India, world’s top DDT user, socked with malaria increase

July 22, 2015

Were it true that DDT is a magic solution to malaria, by all measures India should be malaria free.

Not only is India not malaria-free, but the disease increases in infections, deaths, and perhaps, in virulence.

Map showing location of Odisha, or Orissa, state, in India. Wikipedia image

Map showing location of Odisha, or Orissa, state, in India. Wikipedia image

Since the late 1990s a small, well-funded band of chemical and tobacco industry propagandists conducted a campaign of calumny against Rachel Carson, environmentalists in general, scientists and health care workers, claiming that an unholy and wrongly-informed conspiracy took DDT off the market just as great strides were beginning to be made against malaria.

As a consequence, this group argues, malaria infections and deaths exploded, and tens of millions of people died unnecessarily.

That’s a crock, to be sure. Rachel Carson’s 1962 book, Silent Spring, inspired an already-established campaign against DDT. But the malaria eradication program begun with high hopes by the World Health Organization in 1955, foundered in 1963 when the campaign turned to central, tropical Africa. Overuse of DDT in agriculture and minor pest control had bred DDT-resistant and immune mosquitoes.  Malaria fighters could not knock down local populations of mosquitoes well enough to let medical care cure infected humans.  (The campaign was not helped by political instability in some of the African nations; 80% of houses in an affected area need to be sprayed inside to stop malaria, and that requires government organizational skills, manpower and money that those nations could not muster.)

Detail map of Odisha state, India; map by Jayanta Nath, Wikipedia image

Detail map of Odisha state, India; map by Jayanta Nath, Wikipedia image

That was just a year after Carson’s book hit the shelves. DDT had been banned nowhere. WHO’s workers tried to get a campaign going, but complete failures stopped the program in 1965; in 1969 WHO’s board met and officially killed the malaria eradication program, in favor of control.

Malaria infections and deaths did not expand with the end of WHO’s campaign.  At peak DDT use, roughly 1958 to 1963, malaria deaths are estimated by WHO to have been as high as 5 million per year, 4 million by 1963. Total malaria infections, worldwide, were 500 million.

The first bans on DDT use came in Europe. When the U.S. banned DDT use on crops in 1972, okaying use to fight malaria, malaria deaths had fallen to more than 2 million annually by optimistic estimates.  Death rates and infection rates continued to fall without a formal eradication campaign. By the late 1980s, malaria killed about 1.5 million each year, a great improvement over the DDT go-go days, but still troubling.

Beating malaria is a multi-step program.  Malaria parasites must complete a life cycle in a human host, and then when jumping to a mosquito, another cycle of about two weeks in the mosquito’s gut, before being transmissible back to humans. Knocking down mosquito populations helps prevent transmission temporarily, but that is only useful if in that period the human hosts can be cured of the parasites.

In the late 1980s, malaria parasites developed strong resistance and immunity to pharmaceuticals given to humans to cure them.  Regardless mosquito populations, human hosts were always infected, ready to transmit the parasite to any mosquito and send drug-resistant malaria on to dozens more.

From about 1990 to about 2002, malaria deaths rose modestly to more than 1.5 million annually.

New pharmaceuticals, and new regimens of administration of pharmaceuticals, increased the effectiveness of human treatments; coupled with much better understanding of malaria vectors, the insects that transmit the disease, and geographical data and other technological advances to speed diagnosis and treatment of humans, and increase prevention measures, WHO and private foundations started a series of programs in malaria-endemic nations to reduce infections and deaths. Insecticide-impregnated bednets proved to be less-expensive and more effective than Indoor Residual Spraying (IRS) featuring DDT or any of the other 11 pesticides WHO authorizes for home spraying.  (Home spraying targets mosquitoes that carry malaria, and limits expensive overuse of pesticides, plus limits and prevents environmental damage.)

Health care workers and most nations made dramatic progress in controlling and eliminating malaria, between 2000 and 2015, mostly without using DDT which proved increasingly ineffective at controlling mosquitoes, and which also proved unpopular among malaria-affected peoples whose cooperation is necessary to fight the disease.

By 2014, fewer than 220 million people got malaria infections, worldwide, a reduction of about 55% over DDT’s peak-use years. This is remarkable considering the population of the planet more than doubled in that time, and population in malaria-endemic areas rose even more. Malaria deaths were reduced to fewer than 600,000 annually, a reduction of more than 80% over peak DDT years. By 2015, malaria-fighters once again spoke of eradicating malaria from the planet.

In contrast, India assumed the position of top producer of DDT in the world, still making it even after China and North Korea stopped making it. But malaria control in India weakened, despite greater application of DDT.  The world watches as DDT, once the miracle pesticide used in anti-malaria campaigns, became instead a depleted tool, unable to stop malaria’s spread despite increasing application.

Were DDT the magic powder, or even “excellent powder” its advocates claim, India should be free of malaria, totally. Instead, Indians debate how best to get control of the disease again, and start reducing infections and deaths, again. Below is one story, rather typical of many that crop up from time to time in India news; this is from the Odisha Sun Times. (Note: Lakh is a unit in the Indian number system equal to 100,000; crore is a unit equal to 10,000,000.)

Odisha has 36% of malaria cases in India; ranks third in deaths

Odisha Sun Times Bureau
Bhubaneswar, Mar 15:

Odisha has earned the dubious distinction of having a hopping 36% share of all malaria cases in India and ranking third in the list of states with the most number of deaths leaving most of its neighbours way behind.

Malaria Mosquito

These startling revelations have been made in a report tabled by the Union Health and Family Welfare department in the Parliament.

What is more disturbing is that the number of persons getting afflicted with the disease in the state is rising every year despite the state government spending crores of rupees to arrest the spread of the disease.

The state government has been spending crores of rupees on a scheme christened ‘Mo Masari’ (“My Mosquito Net’) and has been claiming that the number of afflicted has been falling in the state. But the Central government report has exposed the hollowness of the claim.

