Spreading the news: Environmental Health News says we can learn from saving eagles, to save honeybees now

July 5, 2015

Environmental Health News invites repostings of this story, with attribution and links back to EHN’s original story.

It’s a good article. Can’t improve on it much, so let’s save time and pass it directly.

Can we learn from the success in saving the bald eagle from extinction, to save our domestic bee industry and native American pollinators?

Unintended consequences

How a law that failed to protect eagles could offer a lesson to save honeybees

June 6, 2015

By Peter Dykstra
Environmental Health News

Spraying DDT on a beach

Historic photo from EPA

The Bald Eagle Protection Act, signed into law 75 years ago on June 8, 1940, was well-intended. A multi-pronged assault on the raptors was taking its toll — habitat loss, lead-shot poisoning, and bounty-hunting by ranchers and fishermen all contributed to a growing threat. (Click here to see how this played out in Alaska.)

Congress passed, and President Franklin D. Roosevelt signed, the act to outlaw the “taking” of eagles and their eggs, disruption of their nests, or sale or possession of eagle feathers or parts.

It didn’t work. Bald eagle populations accelerated their decline, for reasons that Congress, wildlife officials, and FDR couldn’t possibly anticipate.

Throughout the late 1930’s Swiss chemist Paul Müller labored to find the right mix of synthetic chemicals to control moths. Not only did dichlorodiphenyltrichloroethane do the trick, but Müller’s lab work found it was effective against lice, houseflies, beetles, and the dreaded mosquito. Müller’s employers, J.R. Geigy AG, applied for the first DDT permit about two months before the Eagle Act passed.

Pest Management Professional Hall of Fame

Swiss chemist Paul Muller, of A. G. Geigy corporation; the man who discovered DDT kills.  Pest Management Professional Hall of Fame

The rest is natural and human history. Cheap to produce and an effective defense against lice-borne typhus and mosquito-borne malaria, DDT quickly became a fixture in farm fields, living rooms, and World War II battle theaters. Müller became a science rock star, garnering a Nobel in 1948 and — wait for it — membership in the Pest Management Professional Hall of Fame in 2004.

But bald eagles continued to decline. So did hummingbirds, robins, ospreys, pelicans and peregrine falcons. Years of science, met with serious blowback from the chemical industry, eventually proved that DDT was thinning birds’ eggshells, not to mention causing impacts in fish, humans, and other mammals. Rachel Carson’s Silent Spring drew international attention to the threat, and in the U.S., DDT was outlawed on the last day of 1972. Bald eagles, ospreys, brown pelicans and peregrine falcons have all since staged remarkable comebacks from the Endangered Species list.

Which brings us to today’s threat to other ecologically priceless wildlife — pollinators. Honeybee populations have been in freefall for more than a decade. Like the threats to eagles, the potential causes are multiple: loss of habitat and native plants, parasites, and a mix of insecticides and fungicides. Newest, and most notable among the suspects, are neonicotinoid pesticides. Like DDT, neonics were developed in the 1980’s and 1990’s and welcomed as a step forward, since they were thought to be effective on insect pests but relatively benign on non-target wildlife and ecosystems. Today they are a billion-dollar agricultural product, ubiquitous on common crops like corn and soybeans.

But mounting evidence shows that neonicotinoids may be part of the frontal assault on bees and other pollinators. In 2013, the European Union banned the use of three of the most contentious types of neonicotinoids, citing a clear and immediate risk.

In 2014, President Obama ordered the creation of a federal pollinator strategy. Its first draft came out last month, calling for everything from creating bee-friendly habitat to further study on neonics and other agricultural chemicals. The first edition of the strategy, issued in May, outlines a multi-year process for re-examining use of neonics.

If the EPA and other federal agencies concur with other studies on the potential harm of neonicotinoids, the U.S. will issue assessments for neonics in 2016 and 2017, and may or may not take action until 2018 to 2020. All of this will take place under a new president who may or may not take interest in protecting bees.

That timetable may work. Or not. Or, with a president with little more than a year left in office and a hostile Congress, it may be a moot point.

But perhaps a more important point is that in 1940, the President and Congress took action on the known threats to eagles. They didn’t know about the chemical risk from DDT. If neonics are as big a threat as the science suggests, the current president and Congress won’t have ignorance as an excuse for waiting.


EHN welcomes republication of our stories, but we require that publications include the author’s name and Environmental Health News at the top of the piece, along with a link back to EHN’s version.

For questions or feedback about this piece, contact Brian Bienkowski at bbienkowski@ehn.org.

Prior to the 20th century, all eagles, including bald eagles were regarded as pest predators and pest carrion eaters.  Populations of the birds plunged between 1492 and 1900.  The first eagle protection law in 1918 did little to stop the decline in eagle populations.  A harder-toothed anti-hunting law in 1941 helped, as discussed above. Anti-environmentalists often seize on these historic facts to claim that DDT was not to blame for the failure of the eagles to recover after 1941.  But recovery of the birds started as soon as DDT was banned.  Fecundity of bald eagle populations rose in direct proportion to the drop in residual DDT and DDT breakdown products in the flesh and fat of eagles.

