Report that malaria and DDT hoaxsters hope you never see

January 21, 2016

 Cover of World Health Organization's "World Malaria Report 2015," which reported dramatic progress controlling malaria.

Cover of World Health Organization’s “World Malaria Report 2015,” which reported dramatic progress controlling malaria.

World Malaria Report 2015 dropped in mid-December, with United Nations-style fanfare.

Which means, you probably heard little to nothing about it in U.S. media, and “conservatives” and anti-science hoaxsters hope you won’t ever see it, so they can claim contrary to the facts that liberals kill kids in Africa.

My cynicism about the fight against malaria dissipates some, but my cynicism about hoaxes substituting for political dialogue grows.

World Health Organization (WHO) releases an annual report near the end of every year, detailing the fight against malaria and progress or lack of it.

Good news this year: WHO estimates deaths to malaria fell below 500,000 per year in 2015. That’s at least a 50% reduction since renewed vigor in the malaria fight in 2000, and it’s a 90% reduction from peak DDT use years, 1958-1963, when WHO estimated 5 million people died each year from malaria.

About 80% of malaria deaths take children under the age of 5.

Bigger picture: Malaria is on the run. Humans are winning the fight against malaria. Much remains to be done, however. Plus, malaria fighters warn that malaria can come roaring back, if governments neglect to follow through on promises of funding, and with well-run programs to cure humans of malaria and prevent new cases.

World Malaria Report 2015 should influence policy discussions in U.S. elections. But generally, this report was ignored.

Millard Fillmore’s Bathtub will feature in-depth discussions of parts of the report, and simple repetition for the record of the report, as part our long-term battle against hoaxsters who claim the U.S. ban on use of DDT on U.S. farms somehow increased malaria in Africa, and killed millions, when malaria actually decreased and millions were saved from death.

Malaria loses only with hard work on the ground by medical people treating and curing humans of the disease, and by public health people working hard to prevent new infections. Most of that work is not glorious, occurs relatively anonymously and away from television cameras and photographers with access to social media.  Which is to say, the hard work of defeating malaria goes unsung around the world. We should work to change that.

What did others say about World Malaria Report?

A collection of Tweets, and other links, for your study.


How USA spends so much money to fight malaria in other nations

January 2, 2016

Fighting malaria is difficult, and complex, and expensive. No magic bullet can slow or stop malaria.

Reasonable people understand the stakes, not only for Africa, where $12 billion is lost every year to malaria illness and death, according to WHO records; but also for all nations who trade with Africa and other malaria endemic nations in the world.

What should we do about malaria?

Before we leap to solutions, let us look to see what the United States is already doing, according to USAID, the agency which has led U.S. malaria-fighting since the 1950s.

USAID explains on their website:

Fighting Malaria

A mother and child sit under the protection of malaria nets

A mother and child sit under the protection of malaria nets. Learn more about PMI’s contributions to the global fight against malaria. Maggie Hallahan Photography

Each year, malaria causes about 214 million cases and an estimated 438,000 deaths worldwide

While malaria mortality rates have dropped by 60 percent over the period 2000–2015, malaria remains a major cause of death among children. Although the disease is preventable and curable, it is estimated that a child dies every minute from malaria. In Asia and the Americas, malaria causes fewer severe illnesses and deaths, but antimalarial drug resistance is a serious and growing problem.

The U.S. Agency for International Development (USAID) has been committed to fighting malaria since the 1950s. Malaria prevention and control remains a major U.S. foreign assistance objective and supports the U.S. Government’s vision of ending preventable child and maternal deaths and ending extreme poverty. USAID works closely with national governments to build their capacity to prevent and treat the disease. USAID also invests in the discovery and development of new antimalarial drugs and malaria vaccines. USAID-supported malaria control activities are based on country-level assessments, and a combination of interventions are implemented to achieve the greatest public health impact – most importantly the reduction of maternal and child mortality. These interventions include:

  • Indoor residual spraying (IRS): IRS is the organized, timely spraying of an insecticide on the inside walls of houses or dwellings. It kills adult mosquitoes before they can transmit malaria parasites to another person.
  • Insecticide-treated mosquito nets (ITNs): An insecticide-treated mosquito net hung over sleeping areas protects those sleeping under it by repelling mosquitoes and killing those that land on it.
  • Intermittent preventive treatment for pregnant women (IPTp): Approximately 125 million pregnant women annually are at risk of contracting malaria. IPTp involves the administration of at least two doses of an antimalarial drug to a pregnant woman, which protects her against maternal anemia and reduces the likelihood of low birth weight and perinatal death.
  • Diagnosis and treatment with lifesaving drugs: Effective case management entails diagnostic testing for malaria to ensure that all patients with malaria are properly identified and receive a quality-assured artemisinin-based combination therapy (ACT).