According to the report, out of the 10.70 lakh people who were afflicted with malaria in India in the year 2014, about 3.88 lakh (36.26%) were from Odisha. In 2010, around 3.95 lakh were afflicted with the disease. The number had come down to 3.08 lakh in 2011 and had further scaled down to around 2.62 lakh in 2012, the report says.

But the number of malaria patients in Odisha is again rising at a faster pace since then, according to the Health Ministry report.

Even though the neighbouring states of Jharkhand and Chhattisgarh are identified as malaria prone states, much less people are afflicted with malaria in these states as compared to Odisha. In 2014, only 1.22lakh people were affected with the disease in Chhattisgarh while only 96,140 persons were affected by malaria in Jharkhand in the same year.

Statistics cited in the report also reveal that Odisha has left many states behind and has marched ahead of others in the matter of number of deaths due to malaria. It ranks third on this count in the country.

In the year 2014, a total of 535 persons had died of malaria across the country. Out of them 73 (13.64%) were from Odish while Tripura had the maximum number of deaths in terms of percentage at 96 (17.94%) followed by Meghalaya, another hilly state, with a toll count of 78 (14.58%).

Another disturbing fact that has emerged from the report is that out of those who have died of malaria in Odisha, 80 percent are from tribal dominated areas.

The districts of Gajapati , Kalahandi , Kandhamal, Keonjhar, Koraput, Malkangiri, Mayurbhanj, Nabarangpur, Nuapada, Rayagada and Sundargarh account for both the maximum number of deaths due to malaria and maximum number of persons afflicted with the disease.


Hoax victims afraid to discuss their misplaced DDT & malaria anger . . .

July 20, 2015

We see it almost daily — probably because we’ve got searches set to find comments on malaria and DDT.

British robin, or robin redbreast. Image found on Pinterest, and also ironically used to illustrate Pointman's screed for DDT.

British robin, or robin redbreast. Image found on Pinterest, and also ironically used to illustrate Pointman’s screed for DDT. Ironic, because Britain didn’t use as much DDT, and European robins were not so badly affected as U.S. robins. Not sure if Pointman knew that and used the photo to intentionally mislead, or if he’s just really bad at identifying species.

Some well-meaning guy (or woman) writes a long piece about conscience, and then claims to have lost respect for science, or medicine professionals, or the World Health Organization (WHO), or Rachel Carson or environmentalists, or all of them at once, because Rachel Carson’s ban on DDT meant malaria infections and deaths exploded, and libruls just won’t allow anyone to fix it.

If you’re a regular reader, you know that story is impossible, because:

The standard rant against Rachel Carson in favor of DDT is impossible in three ways:

  1. EPA’s regulation cannot travel back in time to cause an end to WHO’s malaria eradication campaign (1963) nine years before the rule was made (1972); nor can history and international law be changed to make EPA’s campaign stop the use of DDT outside the U.S.
  2. Mosquitoes do not migrate thousands of miles, across oceans. EPA’s ban on spraying U.S. crops with DDT, chiefly cotton, did not cause mosquitoes to migrate from Arkansas to Africa to spread malaria.  Had they done so, DDT in Africa had a pretty good chance to getting them, anyway.
  3. A reduction of malaria deaths from 4 million to 584,000, is not an increase in deaths.

These impossibilities do not even act as speed bumps to people in a hurry to condemn science, Rachel Carson, malaria fighters and environmentalists, in a mad rush to praise DDT, a deadly poison that doesn’t do what we hoped it would, any more.

Those undeterred from slandering Rachel Carson and environmentalists often don’t want to be informed of any errors in their rant. And so, Pointman, with a nasty false indictment of science, law and environmentalists, refuses to allow my posts to correct his errors.

His screed here.  It contains at least 6 gross errors, repeating all the impossibilities listed above, and slandering both Rachel Carson and William Ruckelshaus as “mass murderers,” with the false claim that EPA stopped DDT use against malaria.

My response, dealing with a small part of the errors, below (and here at Pointman’s blog; but in moderation, so you can’t see it, at the time of this posting).

EPA’s order banning DDT use in the U.S., on crops, specifically lifted the court-imposed ban on DDT manufacture, and specifically allowed use of DDT in the U.S. or anywhere else on Earth to fight vector-borne diseases — that is, malaria.

DDT manufacture continued in the U.S. until late 1984, when a new law made DDT manufacturers responsible for not poisoning their neighbors and neighborhoods. Most DDT manufacturing arms of larger chemical companies were spun off as separate enterprises, and they declared bankruptcy rather than assume any liability for the poisons they made for huge profits.

See description of EPA order and links to the original documents here: https://timpanogos.wordpress.com/2014/10/29/oh-look-epa-ordered-ddt-to-be-used-to-fight-malaria-in-1972/

I waited several days, and send two notices asking to spring the comment from moderation. I don’t think “Pointman” is interested in discussion.

[Update]
Further reflection, a further thought — “Pointman” probably is not interested in discussion, not because he fears it — he’s probably armed, what does he have to fear? — but because he no longer caresHe’s seen the effects of good intentions gone wrong, and if it ever occurs to him it’s not his intentions, nor his going, that might be wrong, he’ll never let on.

More:


I get e-mail: Nothing But Nets needs your help with Congress, to fight malaria

May 26, 2015

Money, not DDT.

Among other goals of the hoaxsters who claim Rachel Carson was wrong and evil, and that the imaginary ban on DDT to fight malaria causes “millions of deaths,” is the erosion of trust in international  organizations that lead the fight against malaria, especially WHO, UNICEF and USAID.  Sadly, the hoaxsters have friends in Congress who threaten to withhold funding to fight malaria, often insisting that now-mostly-ineffective DDT be used instead of good, working preventive measures and medicines to cure humans of malaria.

