DDT FAIL: Mosquito-borne diseases deplete medical care in DDT’s world capital

September 15, 2016

India News Today photo shows insecticide fogging in crowded Delhi neighborhoods to combat Chikungunya virus by striking down mosquitoes that transmit the disease from one human to another.

India News Today photo shows insecticide fogging in crowded Delhi neighborhoods to combat Chikungunya virus by striking down mosquitoes that transmit the disease from one human to another.

In the western world, libertarians, so-called conservatives and anti-science people call for a “return” of DDT to fight Zika virus spread.

But in the world’s DDT capital, India, where DDT is still made and more DDT is applied than in the rest of the world combined, DDT’s failures stand out. News reports say health care in key Indian cities is hamstrung by doctors and nurses getting mosquito-borne diseases.

Why don’t they just use “the magic powder,” DDT, to wipe out mosquitoes? Oh, Dear Reader, India has used DDT extensively, for everything, for 60 years. Mosquitoes that carry disease, and all other mosquitoes, and many other insect pests, developed resistance and immunity to DDT from that use.

Apart from the fact that DDT would be the WRONG pesticide to use for anything other than malaria-carrying mosquitoes from the genus Anopheles, it simply does not work.

If DDT advocates paid attention to news and history, they’d not call for more DDT anywhere for any reason.

India Today detailed the simmering crisis in Delhi in a story headlined, “Dengue-chinkungunya outbreak takes down doctor, nurses and sanitation workers”:

Subhead:

Apart from doctors, even nurses, other members of the medical staff and sanitation workers are going on leave at a time when the number of people afflicted by dengue and chikungunya this year in the city and its suburbs has crossed two thousand.

As outcry over an onslaught of viral diseases in the Capital reaches fever pitch and hospitals struggle in the face of an unrelenting tide of patients, the men in white too have started calling in sick.

Apart from doctors, even nurses, other members of the medical staff and sanitation workers are going on leave at a time when the number of people afflicted by dengue and chikungunya this year in the city and its suburbs has crossed two thousand.

Malaria is carried almost always by Anopheles, but chikungunya is carried by two species of Aedes, Aedes aegypti and Aedes albopictus. These mosquitoes also carry dengue fever and Yellow fever. A. aegypti is the principal carrier of the Zika virus, worldwide. Health workers being felled by dengue and chikungunya tells us the area would also be fertile territory for the spread of Zika virus, if it were introduced there.

Careful watchers, therefore, will understand that DDT has worn out its usefulness against a wide variety of mosquito-borne diseases including Zika.

“In our hospital, 10 per cent of the staff is currently down with fever,” said Dr Ramesh Chugh, medical superintendent of Pt Madan Mohan Malaviya Hospital in south Delhi. “We have over 100 doctors, and currently 7-8 doctors are down with fever.”

Experts say heavier than usual rainfall, a large number of construction projects and scores of open drains in Delhi are allowing mosquitoes to breed in stagnant water.

Far too many commenters fail to understand that DDT was never the chief tool in fighting malaria, or any other disease. Instead, DDT was used to knock down local populations of mosquitoes, temporarily, so health care and better housing and other measures could cure humans of the diseases and remove mosquito breeding areas from areas around human homes and human activities. India’s failure to provide good sewage drainage, good storm sewage drainage, and otherwise plug up potholes and even tiny water catching places allows mosquitoes almost free rein. India relied too long on poisoning everything with DDT, instead of building a mosquito-resistant urban area.

At Lok Nayak Hospital in central Delhi, 18 doctors are on leave. “Either the doctors are down with fever or somebody in their family is ill. The doctors are taking leave for at least 4-5 days. We have had cases where physicians were ill but returned to work early seeing the number of patients,” said a senior doctor.

NURSES AND SANITATION WORKERS ALSO ON LEAVE

In east Delhi’s Lal Bahadur Shastri Hospital, 18 members of the medical staff, including doctors, nurses and sanitation workers, are absent. “In a staff of nearly 1200, 10-15 doctors are on leave due to viral illnesses,” said Dr Punita Mahajan, medical superintendent of Baba Ambedkar Hospital in northwest Delhi. “We are not exerting pressure on the doctors to continue if they feel slightly unwell as it is very important for the hospital to ensure that they remain healthy.”

The Delhi government has asked hospitals to ensure that dengue and chikungunya patients are treated without distress.