The President’s Malaria Initiative (PMI) works in 19 focus countries in sub-Saharan Africa and the Greater Mekong Subregion in Asia. PMI is an interagency initiative led by USAID and implemented together with the U.S. Centers for Disease Control and Prevention. In 2015, PMI launched its next 6-year strategy for 2015–2020, which takes into account the progress over the past decade and the new challenges that have arisen. It is also in line with the goals articulated in the Roll Back Malaria (RBM) Partnership’s second generation global malaria action plan, Action and Investment to Defeat Malaria (AIM) 2016–2030: for a Malaria-Free World [PDF, 18.6MB] and The World Health Organization’s (WHO’s) updated Global Technical Strategy: 2016–2030 [PDF, 1.0MB]. The U.S. Government’s goal under the PMI Strategy 2015-2020 [PDF, 8.9MB] is to work with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity, toward the long-term goal of elimination. USAID also provides support to malaria control efforts in other countries in Africa, including Burkina Faso, Burundi and South Sudan, and one regional program in the Amazon Basin of South America. The latter program focuses primarily on identifying and containing antimalarial drug resistance.

Do you think the U.S. spends too much on foreign aid, even good aid to fight malaria? How much do you think is spent? Put your estimate in comments, please — and by all means, look for sources to see what the actual amount is.


Bednets enough enough to beat malaria in most places

October 8, 2015

Reuters caption:  A displaced child plays on a mattress under a mosquito net laid in the open at Tomping camp near South Sudan's capital Juba January 7, 2014. Reuters/James Akena/Files

Reuters caption: A displaced child plays on a mattress under a mosquito net laid in the open at Tomping camp near South Sudan’s capital Juba January 7, 2014. Reuters/James Akena/Files

Another blow to the DDT partisans.

In a report published last January, which I just reread, researchers found that bednets alone offer enough prevention of malaria that Indoor Residual Spraying (IRS) using DDT or one of the other 11 WHO-approved insecticides, offers no additional protection, but at additional cost.

Lancet study said bednets alone are effective against malaria transmission, and spraying insecticides gives no additional benefit.

Reuters reported:

Spraying insecticides indoors offers children no additional protection from malaria when bed nets are used, a study said on Tuesday, as malaria cases and deaths worldwide continue to fall.

A study by medical journal The Lancet said donors should invest their limited resources on additional bed nets as the most cost-effective solution to tackling malaria, costing an average of $2.20 per person compared to $6.70 for insecticide.

“High bed net use is sufficient to protect people against malaria in areas that have low or moderate levels of malaria,” lead author Steve Lindsay said in a statement.

Malaria, a mosquito-borne parasitic disease, kills more than 600,000 people a year, and most victims are children under five living in the poorest parts of sub-Saharan Africa.

The study coincided with the launch of the World Health Organisation’s (WHO) annual World Malaria Report, which said the number of global malaria deaths fell by 47 percent between 2000 and 2013, with malaria cases also steadily declining, due to improved access to testing, treatment and bed nets. (http://in.reuters.com/article/2014/12/09/health-malaria-nets-idINKBN0JN0YT20141209)

 

Reuters’s report is longer, at Reuters’s site.

But another report by June indicates that gains against malaria can still be tough to maintain, especially with global warming creeping up on us.

The fight’s not over.


Malaria No More notes milestone: Malaria at all time low

August 20, 2015

Remarkable progress against malaria marks the 21st century — but there was even more progress between 1960 and 2000. This progress usually is not noted in screeds against the World Health Organization (WHO), or Rachel Carson, or “crazy environmentalists.”

Through the 1950s, WHO estimated malaria deaths worldwide at about 5 million people each year. In about a decade of WHO’s malaria eradication campaign in temperate zones, the toll is estimated to have dropped to about 4 million dead each year.  WHO suspended the eradication campaign in 1963 when it was discovered that mosquitoes in central Africa were already resistant and immune to DDT, which was the chief pesticide used for Indoor Residual Spraying to temporarily knock down local mosquito populations. WHO tried to find substitutes for DDT, but by 1969 formally ended the program and stopped asking for money for eradication.