And so, Nothing But Nets writes to ask for help:

Email your members of Congress and let them know that you support full funding for malaria prevention programs.                                       

Dear Ed,

Imagine this: working from 4:00 AM until well into the night, getting very little sleep, traveling along unpaved roads for hours at a time – all to deliver 2,000 bednets per day to the hardest-to-reach children and families.

Email your members of Congress and let them know that you support full funding for malaria prevention programs.

Take Action

In Mozambique, this is a typical day for health workers as they distribute nets to save lives as part of a campaign funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Thanks to the work of the Global Fund and other partners – including UN agencies and local communities on the ground – bednet coverage in Mozambique has gone from less than 5 percent of the population in 2000 to an impressive 60 percent today.

But without continued support from Congress, the life-saving impact of these nets could be lost.

Your member of Congress will vote soon on how much assistance the U.S. will provide to the Global Fund, along with partners like the President’s Malaria Initiative and the United Nations, the core agencies leading the fight against malaria. By showing your support to your representatives in Washington, you can help to make them champions in the fight against malaria and ensure that these bednets continue to make it to families who need them the most.

Thousands of people have already asked their members of Congress to support the crucial work of the Global Fund and other partners in the fight against malaria—will you join them today?

From all of us at Nothing But Nets, thanks for helping community health workers reach the last mile!

Dan Skallman
Senior Campaign Associate, Nothing But Nets

Original story and photo from The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Take Action


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.


Do something to fight malaria today: April 25, 2015, is World Malaria Day

April 25, 2015

Photo from the World Health Organization (WHO), the lead agency in fighting malaria.

Photo from the World Health Organization (WHO), the lead agency in fighting malaria. “A child dies every minute from #malaria in Africa http://goo.gl/46QhJq #WorldMalariaDay”

One day dedicated to education and spurs to action to beat malaria.

Amazingly, there are ways to get it wrong. Please avoid them.

Don’t claim that all we need to do to beat this nasty disease is shoot environmentalists and poison the world with DDT.  Don’t claim that health workers who risk their lives to prevent malaria with bednets, are misguided. No, Rachel Carson didn’t kill millions with false claims against DDT (in fact, she tried to keep DDT viable as a key tool to fight malaria, but we failed to listen to her in time).

You might kick in $10 to Nothing But Nets, and save a life in the most effective anti-malaria campaign in the last 50 years. In fact, I recommend it.

Have a thoughtful World Malaria Day.


Good news: Malaria deaths cut by half in last 15 years

March 20, 2015

Bad news — still about 600,000 people die from malaria every year, worldwide.

Good news: Dramatic progress against malaria since the turn of the century renews hopes that the disease might be mostly conquered in another 15 to 20 years, and perhaps even obliterated from the Earth. Malaria deaths have been cut in half in the past 15 years, from just over a million a year, to fewer than 610,000.

Since 1963, malaria deaths have been cut more than 80%, from more than 4 million per year, to fewer than 610,000.

That’s dramatic progress.

The Bill and Melinda Gates Foundation shared a video from Comic Relief, a charity set up to fight diseases, featuring David Tennant, perhaps better known the Harry Potter movies and Dr. Who sci-fi series.

Comic Relief isn’t such a big deal in the U.S.  But perhaps you’ll share, and donate?

Red Nose Day was March 13.


How is DDT used to fight malaria?

February 20, 2015

Can we dispel common misapprehensions about fighting malaria?

In fighting malaria, DDT is not used outdoors.  Spraying swamps with insecticide does little to combat malaria because malaria-carrying mosquitoes don’t usually breed or rest there, and collateral damage from DDT reduces mosquito predators.

USAID-paid workers conducting Indoor Residual Spraying (IRS) campaign. (Where? When?) USAID photo, via Stanford University, Human Biology 153

USAID-paid workers conducting Indoor Residual Spraying (IRS) campaign. (Where? When?) USAID photo, via Stanford University, Human Biology 153

DDT’s utility in fighting malaria comes from its persistence when used close by humans bitten by those species of mosquito that carry malaria. Malaria is a parasitic disease.  Malaria parasites complete their life cycle in a human host (victim), and any insect taking blood from an infected human gets some of those parasites.  The parasite completes another phase of its life cycle in certain species of mosquito — not flies nor other biting insects — and after about two weeks, mosquitoes can infect humans with newly-ready parasites.

Those species that carry malaria are usually active from about dusk until after midnight.  Consequently, they bite people usually as they sleep.  Because the “blood meal” is heavy, newly-fed mosquitoes usually fly to a nearby wall of the home to excrete water from the meal, so they fly with a lighter load.  If DDT, or some other pesticide, coats that wall, the mosquito will die before being able to pass new parasites on to new victims.

DDT is NOT used to spray outdoors, to fight malaria.  Among other things, outdoor spraying threatens domestic animals and any creature that preys on the malaria-carrying mosquito; as a pragmatic matter, outdoor use affects only a tiny percentage of malaria-carrying mosquitoes. Malaria-carriers tend to breed in small, temporary pools of water from rain; this transience makes outdoor fighting difficult.  Many people fail to understand this crucial point: DDT outdoors doesn’t help in the fight against malaria.  (Other outdoor campaigns can provide relief, such as elimination of old tires, filling potholes in roads, draining raingutters, and generally eliminating the mosquito breeding areas close to human homes, since mosquitoes rarely move more than about 50 yards in their lifetime.)

It’s important to realize that DDT in IRS allows a mosquito a free first bite.  The hope is that bite is from an uninfected mosquito, who will then land on the treated wall of the home and get a fatal dose of pesticide, so that spreading malaria it may have picked up from its victim, is stopped.  Bednets, which form a physical barrier, prevent even the first bite.  Bednets gain effectiveness from treatment with impregnated insecticides.

The U.S. Centers for Disease Control, the lead agency in the campaign to eradicate malaria from the U.S. after World War II, explains this use of DDT in Indoor Residual Spraying, or IRS:

Indoor Residual Spraying

Many malaria vectors are considered “endophilic”; that is, the mosquito vectors rest inside houses after taking a blood meal. These mosquitoes are particularly susceptible to control through indoor residual spraying (IRS).