Officials say the health department has already dedicated an additional 1,000 beds for those suffering from fever at the Rajiv Gandhi Super Speciality Hospital, Janakpuri Super Speciality Hospital and Deep Chand Bandhu Hospital.

These institutes have been designated nodal hospitals for fever in the city. All hospitals- government and private – in the National Capital Territory have been directed to increase their surge capacity.

“While doctors are trying their best to remain on duty till the effect of vector-borne diseases recedes the city, the shortage in staff and the new directions from the government would add to the existing burden,” said a doctor on condition of anonymity.

The Delhi government says it is fully prepared to battle with the onslaught of diseases and has denied in the city high court claims that the Capital is facing its worst dengue crisis.

In an affidavit filed in the court, it said strict surveillance of preparedness and impact of these diseases has been carried out for taking further preventive measures as, due to environmental conditions, the number of diseases such as dengue, chikungunya and malaria shows an upswing during July to October.

India continues to learn that DDT is not magic, not often useful, and sometimes detrimental to disease control efforts.

Will the rest of the world watch and learn? No, DDT will not and cannot help in the fight against Zika virus’s spread to humans. Waste no more time wondering, but get on with the hard work of draining mosquito breeding places, improving houses with window screens and other improvements, and developing vaccines and other medicines. Now.

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DDT use plunged to just 10 nations in 2015; gone by 2020?

April 13, 2016

UN photo showing a mother and child protected from mosquito-borne disease by a bednet, the chief tool used in 2015 to prevent malaria transmission in endemic areas.

UN photo showing a mother and child protected from mosquito-borne disease by a bednet, the chief tool used in 2015 to prevent malaria transmission in endemic areas.

Just ten nations still used DDT in 2015, putting the planet on target to phase out all DDT use by 2020.

World Malaria Report 2015, published by the World Health Organization (WHO) in early December, notes those nations reporting that they use DDT in public health fights against disease. Under the Persistent Organic Pollutants Treaty, any nation may use DDT simply by notifying WHO.  Signatories of the treaty usually agree to stop all use of DDT once current use ends. Since 2003, most nations using it found DDT simply didn’t work well enough to continue use it to fight malaria or any other vector-borne diseases.

In the 2015 Report, Appendix 2A lists methods of vector control used in nations (“vector” being the fancy word for carrier of the disease, or mosquitoes in the case of malaria).  (See pages 234 to 237 of the .pdf.)

Nations in which DDT is used to fight malaria
World Malaria Report 2015 Appendix 2A

  1. Botswana
  2. Democratic Republic of the Congo
  3. Gambia
  4. Mozambique
  5. Namibia
  6. South Africa
  7. Swaziland
  8. Zambia
  9. Zimbabwe
  10. India

Ten nations total, nine in Africa, plus India.

Despite political calls to “bring back” DDT as a means of fighting mosquitoes that carry the Zika virus, no reports show any nation notified WHO it would do so. Most nations afflicted by Zika have been earlier afflicted by other diseases carried by the same species of mosquito, Aedes aegypti.  This species carries dengue fever, yellow fever and chikungunya, and perhaps others. Consequently, most of these nations have already tried DDT against the Zika carriers, and abandoned the projects when hoped-for results did not occur.

Every mosquito on Earth in 2016 carries at least a few of the alleles that make them resistant to, or even immune to DDT. DDT use also pushes mosquito populations to develop paths that make them quickly resistant to other pesticides. WHO guidelines urge public health officials never to use just one pesticide, but instead rotate among a dozen approved for vector use, in order to prevent the bugs from developing resistance. Resistance to pesticides remains one of the chief obstacles to eliminating disease, and a growing obstacle.

India is the world’s only known maker of DDT in 2015, and the heaviest user, using more of the pesticide than all other nations combined. Due to decreasing effectiveness of DDT as mosquito resistance to to it spreads and grows stronger, malaria has proliferated in India despite increased DDT application. In 2015, India announced to WHO it would suspend manufacture and use of DDT by 2020.

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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.


India, world’s last DDT maker, heaviest user, plans to stop

August 29, 2015

DDT sprayed in a vegetable market in India. (Photo: rzadigi) Living on Earth image

DDT sprayed in a vegetable market in India. (Photo: rzadigi) Living on Earth image

Sometimes big news sneaks up on us, without press releases. We often miss it.

Quiet little Tweet from journalist I’d never heard of, who passed along news from an obscure journal:

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 the Deccan 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 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. DH file photo

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. DH file photo

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.

When will the news leak out?

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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.


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