The fight against malaria continued, however. In 1972 the U.S. flooded malaria-prone nations with DDT which had been intended for use on U.S. crops, after the U.S. prohibited DDT on U.S. crops. For a dozen years all U.S. DDT production got channeled into Africa and Asia to fight disease.  U.S. makers had gotten out of DDT production by 1985 as production shifted to other nations.

Despite DDT’s failure, progress was made in medical care and especially in education on how to prevent mosquito bites.  The death toll dropped toward 1 million annually until about 1990. In the late 1980s, the medicines used to cure humans from malaria parasites failed, as the parasites developed their own resistance to the drugs. Through the 1990s, malaria deaths remained constant, or even rose.

A flood of concern in the late 1990s produced a coalition of malaria fighters with funding through the United Nations and non-governmental organizations (NGOs) such as the Gates Foundation and Wellcome Trust. In 1999, most of these groups agreed to fight harder, using “integrated vector management,” a variety of methods calculated to prevent mosquitoes from developing resistance to new pesticides, and prevent the malaria parasites from developing resistance to pharmaceuticals.

Plus, in nations where houses often were leaky to mosquitoes, these agencies provided bednets to prevent bites of malaria-carriers at peak biting periods, when people slept. By 2008, deaths dropped below a million each year for the first time, and progress has continued.

Beating malaria is a top goal of the United Nations’ Millennium Development Goals (MDGs); Malaria No More reported on a recently-completed report on those goals, which noted the progress against malaria.

Here is the press release from Malaria No More.

Malaria Deaths Reach All Time Low, U.N. Secretary General’s Final MDG Report Shows

NEW YORK, NY – July 6, 2015 – Malaria deaths have reached an all-time low and 6.2 million lives have been saved from the disease between 2000-2015, according to a new United Nations report announced by U.N. Secretary-General Ban Ki-moon’s office today. The final report on progress of the Millennium Development Goals (MDGs), which are set to expire this year, highlights an historic 69 percent decline in the rate of child deaths from malaria in Africa.

The report provides an update to all eight MDG Goals. The unprecedented global leadership over the past ten years to combat malaria has not only surpassed the disease-specific MDG target (Goal 6, Combat HIV/AIDS, Malaria and Other Diseases), but those efforts also contributed to critical progress toward achieving Goals 4 (Reduce Child Mortality) and 5 (Improve Maternal Health).

“Malaria is one of the standout successes of the MDGs thanks to continuous innovation, bold endemic country leadership and steadfast donor commitment,” said Ray Chambers, the U.N. Secretary-General’s Special Envoy for Malaria and Financing the Health MDGs. “We need to build on this success to ensure no child, woman or man dies from a mosquito bite and that we ultimately eradicate this disease.”

Thanks to the leadership of the United States, the Global Fund to Fight AIDS, Tuberculosis and Malaria and other international donors, malaria financing has grown dramatically from 2000-2015 to more than $3 billion annually, and political leadership has fueled the delivery of more than 1 billion mosquito nets to Africa along with hundreds of millions of effective tests and treatments.

Although these results have successfully surpassed the MDG target, the fight against malaria is not finished. Malaria remains a major global health security challenge with an estimated 3.3 billion people at risk globally. Thanks to recent success in achieving real and measureable progress, coupled with steadfast political leadership and a promising pipeline of transformative new technologies, malaria-affected regions have set ambitious goals for elimination including transformative 2020 targets in Southern Africa, Southeast Asia and the Caribbean.

“Malaria is one of the oldest and deadliest diseases in human history,” said Martin Edlund, CEO of Malaria No More. “For the first time in history we have the opportunity to capitalize on our success and end malaria within a generation; we can’t afford to miss that opportunity.”

Click here to download the full report.

Chart from USNews.com:

Estimated change in malaria incidence rate (cases per 1,000 population at risk) and malaria mortality rate (deaths per 100,000 persons at risk), 2000-2015. USNews.com chart, based on MDG report.

Estimated change in malaria incidence rate (cases per 1,000 population at risk) and malaria mortality rate (deaths per 100,000 persons at risk), 2000-2015. USNews.com chart, based on MDG report.