What Is Indoor Residual Spraying?

As its name implies, IRS involves coating the walls and other surfaces of a house with a residual insecticide. For several months, the insecticide will kill mosquitoes and other insects that come in contact with these surfaces. IRS does not directly prevent people from being bitten by mosquitoes. Rather, it usually kills mosquitoes after they have fed if they come to rest on the sprayed surface. IRS thus prevents transmission of infection to other persons. To be effective, IRS must be applied to a very high proportion of households in an area (usually >80%).

Health workers sparying insecticide on the walls of a wood and adobe dwelling.

Health worker spraying insecticide on the walls of a wood and adobe dwelling, in Indoor Residual Spraying (IRS). CDC image

History of IRS

IRS with DDT was the primary malaria control method used during the Global Malaria Eradication Campaign (1955-1969). The campaign did not achieve its stated objective but it did eliminate malaria from several areas and sharply reduced the burden of malaria disease in others.

Concern over the environmental impact of DDT led to the introduction of other, more expensive insecticides. As the eradication campaign wore on, the responsibility for maintaining it was shifted to endemic countries that were not able to shoulder the financial burden. The campaign collapsed and in many areas, malaria soon returned to pre-campaign levels.

As a result of the cost of IRS, the negative publicity due to the failure of the Malaria Eradication Campaign, and environmental concerns about residual insecticides, IRS programs were largely disbanded other than in a few countries with resources to continue them. However, the recent success of IRS in reducing malaria cases in South Africa by more than 80% has revived interest in this malaria prevention tool.

Rachel Carson understood this use of DDT, and she understood that outdoor use of DDT, such as crop spraying, or fighting insects affecting trees, could induce insects to evolve resistance and immunity to DDT.  In Silent Spring Carson warned that unless outdoor uses were greatly curtailed, DDT would be rendered ineffective to fight diseases.  Fred Soper, the super-mosquito killer from the Rockefeller Foundation who organized and led the UN’s malaria eradication effort, also understood the race against evolution of DDT resistance.  He had hoped resistance would not show up in tropical areas until the 1970s — malaria campaigns around the Mediterranean produced DDT resistance as early as 1948.  Sadly, resistance to DDT was already established in many mosquito populations in tropical Africa before Soper could take the UN’s program to them.  The UN had to abandon the campaign, as CDC’s explanation indicates.

Today, every mosquito on Earth carries some of the alleles of resistance to DDT, and many are immune to it.


Malaria fight, February 2015

February 20, 2015

Timely infographic from Agence France Presse.

Some background:  The newly-formed World Health Organization (WHO) estimated worldwide malaria deaths at more than 5 million per year, when it kicked off the ambitious but ultimately unsuccessful malaria eradication program in 1955.  Eradication hopes hung on the use of DDT, sprayed on the walls of homes in affected areas (Indoor Residual Spraying, or IRS), to temporarily knock down mosquito populations so that humans infected with malaria could be cured.  After early successes in temperate zones, malaria fighters took the fight to tropical Africa in 1963.  There they discovered that overuse and abuse of DDT had already bred mosquitoes resistant to the pesticide.  With no substitute for DDT available, WHO wound down the campaign on the ground by 1965, and officially abandoned it in 1969.

Nations who had pledged money for the fight early, cut back when DDT failed.  In 1963, about 4 million people died from malaria, worldwide.

Despite the lack of an international, worldwide fight against malaria, malaria fighters soldiered on.  Better housing and better medicines made gains.  By the time the U.S. banned DDT use on crops in 1972, pledging all U.S. production of DDT to fight disease elsewhere, annual malaria deaths had fallen to just over 2 million per year. By 1990, the annual death toll was cut to about a million per year.  Through the 1980s, malaria parasites themselves developed resistance to the main pharmaceuticals used to cure humans.

By the end of the 1990s, international agencies and especially NGOs like the Bill and Melinda Gates Foundation brought new funding and new urgency to the fight against malaria.  Expansion of production of artemisinin-based pharmaceuticals provided a new tool for health workers.  Funding from the U.S., through the President’s Malaria Initiative, helped a lot.  In 2000, about a million people died from malaria.  By 2014, malaria deaths fell to under 600,000.

Parasite resistance to the new pharmaceuticals poses a new threat to continued progress.  Funding is still far short of what experts estimate to be needed, and short of pledges from developed nations.  Mosquitoes that carry malaria parasites from human to human (after a step of the life cycle in infected mosquitoes) quickly evolve resistance to pesticides; malaria parasites develop resistance to pharmaceuticals used to treat humans.  Funding to rotate pesticides and drugs falls short, causing improper use of both, and quicker evolution of resistance in mosquitoes, and parasites.

Infgraphic from Agence France Presse, on the fight against malaria, February 2015.

Infgraphic from Agence France Presse, on the fight against malaria, February 2015.


Bill Gates agrees: We can eliminate malaria in a generation

January 9, 2015

Do we have the will to do it?

More:

Gates Foundation image:  A nurse dispenses a malaria drug to treat an infected child in Tanzania.

Gates Foundation image: A nurse dispenses a malaria drug to treat an infected child in Tanzania.


Want to do a good turn? Nothing But Nets needs you to save a kid from malaria. It’s cheap.

December 30, 2014

I get e-mail from the good people fighting malaria, those who can take your ten-spot and save an African kid from death by malaria.

Dear Ed,

We have 6,000 nets left to reach our 60,000 goal to protect refugee children and their families in Cameroon from malaria!

But I still need your last-minute help to hit our target before the December 31 deadline.

That’s why a generous donor has extended his extraordinary $500,000 matching gift campaign until midnight, December 31.

I can’t think of a more meaningful way to close out the year than by making a life-saving difference for $10.

Contribute now and your tax-deductible donation will have twice the life-saving impact and help Nothing But Nets and our UN partners protect refugees in Cameroon.

Doubled!

That means your year-end donation of $25 will be worth $50, and a generous gift of $50 will be worth $100.

Thank you for caring enough to help us defeat malaria and protect even more lives.

Chris Helfrich

Chris Helfrich
Director, Nothing But Nets

P.S. Please don’t wait another moment. Contribute now to our 60,000 net campaign for Cameroon and your donation will be matched by an extraordinary $500,000 matching gift provided by a generous donor—doubling the impact of your life-saving gift. Thank you for whatever you can afford.

Donate Now | View in browser

1750 Pennsylvania Avenue NW, Suite 300, Washington, DC 20006
© Nothing But Nets

$10 buys one net, delivered to a family in Africa, usually for a child. When the net is suspended over the bed of the child, mosquitoes cannot bite, and malaria transmission can be stopped. Nets help even if a kid already has malaria, because mosquitoes can’t bite him and get malaria parasites to spread.

Studies over the past 20 years show bednets alone are more effective than Indoor Residual Spraying (IRS), with DDT or any of the other eleven pesticides used.  To increase effectiveness, nets usually come impregnated with an insecticide, so mosquitoes that try to get to the sleeping people inside will die, too.

With the help of the Bill and Melinda Gates Foundation, millions of nets stopped malaria in its tracks in several different African nations; since the campaign got underway in earnest in 1999, malaria deaths have been cut by 45%, from more than a million each year in 1999 to fewer than 610,000 in 2013, according to the World Health Organization (WHO).

Malaria deaths declined from the 4 million per year at peak DDT use, circa 1958-63, to about 1 million per year in 1999 — a reduction of 75% from peak DDT use. Malaria deaths today may be the lowest in recorded human history.

Got $10 to save a life? Cut that death toll even further.


World Malaria Report 2014: Dramatic progress (no call for DDT)

December 9, 2014

World Malaria Report 2014 dropped this week.  It’s the annual report from the World Health Organization (WHO) on the fight against malaria, the problems, critical needs — and this year, wonderful news of progress.

Cover of WHO's World Malaria Report 2014, a child, and the red blood cells the malaria parasites attack.

Cover of WHO’s World Malaria Report 2014, a child, and the red blood cells the malaria parasites attack.

Copies of the report in .pdf format come in English, French and Spanish.  A host of supplemental materials and statistical compilations accompany the report every year.

The World Malaria Report 2014 summarizes information received from malaria-endemic countries and other sources, and updates the analyses presented in the 2013 report.

It assesses global and regional malaria trends, highlights progress towards global targets, and describes opportunities and challenges in controlling and eliminating the disease. The report was launched in the United Kingdom Houses of Parliament on 9 December 2014.

The press release on the report, from WHO:

Scale-up in effective malaria control dramatically reduces deaths

News release

The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World malaria report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region – where about 90% of malaria deaths occur.

New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.

“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.

Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.

Moving towards elimination

Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific region by 2030.

In 2013, 2 countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Uzbekistan and Turkmenistan). Another 4 countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).

Fragile gains

But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.

In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.

Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under 5 years of age and infants.

In addition, resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.

Dr Alonso believes, however, that with sufficient funding and commitment huge strides forward can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” he says.

While funding to combat malaria has increased threefold since 2005, it is still only around half of the US$ 5.1 billion that is needed if global targets are to be achieved.

“Against a backdrop of continued insufficient funding the fight against malaria needs a renewed focus to ensure maximum value for money,” says Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “We must work together to strengthen country ownership, empower communities, increase efficiencies, and engage multiple sectors outside health. We need to explore ways to do things better at all levels.”

Ray Chambers, who has served as the UN Secretary-General’s Special Envoy for Malaria since 2007, highlights the remarkable progress made in recent years. “While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable,” he says.

Gains at risk in Ebola-affected countries

At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the 3 countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.

Given the intense malaria transmission in these 3 countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.

Note to editors

Globally, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide (range 124-283 million), 82% of which were in the WHO African region. Malaria was responsible for an estimated 584 000 deaths worldwide in 2013 (range: 367 000 – 755 000), killing an estimated 453 000 children under five years of age.

Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015.

The World malaria report 2014 will be launched on 9 December 2014 in the United Kingdom Houses of Parliament. The event will be co-hosted by the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) and Malaria No More UK.

Contacts for press queries will be found at the link above.

Canadian-educated, Dr. Margaret Chan of the Peoples Republic of China heads the World Health Organization.

Canadian-educated, Dr. Margaret Chan of the Peoples Republic of China heads the World Health Organization, the world’s leading anti-malaria organization.

You may note that the press release says nothing about DDT, the pesticide most famous in the malaria fight after World War II.  WHO abandoned its ambitious campaign to eradicate malaria from the Earth, in the mid-1960s, when it was discovered that mosquitoes in central Africa and other malaria-endemic regions near the tropics were already resistant or immune to the pesticide.  DDT had been used by super-mosquito fighter Fred Soper, in campaigns by the Rockefeller Foundation and WHO, to knock down mosquito populations temporarily, to get breathing room to beat malaria.  While the populations were temporarily reduced, health workers would frantically work to diagnose and completely treat to a cure, malaria infections in humans. Then, when the mosquito populations came roaring back, the bugs would have no well of disease from which to draw parasites for new infections.

Soper’s methods used DDT sprayed on walls of homes, to specifically get those mosquitoes that bite humans. Anopheles spp. mosquitoes carry malaria parasites through a critical part of the parasites’ life cycle; those mosquitoes typically bite from about dusk to just after midnight.  After a blood meal, mosquitoes pause to rest on nearby vertical structures — walls in this case — to squeeze out excess water from the blood they’ve ingested, so they’re light enough to fly.  When the mosquito encounters DDT on the walls, the hope is that the DDT kills the mosquito, ending the transmission cycle.

A brutal public relations campaign in Africa, the U.S. and Europe through the late 1990s to now, has vilified science writer Rachel Carson for her indictment of DDT in Silent Spring, her brilliant book on the dangers of indiscriminate use of untested new chemicals.

So it’s important to note that the world’s leading organization that fights malaria makes no call for more DDT.  Professional health care workers worldwide have not been hornswoggled by pro-DDT, anti-environment, anti-science, anti-WHO propaganda.  That’s good news, too.

More:


November is National Malaria Awareness Month in Philippines

November 9, 2014

Education is still a key tool in the fight against malaria.  In that spirit, the President of the Philippines declares November as National Malaria Awareness Month.

Philippines President Gloria Macapagal-Arroyo

Philippines President Gloria Macapagal-Arroyo – Wikipedia image

Hope it works.

Proclamation from the President of the Philippines:

MALACAÑANPALACE

MANILA

BY THE PRESIDENT OF THE PHILIPPINES

PROCLAMATION NO. 1168

DECLARING THE MONTH OF NOVEMBER OF EVERY YEAR AS MALARIA AWARENESS MONTH

WHEREAS, Malaria is the 8th leading cause of morbidity in the Philippines, affecting most Filipinos of productive age group, and vulnerable groups which includes pregnant women, children and indigenous population groups, and continue to be a major impediment to human and economic development in area where it persists;

WHEREAS, Malaria remains endemic in 65 of the 79 provinces affecting 12.5 million Filipinos, with pockets of high endemicity along municipal/provincial borders, in far flung remote areas and barangays populated by indigenous cultural groups and areas with socio-political conflicts;

WHEREAS, Malaria, with morbidity rate of 55 per 100,000 population and mortality rate of 0.17 per 100,000 population, has to be reduced and controlled by effective malaria prevention and treatment measures, such as increase in the use of insecticide-treated mosquito nets and early diagnosis and prompt treatment in malaria risk areas;

WHEREAS, Goal six of Millennium Development Goals aims to combat HIV/AIDS, malaria and other diseases, with the target of halting and reversing the incidence of malaria and other diseases by 2015;

WHEREAS, the WHO/UNICEF Regional Child Survival Strategy focuses on the implementation of an Essential Package for Child Survival, one of which is the use of insecticide-treated mosquito nets of children 0-59 months in malarious areas;

WHEREAS, Malaria is one of the 5 diseases to be targeted under the disease-free zones initiative of service delivery component of “FOURmula One for Health”, an implementation strategy for health reforms;

WHEREAS, recent advances in the field of diagnosis, treatment and vector control makes the disease preventable and curable despite increasing trends of drug and insecticide resistance;

WHEREAS, the main strategies to reduce morbidity and mortality against malaria are through early diagnosis and prompt treatment, vector control through the use of insecticide treated mosquito nets supplemented by indoor residual spraying of insecticides, and early detection and management of epidemics;

WHEREAS, Republic Act No. 7160, otherwise known. as the Local Government Code, devolves the provision of basic health services to prevent and control malaria to the local government units. Enhancement on the program management capacity of the LGUs will be one of the major thrusts of the Department of Health and its partners;

WHEREAS, to facilitate program management and inculcate better health-seeking behaviors among the general population especially the high risk population on prevention and control of malaria, the National Malaria Control Program in consultation with the Regional Coordinators, Provincial Health Offices, LGUs, and other stakeholders, recommends that the month of November of every year be declared for the creation of awareness on the prevention and control of malaria.

NOW, THEREFORE, I, GLORIA MACAPAGAL-ARROYO, President of the Republic of the Philippines, by virtue of the powers vested in me by law, do hereby order:

SECTION 1.            Lead agency. — The Department of Health (DOH) shall lead in the implementation of the Malaria Awareness Month every November of the year starting 2006. As such, it shall call upon all government agencies/organizations for assistance in the implementation of this Proclamation, including but not limited to the following:

a.              Department of the Interior and Local Government

b.              Department of Education

c.              Department of National Defense

d.              National Disaster and Coordinating Council

e.              Department of Tourism

f.               Local Government Units/Organizations

1.              Liga ng mga Barangay

2.              League of Municipalities

3.              League of Provinces

g.              Philippine Information Agency

h.              National Commission on Indigenous Peoples

As the lead agency, the Department of Health shall formulate and disseminate guidelines and procedures on the implementation of the campaign, provide technical assistance to LGUs and/or implementing units or organizations, conduct national/regional advocacy and social mobilization in endemic provinces, augment local logistics for malaria prevention and control, and monitor LGU activities in all phases of the campaign. The DOH will also coordinate activities with major donor funded programs such as Global Fund to Fight AIDS, Tuberculosis and Malaria — Malaria Component and Australian Agency for International Development — WHO-RBM [Roll Back Malaria] projects.

SECTION 2.            Responsibilities of the. Department of the Interior and Local Government (DILG). — The DILG, through its Secretary, shall issue and disseminate appropriate memorandum, circulars to all local chief executives, mobilize field offices, and assist in the supervision and monitoring of malaria awareness campaign and other prevention and control activities.

SECTION 3.            Responsibilities of the Department of Education (DepEd). — The DepEd, through its Secretary, shall incorporate or integrate malaria prevention and control into the school curriculum, provide a venue in schools for treatment or re-treatment of mosquito nets through school children (each pupil will bring their mosquito net for re-treatment) in coordination with local health officials. The DepEd shall issue and disseminate appropriate circulars for the purpose.

SECTION 4.            Responsibilities of the Department of National Defense (DND). — The DND, through its Secretary, shall issue and disseminate appropriate memorandum circulars to its regional and provincial units to conduct activities in raising the awareness on malaria prevention and control among their personnel and staff especially in endemic areas. The Armed Forces of the Philippines, through the Surgeon General, must ensure that military personnel assigned to endemic areas should undergo the pre- and post- malaria smear test. Provide assistance in terms of transportation and security support to local health personnel in the implementation of the campaign. Strengthen management of severe malaria to prevent deaths in its hospitals in partnership with DOH.

SECTION 5.            Responsibilities of the National Disaster Coordinating Council (NDCC). — The NDCC, through the Office of Civil Defense (OCD), shall coordinate the implementation of the malaria awareness month activities with the LGUs through the Barangay/Municipal/City Disaster Coordinating Councils, Regional Disaster Coordinating Councils, and Provincial Disaster Coordinating Councils.

SECTION 6.            Responsibilities of the Philippine Information Agency (PIA). — The PIA, through its Director-General, shall guide, integrate and supervise the public communication activities including advertisements of the malaria awareness communication campaign.

SECTION 7.            Responsibilities of the Local Government Units (LGUs). — The LGUs shall lead the local implementation of the malaria awareness campaign and allocate appropriate resources for the purpose. Ensure that basic quality health, services on the diagnosis, treatment, vector control (distribution of treated mosquito nets, re-treatment, indoor residual spraying) are sustained until 2015. Further, the LGUs shall coordinate with partner NGOs and/or private sectors in the conduct of the campaign and establish a network of all partners at the local level. The concerned LGUs shall issue appropriate local ordinances, resolutions, memorandum circulars and other relevant orders.

SECTION 8.            Responsibilities of the League of Provinces/Municipalities/Barangays. — Through their presidents, shall issue circulars, memoranda and other issuances to their members on the local implementation of malaria awareness activities.

SECTION 9.            Responsibilities of the National Commission on Indigenous Peoples (NCIP). — The NCIP, through their Chairperson, shall issue memorandum circulars to the field offices to participate actively in the conduct of malaria awareness campaign among tribal minorities/indigenous communities in coordination with local health officials. The NCIP shall likewise support and help in coordinating field activities and help in the translation of IEC materials.

SECTION 10.         Responsibilities of the Department of Tourism (DOT). — The DOT, through its Secretary, shall issue and disseminate appropriate memorandum circulars to its regional field offices to conduct activities, in coordination with the Provincial Health Offices, in raising the awareness of tourists on malaria prevention especially in endemic areas.

SECTION 11.         Participation of the Civil Societies. — All non-government organizations, members of the civil societies, professional groups, business sectors and other concerned groups are encouraged to contribute to the success of the malaria awareness campaign through information dissemination, social mobilization, providing donations and other appropriate means.

SECTION 12.         Bilateral and multilateral agencies. — All donor partners will be encouraged to support malaria control program in line with the goals of Millennium Development Goal No. 6: Combat HIV/AIDS, malaria and other diseases at all levels. Integrated programs shall be encouraged.

IN WITNESS WHEREOF, I have hereunto set my hand and caused the seal of the Republic of the Philippines to be affixed.

DONE in the City of Manila, this 10th day of November, in the year of Our Lord, Two Thousand and Six.

(Sgd.) GLORIA MACAPAGAL-ARROYO


Oh, look: EPA ordered DDT to be used to fight malaria in 1972!

October 29, 2014

U.S. Environmental Protection Agency did not start a “worldwide ban” on using DDT to fight malaria. EPA instead lifted a court imposed ban on use of the pesticide to fight disease.

At least a couple of times a week I run into someone who claims that environmentalists are evil people, led by Rachel Carson (who, they say, may be as evil as Stalin, Hitler and Mao put together), and that their hysteria-and-n0t-fact-based “worldwide ban” on DDT use led to tens of millions of people dying from malaria.

Each point of the rant is false.

air pollution control activities in the Four Corners area of the U.S., in the 1970s -- soon after the agency completed its hearings and rule making on the pesticide DDT.  EPA photo.

EPA Administrator William Rucklshaus during an airplane tour of air pollution control activities in the Four Corners area of the U.S., in the 1970s — soon after the agency completed its hearings and rule making on the pesticide DDT. EPA photo.

But lack of truth to claims doesn’t stop them from being made.

Serious students of history know better, of course.  Federal agencies, like EPA, cannot issue orders on science-based topics, without enough hard science behind the order to justify it.  That’s the rule given by courts, inscribed in law for all agencies in the Administrative Procedure Act (5 USC Chapter 5), and required of EPA specifically in the various laws delegating authority to EPA for clean air, clean water, toxics clean up, pesticides, etc.   Were an agency to issue a rule based on whim, the courts overturn it on the basis that it is “arbitrary and capricious.”  EPA’s 1972 ban on DDT use on certain crops was challenged in court, in fact — and the courts said the science behind the ban is sufficient.  None of that science has been found faulty, or the DDT manufacturers and users would have been back in court to get the EPA order overturned.

Reading the actual documents, you may discover something else, too:  Not only did the EPA order apply only to certain crop uses, not only was the order restricted to the jurisdiction of the EPA (which is to say, the U.S., and not Africa, Asia, nor any area outside U.S. jurisdiction), but the order in fact specifically overturned a previously-imposed court ruling that stopped DDT use to fight malaria.

That’s right: Bill Ruckelshaus ordered that use of DDT fight malaria is okay, in the U.S., or anywhere else in the world.

Quite the opposite of the claimed “worldwide ban on DDT to fight malaria,” it was, and is, an order to allow DDT to be used in any disease vector tussle.

How did the ranters miss that?

Here are the relevant clauses from the 1972 order, from a short order following a few pages of explanation and justification:

Administrator’s Order Regarding DDT

Order. Before the Environmental Protection Agency. In regard: Stevens Industries, Inc., et al. (Consolidated DDT Hearings). I.F.&R. Docket No. 83 et al.

In accordance with the foregoing opinion, findings and conclusions of law, use of DDT on cotton, beans (snap, lima and dry), peanuts, cabbage, cauliflower, brussel sprouts, tomatoes, fresh market corn, garlic, pimentos, in commercial greenhouses, for moth-proofing and control of bats and rodents are hereby canceled as of December 31, 1972.

Use of DDT for control of weevils on stored sweet potatoes, green peppers in the Del Marva Peninsula and cutworms on onions are canceled unless without 30 days users or registrants move to supplement the record in accordance with Part V of my opinion of today. In such event the order shall be stayed, pending the completion of the record, on terms and conditions set by the Hearing Examiner: Provided, That this stay may be dissolved if interested users or registrants do not present the required evidence in an expeditious fashion. At the conclusion of such proceedings, the issue of cancellation shall be resolved in accordance with my opinion today.

Cancellation for uses of DDT by public health officials in disease control programs and by USDA and the military for health quarantine and use in prescription drugs is lifted. [emphasis added]

In order to implement this decision no DDT shall be shipped in interstate commerce or within the District of Columbia or any American territory after December 31, 1972, unless its label bears in a prominent fashion in bold type and capital letters, in a manner satisfactory to the Pesticides Regulation Division, the following language:

  1. For use by and distribution to only U.S. Public Health Service Officials or for distribution by or on approval by the U.S. Public Health Service to other Health Service Officials for control of vector diseases;
  2. For use by and distribution to the USDA or Military for Health Quarantine Use;
  3. For use in the formulation for prescription drugs for controlling body lice;
  4. Or in drug; for use in controlling body lice – to be dispensed only by physicians. [emphasis added]

Use by or distribution to unauthorized users or use for a purpose not specified hereon or not in accordance with directions is disapproved by the Federal Government; This substance is harmful to the environment.

The Pesticides Regulation Division may require such other language as it considers appropriate.

This label may be adjusted to reflect the terms and conditions for shipment for use on green peppers in Del Marva, cutworms on onions, and weevils on sweet potatoes if a stay is in effect.

Dated: June 2, 1972

William D. Ruckelshaus

[FR Doc.72-10340 Filed 7-6-72; 8:50 am]
Federal Register, Vol. 37, No. 131 – Friday, July 7, 1972 pp. 13375-13376

Here is the entire order, in an image .pdf format.

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Curing malaria in the USA, 1938

September 26, 2014

Photo from the collections of the Library of Congress:

“Groves Bromo Quinine,” sign on a shack advertises a treatment for malaria, and other products; near Summerville, South Carolina. Photo by Marion Post Wolcott, December 1938. Library of Congress.

This photo was taken by Marion Post Wolcott for the Farm Security Administration, documenting how farmers and other Americans lived during the Great Depression.

1938 was a year before DDT’s insecticidal properties were discovered, and at least six years before DDT became available for civilian work against malaria and the mosquitoes who spread the parasites.


U.N. General Assembly notes progress against malaria

September 16, 2014

In Ghana:  Community members perform a scene to educate others on how and why to use bednets. (USAID/Kasia McCormick) 2012. USAID Africa Bureau

In Ghana: Community members perform a scene to educate others on how and why to use bednets. (USAID/Kasia McCormick) 2012. USAID Africa Bureau, via Wikimedia

In stark contrast to the usual hoax stories we get in the U.S. about malaria and DDT, the United Nations General Assembly this past week passed a resolution noting progress made in fighting the parasitic disease.

Quoting wholesale from Ghana Web:

The United Nations General Assembly at its 68th Session, adopted Resolution A/68/L.60, “Consolidating Gains and Accelerating Efforts to Control and Eliminate Malaria in Developing Countries, Particularly in Africa, by 2015” by consensus.

Recognising progress made through political leadership and a broad range of national and international actions to scale-up malaria control interventions, this annual resolution urges governments, United Nations agencies, and all stakeholders to work together to meet the targets set out in the Roll Back Malaria Partnership’s Global Malaria Action Plan (GMAP) and the UN’s Millennium Development Goals (MDGs).

An official statement issued in Accra and copied the Ghana News Agency said with just less than 500 days until the 2015 deadline of the MDGs, the adoption of this resolution by the General Assembly reiterates the commitment of UN Member States to keep malaria high on the international development agenda.

“We have seen tremendous progress against this killer disease in recent years, but continued success will require increased political and financial commitment from donor and endemic governments alike. Together we can scale-up efforts and continue saving lives,” it said.

The statement said since 2001, the World Health Organisation (WHO) estimated that malaria death rates have decreased by nearly 50 per cent in Africa alone, where 90 per cent of all malaria-related deaths still occur – contributing to a 20 per cent reduction in global child mortality and helping drive progress towards UN MDG 4.

“Between 2001 and 2012, collective efforts helped avert an estimated 3.3 million deaths (69 per cent) of which were in the 10 countries with the highest malaria burden in 2000 and more than half of the 103 countries that had ongoing malaria transmission in 2000 are meeting the MDG of reversing malaria incidence by 2015.

“Despite these advances, almost half of the world’s population remains at risk from malaria, with an estimated 207 million cases of infection around the world each year and 627,000 deaths. Around the world, a child still dies from malaria every minute.

“The resolution calls for donor and endemic governments alike to support global malaria control efforts, including the secretariat of the Roll Back Malaria Partnership, and to intensify efforts to secure the political commitment, partnerships and funds needed to continue saving lives.

“Increased financing will be critical to further advancements, as current international and domestic financing for malaria of US 2.5 billion dollars in 2012 amounts to less than half of the US 5.1 billion dollars estimates to be needed annually through 2020 to achieve universal coverage of malaria control interventions,” the statement said.

In 2012, United Nations Secretary-General Ban Ki-moon named malaria as a top priority of his second mandate. Malaria control has consistently proven to be a strong global health investment, generating high return on low investments.

Impacting all eight of the United Nations MDGs, malaria prevention and treatment serves as an entry point to help advance progress against other health and development targets across the board by reducing school absenteeism, fighting poverty, and improving maternal and child health.

Did you see that report in your local newspapers, or on radio or television?

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