincoln who signed the act into law on May 20, 1862.

The Homestead Act encouraged western migration by providing settlers with 160 acres of land in exchange for a nominal filing fee. Among its provisions was a five-year requirement of continuous residence before receiving the title to the land and the settlers had to be, or in the process of becoming, U.S. citizens. Through 1986, when the last claim was made in Alaska, the Homestead Act distributed 270 million acres of land in the United States making it arguably one of the most far-reaching pieces of legislation in American history.

More:

Much of this post has appeared at Millard Fillmore’s Bathtub before; the Homestead Act deserves commemoration.


Misquoting the founders, still: Jefferson didn’t say banking is the end of America

May 20, 2015

He may have believed something similar, but Jefferson did not say this:

Quote, maybe edited, falsely attributed to Thomas Jefferson; gathered from Twitter, 2015

Quote, maybe edited, falsely attributed to Thomas Jefferson; gathered from Twitter, 2015

I’m not sure who originated the poster.  They probably had good intentions.

But turn to the Monticello website, the scholars who track Jefferson’s words most closely, in February 2012.

Quotation: “The end of democracy and the defeat of the American Revolution will occur when government falls into the hands of lending institutions and moneyed incorporations.”

Sources consulted:

  1. Papers of Thomas Jefferson: Digital Edition
  2. Thomas Jefferson: Papers collection in Hathi Trust Digital Library
  3. Retirement Papers

Earliest known appearance in print: 19941

Earliest known appearance in print, attributed to Thomas Jefferson: see above

Status:  This exact quotation has not been found in the writings of Thomas Jefferson.  It may be a mistaken amalgamation of the author’s comments in the above 1994 reference with a real Jefferson quotation.  Jefferson wrote in 1825 to William Branch Giles of “vast accession of strength from their younger recruits, who having nothing in them of the feelings or principles of ’76 now look to a single and splendid government of an Aristocracy, founded on banking institutions and monied in corporations under the guise and cloak of their favored branches of manufactures commerce and navigation, riding and ruling over the plundered ploughman and beggared yeomanry.”2  Chomsky’s 1994 book quotes Jefferson’s 1825 letter to Giles and then comments that “[Jefferson] warned that that would be the end of democracy and the defeat of the American revolution.”

Jefferson didn’t like the idea of the marriage of banks, rich people and control of government policy.  Jefferson scholar Anna Berkes commented at the Monticello site:

Yes, I’ve quoted this letter myself above – I’m seeing that quote a lot lately. The full sentence as it appeared in Jefferson’s letter is, “I hope we shall take warning from the example and crush in it’s birth the aristocracy of our monied corporations which dare already to challenge our government to a trial of strength, and to bid defiance to the laws of their country.” The letter was first published in Ford’s Writings of Thomas Jefferson in 1892 (see http://hdl.handle.net/2027/uc2.ark:/13960/t3pv6bn68?urlappend=%3Bseq=93 – the edition you link to is a 1904 commemorative edition of Ford), and the polygraph copy is also online: http://hdl.loc.gov/loc.mss/mtj.mtjbib022651.

Anna Berkes
February 29, 2012 – 4:24pm

In any case, it’s not the end of our democratic republic yet! Get out there and organize, and vote.

Jefferson always offered good advice.

Jefferson's advice on quotes found on the internet

Jefferson’s advice on quotes found on the internet


No shortcuts on the road to success; but watch out for low bridges

May 19, 2015

Meeting of trailer and railroad viaduct.  Photo credit, and location, unknown

Meeting of trailer and railroad viaduct. Photo credit, and location, unknown

Many already caught the irony.

I wonder:

  • Was the truck driver using GPS to plan the route?  Which system, so we can avoid it?
  • Stories in the past couple of days say robots should be doing all kinds of jobs, including driving cars and big trucks.  Can a robot do this?

Not to embarrass, but just for the record, does anyone know when and where this picture was taken?

Tip of the old scrub brush to Andre Houser.