Malaria Twitterstorm, summer of 2015

August 18, 2015

Several good developments in the War on Malaria, worldwide — along with some alarming signs.  Maybe there will be time to blog seriously about each of these things later. Let’s get them known, and keep discussion going for the best way to beat malaria in a post-DDT world.

QPharm Tweeted about DSM 265, an experimental, one-dose treatment developed by the Medicines for Malaria Venture (MMV); the video is useful for the background those new to the issue can get on the problems of treating malaria, which make great hurdles for campaigns to eradicate malaria.

Here’s the video the Tweet leads to.

MMV said:

DSM265 is a selective inhibitor of the plasmodial enzyme called DHODH. DHODH is a key enzyme in the replication of the parasite. If we can inhibit that enzyme with DSM265, we can stop the life of the parasite.

Voice of America reported on Rollback Malaria’s call for $100 billion to be spent in the next 15 years, to stamp out the disease.

Malaria deaths are, in 2015, at an “all time low.” Deaths hover around 500,000 per year, most in Africa, and most among children under the age of 5. A staggering total, until compared to the post-World War II estimates of more than 5 million deaths per year, or the more than 3 million deaths per year in 1963, the year the World Health Organization (WHO) had to stop its ambitious campaign to eradicate malaria when pesticide DDT, upon which the campaign was based, produced resistance in mosquitoes in areas where the campaign had not yet reached.

Beating malaria is one of the Millennium Development Goals of the United Nations; this year’s report on MDG acknowledged the great progress already made.

Another non-governmental malaria-fighting organization discussed the news; see the press release from Malaria No More.

Medical News Today Tweeted out a tout for its own coverage of malaria — notable for a good, basic explanation of malaria and how to fight it.  I wish critics of Rachel Carson and WHO were familiar with half of these basic facts.

Medical News Now's Fast Facts on Malaria

Medical News Now’s Fast Facts on Malaria. Notable, that annual deaths now are way below the million mark. Good news!

One malaria vaccine has won approval for final testing. Good news, though anyone who follows vaccines knows it will take a while to test, and anyone who knows malaria fighting knows there are four different parasites, and delivery of any medical care is tough in far too many parts of the world where any form of malaria is endemic. Even small good news is good news.

Are we better informed about malaria now? Do we understand spreading a lot more DDT is not the answer?

 


Wellcome Trust interactive on malaria parasites’ lifecycle

August 12, 2015

Screen capture of the Wellcome Trust HTML presentation on the life cycle of malaria parasites. Malaria fighters know all this almost instinctively; too often policy makers fail to understand it, and so they recommend policies that do not make medical or economic sense in fighting the disease. Click image to go to Wellcome Trust site for full presentation.

Screen capture of the Wellcome Trust HTML presentation on the life cycle of malaria parasites. Malaria fighters know all this almost instinctively; too often policy makers fail to understand it, and so they recommend policies that do not make medical or economic sense in fighting the disease. Click image to go to Wellcome Trust site for full presentation.

Britain’s Wellcome Trust takes as one of its key missions the fight against malaria.  The Trust is a charitable foundation created from profits of pharmaceutical development and sales.

Recently I found this HTML animation presentation on the life cycle of the malaria parasite, something all malaria fighters must know to be effective.

It’s also something that DDT advocates seem unable to comprehend.  Malaria is not a virus, nor is it a venom mosquitoes manufacture, but it is a parasite that infects (and disables) both mosquitoes and humans. Mosquitoes catch the parasite from an infected human host. After the malaria parasite completes a couple of cycles in the gut of the mosquito, the parasite can be transmitted back to humans by a mosquito bite. And the cycle continues.

Since complete eradication of malaria-carrying mosquitoes is practically impossible in almost all cases, beating malaria requires an interruption in the cycle of transmission of the parasite, plus the curing of the disease in infected human hosts.

For example, the old World Health Organization (WHO) malaria eradication campaign, which operated from 1955 to 1963, DDT was used to temporarily knock down a population of mosquitoes, with hopes human hosts would be ridded of malaria parasites so that, in six months or so, when the mosquito populations roared back, there would be no malaria in local humans to infect mosquitoes. Consequently, mosquitoes can’t transmit a parasite they don’t have.

Lost on far too many people: Humans must be cured of malaria to prevent transmission. Beating malaria takes a lot more than just killing mosquitoes.

Check out the interactive:  Malaria parasite life cycle

While you’re there, snoop around to see what else Wellcome Trust is up to in the malaria fight.

 


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.


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