In Silent Spring Rachel Carson provided 53 pages of notes and citations to science journals, documenting the dangers and the unknowns of DDT and a variety of other chemicals. The book was published in 1962.  It is a tribute to Carson’s meticulous research that every study she pulled from is still accurate today. Later research only supported her conclusions, or in the case of bird damage and eggshell thinning, provided documentation of even more and greater harms.

Do we learn from history?


Early history of EPA: Pesticides regulation and DDT

June 24, 2015

This is an excerpt from EPA’s official shorthand history, online since the 1990s.  I include this part here, dealing with the EPA’s famous regulation of the pesticide DDT, because I refer to it and link to it in several posts — and because over three different administrations, the URL has changed several times.  I fear it will one day go dark.  Here it is for history’s sake, found on June 24, 2015 at http://www2.epa.gov/aboutepa/guardian-epas-formative-years-1970-1973#pest.

Opening to the entire piece; links to subsections go to EPA’s site:

The Guardian: EPA’s Formative Years, 1970-1973

EPA 202-K-93-002
September 1993
by Dennis C. Williams

Table of Contents

The section on DDT hearings and regulation:

Pesticides and Public Health

Unlike the air controversy, which erupted after the agency’s establishment, EPA’s creation coincided with the culmination of the public debate over DDT (dichloro-diphenyl-trichloro-ethane). A chlorinated hydrocarbon, DDT proved to be a highly effective, but extremely persistent organic pesticide. Since the 1940s, farmers, foresters, and public health officials sprayed it across the country to control pests such as Mexican boll weevils, gypsy moths, and pesky suburban mosquitoes. Widespread public opposition to DDT began with the publication of Rachel Carson’s influential Silent Spring. Reporting the effects of DDT on wildlife, Carson demonstrated that DDT not only infiltrated all areas of the ecological system, but was exponentially concentrated as it moved to higher levels in the food web. Through Carson, many citizens learned that humans faced DDT-induced risks. By 1968 several states had banned DDT use. The Environmental Defense Fund, which began as a group of concerned scientists, spearheaded a campaign to force federal suspension of DDT registration–banning its use in the United States. Inheriting Department of Agriculture (USDA) pesticide registration functions, under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) of 1964, EPA was born in the midst of the DDT storm.

In January 1971, a tribunal of the U.S. Court of Appeals in the District of Columbia ordered Ruckelshaus to begin the process of suspending DDT’s registration, and to consider suspending its registration immediately. At the end of a sixty-day review process, the administrator reported that he had found no good reason to suspend DDT registration immediateIy. It and several other pesticides–including 2, 4, 5-T (Agent Orange), Dieldrin, Aldrin, and Mirex–did not appear to constitute imminent health threats. This action infuriated many environmentalists.

By 1971, the Environmental Defense Fund had mobilized effective public opposition to DDT. The furor created by Ruckelshaus’s refusal to stop DDT use prompted many to look for sinister political motivations. Some suggested that Mississippi Congressman Jamie Whitten had used his position as chairman of the agricultural appropriations subcommittee of the House Appropriations Committee to make Ruckelshaus conform to the interests of the agrichemical lobby. While actually, Ruckelshaus took his cautious stance for less menacing reasons.

At its creation, EPA not only inherited the function of pesticide registration from USDA, but also the staff that served that function. The USDA economic entomologists who designed the pesticide registration process in the first place preached the advantages of effective pesticides and minimized discussion of debatable health risks. The same staff that had backed USDA Secretary Clifford Hardin’s earlier claim that DDT was not “an imminent hazard to human health or to fish and wildlife” 8 provided Ruckelshaus with the same counsel.

Rachel Carson's Silent Spring led to banning DDT and other pesticides.

Rachel Carson’s Silent Spring led to banning DDT and other pesticides.

Between March 1971 and June 1972, American newspapers reported both sides of the pesticide debate. Some articles recalled the glory days when pesticides saved thousands of lives in World War II; how they had increased agricultural productivity and allowed relatively few farmers to feed the world’s growing population; and how the most besieged insecticides, such as DDT and Mirex, had little human toxicity. Other journalists praised alternative approaches to pest management such as biological controls (predator introduction, sterile males, and pheromone traps), integrated controls (crop rotation and carefully delimited pesticide use), and refinement of other, less persistent chemicals. Some reported the near panic of Northwestern fruit growers facing beeless, and therefore fruitless, seasons. They attributed the lack of pollinating insects to pesticide use.