Quote of the moment: H. L. Mencken, on Christians and Christianity, and trouble

May 18, 2015

Stolen wholesale from WIST:

The trouble with Communism is the Communists, just as the trouble with Christianity is the Christians.

HL Mencken2H.L. Mencken (1880-1956) American writer and journalist [Henry Lewis Mencken]
“Mr. Mencken Sounds Off,” interview, LIFE Magazine (5 Aug 1946)

You recall, Mencken was the guy who wrote the Millard Fillmore Bathtub hoax in the first place, right?

Mencken held forth in Baltimore, a city that could probably use a newspaper columnist with Mencken’s ability to find corruption and fault in most good things — just to make people think.

You may disagree with Mr. Mencken, of course.  But if you do, tell us in comments:  What do YOU think the trouble with Christianity is?

Found on eBay: H. L. Mencken in bronze, as a bookend -- with a stein of beer and the Statute of Liberty.  Asking $595 for it.

Found on eBay: H. L. Mencken in bronze, as a bookend — with a stein of beer and the Statute of Liberty. Asking $595 for it. Beer and liberty. Mencken probably would have approved. How many of these were made? By whom?


WHO’s malaria fact sheet, April 2015 edition

May 17, 2015

Progress against the diseases we know as malaria — parasitic infections — is dramatic and rapid since several non-governmental organizations (NGOs) entered the fight seriously at the turn of the last century. But problems arise and also rapidly become serious.

Bednets prove the best single method of preventing the spread of malaria. Distribution of bednets in malaria-prone regions greatly aided the 47% reduction in malaria deaths since 1999.  WHO photo.

Bednets prove the best single method of preventing the spread of malaria. Distribution of bednets in malaria-prone regions greatly aided the 47% reduction in malaria deaths since 1999. WHO photo.

For political reasons often obscure, there is an industry in creating misinformation and propaganda against malaria-fighting groups like the World Health Organization, the Bill and Melinda Gates Foundation, and other groups who advocate bednet preventive measures. The propagandists often make absurd and false claims against medical workers, against scientists and activists including people they pejoratively call environmentalists, and in favor of the deadly poison DDT.

Factual matter takes longer to spread — truth has a smaller public relations budget.

What are the facts about malaria?

Here is WHO’s fact sheet on malaria, current as of the first of this month 2015.

WHO’s fact sheet is almost dull in its recitation of the facts.  What you don’t see recorded here is that the death toll of over 500,000 last year, is the lowest death toll from malaria since World War II, the lowest death toll estimated in the past 120 years, and perhaps the lowest death toll in recorded human history.  Similarly, while nearly 200 million malaria infections seems an enormous number, that number records a dramatic reduction from the 500 million estimated in the 1960s.

Malaria is not Rachel Carson’s fault. DDT is not a magic cure for the disease. It’s beatable, but beating a disease requires constant vigilance, militant prevention and treatment — and that costs money. The propagandists won’t tell you those facts, and malaria wins when bad information chases out the good.

For the record:

Malaria

Fact sheet N°94
Reviewed April 2015


Key facts

  • Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes.
  • In 2013, malaria caused an estimated 584 000 deaths (with an uncertainty range of 367 000 to 755 000), mostly among African children.
  • Malaria is preventable and curable.
  • Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places.
  • Non-immune travellers from malaria-free areas are very vulnerable to the disease when they get infected.

According to the latest estimates, released in December 2014, there were about 198 million cases of malaria in 2013 (with an uncertainty range of 124 million to 283 million) and an estimated 584 000 deaths (with an uncertainty range of 367 000 to 755 000). Malaria mortality rates have fallen by 47% globally since 2000, and by 54% in the WHO African Region.

Most deaths occur among children living in Africa where a child dies every minute from malaria. Malaria mortality rates among children in Africa have been reduced by an estimated 58% since 2000.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected Anopheles mosquitoes, called “malaria vectors”, which bite mainly between dusk and dawn.

There are four parasite species that cause malaria in humans:

  • Plasmodium falciparum
  • Plasmodium vivax
  • Plasmodium malariae
  • Plasmodium ovale.

Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.

In recent years, some human cases of malaria have also occurred with Plasmodium knowlesi – a species that causes malaria among monkeys and occurs in certain forested areas of South-East Asia.

Transmission

Malaria is transmitted exclusively through the bites of Anopheles mosquitoes. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

About 20 different Anopheles species are locally important around the world. All of the important vector species bite at night. Anopheles mosquitoes breed in water and each species has its own breeding preference; for example some prefer shallow collections of fresh water, such as puddles, rice fields, and hoof prints. 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. For example, the long lifespan and strong human-biting habit of the African vector species is the main reason why about 90% of the world’s malaria deaths 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.

Symptoms

Malaria is an acute febrile illness. In a non-immune individual, symptoms appear seven days or more (usually 10–15 days) after the infective mosquito bite. The first symptoms – fever, headache, chills and vomiting – 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 involvement is also frequent. In malaria endemic areas, persons may develop partial immunity, allowing asymptomatic infections to occur.

For both P. vivax and P. ovale, clinical relapses may occur weeks to months after the first infection, even if the patient has left the malarious area. These new episodes arise from dormant liver forms known as hypnozoites (absent in P. falciparum and P. malariae); special treatment – targeted at these liver stages – is required for a complete cure.

Who is at risk?

Approximately half of the world’s population is at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected. In 2014, 97 countries and territories had ongoing malaria transmission.

Specific population risk groups include:

  • young children in stable transmission areas who have not yet developed protective immunity against the most severe forms of the disease;
  • non-immune pregnant women as malaria causes high rates of miscarriage and can lead to maternal death;
  • semi-immune pregnant women in areas of high transmission. Malaria can result in miscarriage and low birth weight, especially during first and second pregnancies;
  • semi-immune HIV-infected pregnant women in stable transmission areas, during all pregnancies. Women with malaria infection of the placenta also have a higher risk of passing HIV infection to their newborns;
  • people with HIV/AIDS;
  • international travellers from non-endemic areas because they lack immunity;
  • immigrants from endemic areas and their children living in non-endemic areas and returning to their home countries to visit friends and relatives are similarly at risk because of waning or absent immunity.

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 15 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 “Guidelines for the treatment of malaria” (second edition). An updated edition will be published in 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1970s and 1980s, undermining malaria control efforts and reversing gains in child survival.

In recent years, parasite resistance to artemisinins has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Laos, Myanmar, Thailand and Viet Nam. While there are likely many factors that contribute to the emergence and spread of resistance, the use of oral artemisinins alone, as monotherapy, is thought to be an important driver. When treated with an oral artemisinin-based monotherapy, patients may discontinue treatment prematurely following the rapid disappearance of malaria symptoms. This results in incomplete treatment, and such patients still have persistent parasites in their blood. Without a second drug given as part of a combination (as is provided with an ACT), these resistant parasites survive and can be passed on to a mosquito and then another person.

If resistance to artemisinins develops and spreads to other large geographical areas, the public health consequences could be dire.

WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.

More comprehensive recommendations are available in the “WHO Global Plan for Artemisinin Resistance Containment (GPARC)”, which was released in 2011. For countries in the Greater Mekong subregion, WHO has issued a regional framework for action titled “Emergency response to artemisinin resistance in the Greater Mekong subregion” in 2013.

Prevention

Vector control is the main way to reduce malaria transmission at the community level. It is the only intervention that can reduce malaria transmission from very high levels to close to zero.

For individuals, personal protection against mosquito bites represents the first line of defence for malaria prevention.

Two forms of vector control are effective in a wide range of circumstances.

Insecticide-treated mosquito nets (ITNs)

Long-lasting insecticidal nets (LLINs) are the preferred form of ITNs for public health distribution programmes. WHO recommends coverage for all at-risk persons; and in most settings. The most cost effective way to achieve this is through provision of free LLINs, so that everyone sleeps under a LLIN every night.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly reduce malaria transmission. Its full potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3–6 months, depending on the insecticide used and the type of surface on which it is sprayed. DDT can be effective for 9–12 months in some cases. Longer-lasting forms of existing IRS insecticides, as well as new classes of insecticides for use in IRS programmes, are under development.

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. In addition, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine for pregnant women living in high transmission areas, 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 is recommended delivered alongside routine vaccinations. In 2012, WHO 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

Much of the success to date in controlling malaria is due to vector control. Vector control is highly dependent on the use of pyrethroids, which are the only class of insecticides currently recommended for ITNs or LLINs. In recent years, mosquito resistance to pyrethroids has emerged in many countries. In some areas, resistance to all 4 classes of insecticides used for public health has been detected. Fortunately, this resistance has only rarely been associated with decreased efficacy, and LLINs and IRS remain highly effective tools in almost all settings.

However, countries in sub-Saharan Africa and India are of significant concern. These countries are characterized by high levels of malaria transmission and widespread reports of insecticide resistance. The development of new, alternative insecticides is a high priority and several promising products are in the pipeline. Development of new insecticides for use on bed nets is a particular priority.

Detection of insecticide resistance should be an essential component of all national malaria control efforts to ensure that the most effective vector control methods are being used. The choice of insecticide for IRS should always be informed by recent, local data on the susceptibility target vectors.

In order to ensure a timely and coordinated global response to the threat of insecticide resistance, WHO has worked with a wide range of stakeholders to develop the “Global Plan for Insecticide Resistance Management in malaria vectors” (GPIRM), which was released in May 2012. The GPIRM puts forward a five-pillar strategy calling on the global malaria community to:

  • plan and implement insecticide resistance management strategies in malaria-endemic countries;
  • ensure proper and timely entomological and resistance monitoring, and effective data management;
  • develop new and innovative vector control tools;
  • fill gaps in knowledge on mechanisms of insecticide resistance and the impact of current insecticide resistance management approaches; and
  • ensure that enabling mechanisms (advocacy as well as human and financial resources) are in place.

Surveillance

Tracking progress is a major challenge in malaria control. In 2012, malaria surveillance systems detected only around 14% of the estimated global number of cases. 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.

Elimination

Malaria elimination is defined as interrupting local mosquito-borne malaria transmission in a defined geographical area, i.e. zero incidence of locally contracted cases. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by a specific agent; i.e. applies to a particular malaria parasite species.

On the basis of reported cases for 2013, 55 countries are on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly targets for 2015. Large-scale use of WHO-recommended strategies, currently available tools, strong national commitments, and coordinated efforts with partners, will enable more countries – particularly those where malaria transmission is low and unstable – to reduce their disease burden and progress towards elimination.

In recent years, 4 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), and Armenia (2011).

Vaccines against malaria

There are currently no licensed vaccines against malaria or any other human parasite. One research vaccine against P. falciparum, known as RTS, S/AS01, is most advanced. This vaccine has been evaluated in a large clinical trial in 7 countries in Africa and has been submitted to the European Medicines Agency under art. 58 for regulatory review. A WHO recommendation for use will depend on the final results from the large clinical trial and a positive regulatory review. The recommendation as to whether or not this vaccine should be added to existing malaria control tools is expected in late 2015.

WHO response

The WHO Global Malaria Programme (GMP) is responsible for charting the course for malaria control and elimination through:

  • 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;
  • identifying threats to malaria control and elimination as well as new areas for action.

GMP serves as the secretariat for the Malaria Policy Advisory Committee (MPAC), a group of 15 global malaria experts appointed following an open nomination process. The MPAC, which meets twice yearly, provides independent advice to WHO to develop policy recommendations for the control and elimination of malaria. 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.

WHO is also a co-founder and host of the Roll Back Malaria partnership, which is the global framework to implement coordinated action against malaria. The partnership mobilizes for action and resources and forges consensus among partners. It is comprised of over 500 partners, including malaria endemic countries, development partners, the private sector, nongovernmental and community-based organizations, foundations, and research and academic institutions.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

WHO provides a short video summary of many of these facts.


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