In the 1850s a Hungarian doctor and professor of obstetrics named Ignaz Semmelweis [pictured at left] ordered his interns at the Viennese Lying-in Hospital to wash their hands after performing autopsies and before examining new mothers. The death rate plummeted from 22 out of 200 to 2 out of 200, prompting the following reception from one of Europe’s most respected medical practitioners:
“It may be that it [Semmelweis’ procedure] does contain a few good principles, but its scrupulous application has presented such difficulties that it would be necessary, in Paris for instance, to place in quarantine the personnel of a hospital during the great part of a year, and that, moreover, to obtain results that remain entirely problematical.”
– Dr. Charles Dubois (Parisian obstetrician), memo to the French Academy September 23, 1858
Semmelweiss’ superiors shared Dubois’ opinion; when the Hungarian physician insisted on defending his theories, they forced him to resign his post on the faculty.
Gotta wonder what Dr. Dubois would make of the suits and sanitation procedures required today for health professionals who treat Ebola victims.
As a journalist, this guy has a piece of a world-wide scoop.
India is probably the last nation on Earth producing DDT. In the last decade other two nations making the stuff got out of the business — North Korea and China. For several years now India has been the largest manufacturer of DDT, and far and away the greatest user, spraying more DDT against malaria-carrying mosquitoes, sand flies, and agricultural and household pests than the rest of the world combined.
As if an omen, India’s malaria rates did not drop, but instead rose, even as malaria rates dropped or plunged in almost every other nation on Earth.
Under the 2001 Stockholm Convention on Persistent Organic Pollutants (POPs) signed by more than 150 nations (not including the U.S.), DDT was one of a dozen chemicals targeted to be phased out due to its extremely dangerous qualities, including long-term persistence in the environment and bioaccummulation, by which doses of the stuff increase up the food chain, delivering crippling and fatal doses to top predators.
A perfect substitute for DDT in fighting some disease-carrying insects (“vectors”) has never been developed. Health officials asked, and the Stockholm negotiators agreed to leave DDT legally available to fight disease. Annex B asked nations to tell the World Health Organization if it wanted to use DDT. Since 2001, as DDT effectiveness was increasingly compromised by resistance evolved in insects, fewer and fewer nations found it useful.
The site Mr. Nazakat linked to is up and down, and my security program occasionally says the site is untrustworthy. It’s obscure at best. Shouldn’t news of this type be in some of India’s biggest newspapers?
I found an article in theDeccan Herald, confirming the report, but again with some
India-United Nations pact to end DDT use by 2020
India-United Nations pact to end DDT use by 2020
New Delhi, August 26, 2015, DHNS:
It would be better to switch to another insecticide, says expert
India has launched a $53 million project to phase out DDT by 2020 and replace them with Neem-based bio-pesticides that are equally effective.
India is the lone user of DDT, though only in the malaria control programme, while rest of the world got rid of the chemical that has a lasting adverse impact on the environment.
India on Tuesday entered into a $53 million (Rs 350 crore) partnership with the United Nations Industrial Development Organisation (UNIDO), United Nations Environment Programme and the Global Environment Facility to replace DDT with safer, more effective and green alternatives.
“As per the plan, the National Botanical Research Organisation, Lucknow, tied up with a company to produce Neem-based alternatives for the malaria programme. The production will start in six months,” Shakti Dhua, the regional coordinator of UNIDO told Deccan Herald.
Till last year, the annual DDT requirement was about 6,000 tonnes that has now been cut down to 4,000 tonnes as the government decided to stop using it in the Kala-Azar control programme.
A recent study by an Indo-British team of medical researchers found that using DDT without any surveillance is counter-productive as a vector control strategy as sand flies not only thrive but are also becoming resistant to DDT.
“It would be better to switch to another insecticide, which is more likely to give better results than DDT,” said Janet Hemingway, a scientist at the Liverpool School of Tropical Medicine. While the Health Ministry wanted to bring in synthetic pyrethroids, the United Nation agencies supports the bio-pesticides because of their efficacy and long-lasting effects.
“The new initiative would help check the spread of malaria and other vector-borne diseases. These include botanical pesticides, including Neem-based compounds, and long-lasting insecticidal safety nets that will prevent mosquito bites while sleeping,” Dhua said.
Ending the production and use of DDT is a priority for India as it is a signatory to the Stockholm Convention on Persistent Organic Pollutants (POP) of 2002 that seeks to eliminate the use of these chemicals in industrial processes, drugs and pesticides. DDT is one of the POPs.
The clock is counting down the last years of DDT. Good.
If events unroll as planned, DDT making will end by 2020, 81 years after it was discovered to kill bugs, 70 years after it was released for civilian years, 70 years after problems with its use was first reported by the U.S. Fish and Wildlife Service, 58 years after the publication of Rachel Carson’s Silent Spring, 50 years after European nations banned some uses, 48 years after the famous U.S. ban on agricultural use, 19 years after the POPs Treaty.
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.
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.”
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.
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.
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.
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.
U.S. Supreme Court hearing oral arguments in King v. Burwell. The decision issued on June 25, 2015. Image from Newsworks. [Continued search for credit information on this image turned up this caption; artist is Dana Verkouteren of Associated Press] “This courtroom artist rendering shows Michael Carvin, lead attorney for the petitioners, right, speaking before the Supreme Court in March. King v. Burwell, a major test of the Affordable Care Act, could halt health care premium subsidies in all the states where the federal government runs the insurance marketplaces. (AP Photo/Dana Verkouteren)
In all the rending of garments and gnashing of teeth about the Supreme Court’s decision in the Burwell case today, you’d be lucky to learn what the Court actually said.
Here are the key paragraphs of the majority’s decision (links added here), as written by Chief Justice John Roberts:
Reliance on context and structure in statutory interpretation is a “subtle business, calling for great wariness lest what professes to be mere rendering becomes creation and attempted interpretation of legislation becomes legislation itself.” Palmer v. Massachusetts, 308 U. S. 79, 83 (1939). For the reasons we have given, however, such reliance is appropriate in this case, and leads us to conclude that Section 36B allows tax credits for insurance purchased on any Exchange created under the Act. Those credits are necessary for the Federal Exchanges to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid.
* * *
In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—“to say what the law is.” Marbury v. Madison, 1 Cranch 137, 177 (1803). That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan.
Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.
The judgment of the United States Court of Appeals for the Fourth Circuit is
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:
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.
We've been soaking in the Bathtub for several months, long enough that some of the links we've used have gone to the Great Internet in the Sky.
If you find a dead link, please leave a comment to that post, and tell us what link has expired.