Throughout the spring of 1972, Ruckelshaus reviewed the evidence EPA had collected during the agency’s hearings on DDT cancellation and the reports prepared by two DDT study groups, the Hilton and Mrak Commissions. Both studies suggested that DDT be phased out due to the chemical’s persistent presence in ecosystems and noted studies suggesting that DDT posed a carcinogenic risk to humans. In June, he followed the route already taken by several states he banned DDT application in the United States. Though unpopular among certain segments of EPA’s constituency, his decision did serve to enhance the activist image he sought to create for the agency, and without prohibitive political cost.

The DDT decision was important to EPA for several reasons. While it did not stop the debate over what constituted appropriate pesticide use, DDT demonstrated the effect public pressure could have on EPA policy decisions. It also made very visible the tightrope act a regulatory agency performs when it attempts to balance the demands for protection of human and environmental health against legitimate economic demands. Furthermore, EPA’s decision set a precedent for regulatory decision-making. As an advocate of the environment, Ruckelshaus and the agency chose to risk erring on the side of protecting human health at the expense of economic considerations–a course that would bring the agency under heavy criticism before the end of its first decade.


Rachel Carson’s 108th birth anniversary

May 27, 2015

Rachel Carson, the great biologist and author, was born on May 27, 1907.

Last year, Google’s Doodle featured Ms. Carson, and the crazy, ill-informed, hoaxing and hoaxed right wing, came unglued.

Less flap this year, but I suspect it’s only because there’s been no great public recognition of the date.  Hoaxsters who insist DDT was always safe, or that banning DDT on cotton crops in Arkansas and Texas somehow caused malaria in Africa, or that Idi Amin became a great fan of Rachel Carson and stopped spraying DDT in Uganda to save American eagles, or other similarly silly-but-vicious things, or who just hate anything to do with protecting the environment, usually erupt on Earth Day, World Malaria Day, and Rachel Carson’s birthday.

Not much on her birthday this year (but stay tuned).

Meanwhile, our country’s sober liberal conscience, The Nation, looks back at their review of Silent Spring, and does a little cringing. Probably not necessary:

Rachel Carson, date unknown. (US Department of Agriculture) - via The Nation

Rachel Carson, date unknown. (US Department of Agriculture) – via The Nation

It is difficult not to cringe at the sight of the headline to the following review of Rachel Carson’s groundbreaking book, Silent Spring—“Man and Other Pests”—given that it was a review of what was then probably the most influential intellectual contribution by an American woman to date.

Miss Carson is indignant about the unexpected effects of our thoughtless broadcasting of pesticides. She writes persuasively, for she has taken great pains to gather and check her facts. Parts of the book were published in The New Yorker magazine last summer, and immediately provoked wide interest, discussion and controversy. This reaction will undoubtedly intensify with the publication of the book. No one is in a better position than Miss Carson to arouse the indignation of the public and the conscience of the chemical industry, and it may well be that she has made a real contribution to our salvation.

[At The Nation, you can read the entire review quoted from above.]

Happy birthday, Ms. Carson.  You have become a hero to thinking people, conservationists, scientists and women everywhere.

You’ll be pleased to know the American symbol, the bald eagle, is back from extinction’s verge, along with the brown pelican, peregrine falcons and osprey.  You’d be surprised to know that, despite gross abuse of DDT in the 1950s and 1960s that caused mosquitoes all over the world to carry alleles resistance and immunity, DDT was saved from complete worthlessness by a reduction in use, and is still used in a few places today, indoors to protect wildlife, to fight malaria.  You were right about DDT.

You were right about fighting malaria, too.  You said in Silent Spring we should use integrated pest management to battle the mosquitoes that provide a site for part of the life cycle of the malaria parasites, and who then spread the disease.  When DDT failed the malaria eradication campaign in the 1960s, malaria fighters were left with little else. Malaria deaths have plunged, from the 4 million to 5 million per year you knew, to fewer than 500,000 per year now.  Worldwide, we’ve cut malaria deaths 45% just since 1999, when a group of non-governmental organizations and the World Health Organization formally adopted integrated pest management as the best way to fight the disease, and began distributing mosquito nets in a big way.

You were right, Rachel Carson. Humanity is a part of nature, and if we fight nature we end up fighting and killing ourselves.

More:

One of my favorites from Gus Arriola (also appearing at the DDT Chronicles):


Highlights from the World Health Assembly #68, in graphic form

May 26, 2015

World Health Organization (WHO) summary of the World Health Assembly #68, which met in Geneva last, May 18-26.

Not a peep about “more DDT to fight malaria.’

Graphic from the World Health Organization on major actions of the World Health Assembly 68, in Geneva, Switzerland, May 18-26, 2015

Graphic from the World Health Organization on major actions of the World Health Assembly 68, in Geneva, Switzerland, May 18-26, 2015

 

 


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


One billion nets to Africa

May 21, 2015

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

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

Interesting week.

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

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

One Billion Nets to Africa

Description of the film:

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

  • Music:  “Eyes Wide Open” by Tony Anderson

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

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

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

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


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.


Follow

Get every new post delivered to your Inbox.

Join 2,728 other followers

%d bloggers like this: