Malaria uptick in Botswana: No, more DDT can’t help

March 28, 2017

Health workers in Botswana use a cell phone to report malaria diagnoses and commencement of treatment, enabling real-time tracking of malaria outbreaks and rapid public health service responses. Photo from MalariaNoMore.

Health workers in Botswana use a cell phone to report malaria diagnoses and commencement of treatment, enabling real-time tracking of malaria outbreaks and rapid public health service responses. Photo from MalariaNoMore.

Interested, and interesting, to discover Botswana has a Facebook page where it appears is posted almost every press release or news item from the government.

I found it because some wag claimed on Twitter that Botswana faces a malaria crisis, and therefore DDT should be ‘brought back from the dead.’

Botswana did post about a malaria outbreak, but the nation appears to have good sense about how to fight malaria. The Tweeter missed that Botswana is already doing what a nation would use DDT for, Indoor Residual Spraying (IRS), and that phrase alone means Botswana’s malaria fighters are alert to any need for DDT should it arise, but also to the severe limitations on DDT use. DDT doesn’t work in about 95% of the nations on Earth.

Botswana is among the ten nations remaining on Earth who use DDT when and where they find a population of mosquitoes still susceptible to DDT. Almost all nations on Earth signed the Persistent Organic Pollutants Treaty (POPs, or Stockholm Agreement), which requires annual reporting of DDT use. But there are 11 other pesticides the World Health Organization (WHO) recommends for IRS. Botswana is unlikely to use DDT where it won’t work, which is most places.

Botswana is one of the DDT Ten in 2016, too. But this is down from 43 nations in 2001. DDT’s effectiveness and time as a tool to fight malaria is mostly gone, vanishing quickly.

Botswana has DDT if it can find a use for it; no more DDT is needed. A malaria outbreak in Botswana is no reason to remove the ban on DDT use on U.S. farms.

Here is the story/press release from Botswana’s government:

MALARIA CASES RISE IN OKAVANGO

North West District has been hard hit by a malaria epidemic with 670 recorded cases and five deaths since the beginning of the rainy season.

Head of the District Health Management Team, Dr Malebogo Pusoentsi revealed this at a press conference aimed at evaluating efforts made in the district to control the disease, recently.

A task force was in the district to assess and appreciate the situation as well as discuss what more could be done going forward.

Dr Pusoentsi said the highly affected region was Okavango which recorded over 90 per cent of the cases.

Highly affected areas include Shakawe, Xakao and Seronga in the Okavango District while in Ngami, Tsau and Mababe were the most affected.

Out of the affected people, it was reported that males were mostly affected as compared to females, and that more than 30 per cent of the affected were children. The most affected areas were said to be schools.

Dr Pusoentsi explained that malaria infection in humans was mainly transmitted through the sting of the female anopheles mosquito, adding that the disease in people could present clinically as either uncomplicated, complicated or asymptomatic, especially for people living in malaria endemic areas.

She stated that prevention of malaria remained a priority with strategies aimed at vector control. She said two strategies have been used to control mosquitoes in the area such as indoor residual spraying and the distribution of the long lasting insecticide treated nets. She added that 57 000 nets having been distributed across the country.

Regarding indoor spraying, Dr Pusoentsi revealed that for the transmission period of 2016/17, the district achieved an average of 69 per cent coverage as compared to the 85 per cent target.

Asked if the district was winning the battle, she said they were on the right track as health officials have doubled up efforts to tackle the epidemic.

She said social mobilisation was effective as the community and leadership were taught to make malaria a priority in their agenda, adding that if one member of a family was affected, chances were high that the rest of the family were also at risk.

Furthermore, Dr Pusoentsi explained that many opportunities still existed at community level to effectively control the spread of malaria, citing the cleaning of surroundings to minimise the breeding spaces for the mosquitoes.

Another strategy was to work collaboratively to ensure community knowledge and participation during the epidemic period. She urged the community to visit health facilities if they experience any symptoms of malaria so that they could be assisted on time.

She noted that common signs and symptoms include high temperature, headache and rigors, pallor and vomiting.

Dr Pusoentsi also noted that Botswana was among the countries which were aiming to eliminate malaria by 2018, adding that as part of the strategy, all efforts and investments had been put in place to control the spread.

Effective surveillance mechanism, she said had been put in place to monitor the disease burden and response efficiency at all times.

In addition, she pointed out that case management and drug supply had been strengthened to ensure quality management of cases of malaria to avoid deaths. (BOPA)

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WHO’s World Malaria Report 2016 shows great progress, but funding slowdown hurts the fight against malaria

December 13, 2016

Promotional poster for the World Malaria Report 2016, from WHO

Promotional poster for the World Malaria Report 2016, from WHO; poster shows a woman and her child, protected from mosquitoes behind a bednet.

Incidence of malaria dropped to a new, all-time low in 2016, with reductions in total infections to 212 million, and a drop in malaria deaths to 429,000, worldwide. Malaria fighters had hoped the decreases would be greater.

Cover of World Malaria Report 2016, from the World Health Organization (WHO). The report has been published annually since at least 2008, tracking progress in the fight to control and eradicate malaria, one of the greatest scourge diseases in human history.

Cover of World Malaria Report 2016, from the World Health Organization (WHO). The report has been published annually since at least 2008, tracking progress in the fight to control and eradicate malaria, one of the greatest scourge diseases in human history.

This news comes from the World Health Organization’s (WHO) World Malaria Report 2016, released this morning in Geneva, Switzerland.

Of concern to readers here, the report lists ten nations still using DDT, the same number as 2015. Nine African nations and India still find some utility in DDT, though resistance to the long-used pesticide is found in almost all populations of almost all varieties of mosquito.

India remains the world’s heaviest user of DDT and the only place DDT is manufactured. The nine DDT-using African nations are Botswana, Democratic Republic of Congo, Gambia, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe. Due to mosquito and other vector insect resistance to DDT, India will stop using DDT by 2020, and stop manufacturing at the same time.

Insecticide-impregnated bednets now are the chief tool used to prevent spread of new malaria infections. Nets have proven more effective than Indoor Residual Spraying (IRS), which has always been the chief use of DDT in the malaria fight. The report notes that mosquito resistance grows alarmingly to the preferred net pesticides, pyrethroids. Nets provide a physical barrier to mosquitoes, however, and work even when the insecticides wear off.

This years report is shorter than previous years, but still loaded with statistics and policy issues to be unpacked in the next few days.

WHO’s press release:

 

Malaria control improves for vulnerable in Africa, but global progress off-track

News release

WHO’s World Malaria Report 2016 reveals that children and pregnant women in sub-Saharan Africa have greater access to effective malaria control. Across the region, a steep increase in diagnostic testing for children and preventive treatment for pregnant women has been reported over the last 5 years. Among all populations at risk of malaria, the use of insecticide-treated nets has expanded rapidly.

But in many countries in the region, substantial gaps in programme coverage remain. Funding shortfalls and fragile health systems are undermining overall progress, jeopardizing the attainment of global targets.

Scale-up in malaria control

Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths. Children under five years of age are particularly vulnerable, accounting for an estimated 70% of all malaria deaths.

Diagnostic testing enables health providers to rapidly detect malaria and prescribe life-saving treatment. New findings presented in the report show that, in 2015, approximately half (51%) of children with a fever seeking care at a public health facility in 22 African countries received a diagnostic test for malaria, compared to 29% in 2010.

To protect women in areas of moderate and high malaria transmission in Africa, WHO recommends “intermittent preventive treatment in pregnancy” (IPTp) with sulfadoxine-pyrimethamine. The treatment, administered at each scheduled antenatal care visit after the first trimester, can prevent maternal and infant mortality, anaemia, and the other adverse effects of malaria in pregnancy.

According to available data, there was a five-fold increase in the percentage of women receiving the recommended 3 or more doses of this preventive treatment in 20 African countries. Coverage reached 31% in 2015, up from 6% in 2010.

Insecticide-treated nets are the cornerstone of malaria prevention efforts in Africa. The report found that more than half (53%) of the population at risk in sub-Saharan Africa slept under a treated net in 2015, compared to 30% in 2010.

Last month, WHO released the findings of a major 5-year evaluation in 5 countries. The study showed that people who slept under long-lasting insecticidal nets (LLINs) had significantly lower rates of malaria infection than those who did not use a net, even though mosquitoes showed resistance to pyrethroids (the only insecticide class used in LLINs) in all of these areas.

An unfinished agenda

Malaria remains an acute public health problem, particularly in sub-Saharan Africa. According to the report, there were 212 million new cases of malaria and 429 000 deaths worldwide in 2015.

There are still substantial gaps in the coverage of core malaria control tools. In 2015, an estimated 43% of the population in sub-Saharan Africa was not protected by treated nets or indoor spraying with insecticides, the primary methods of malaria vector control.

In many countries, health systems are under-resourced and poorly accessible to those most at risk of malaria. In 2015, a large proportion (36%) of children with a fever were not taken to a health facility for care in 23 African countries.

“We are definitely seeing progress,” notes Dr. Pedro Alonso, Director of the WHO Global Malaria Programme. “But the world is still struggling to achieve the high levels of programme coverage that are needed to beat this disease.”

Global targets

At the 2015 World Health Assembly, Member States adopted the Global Technical Strategy for Malaria 2016-2030. The Strategy set ambitious targets for 2030 with milestones every 5 years to track progress.

Eliminating malaria in at least 10 countries is a milestone for 2020. The report shows that prospects for reaching this target are bright: In 2015, 10 countries and territories reported fewer than 150 indigenous cases of malaria, and a further 9 countries reported between 150 and 1000 cases.

Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent months, the WHO Director-General certified that Kyrgyzstan and Sri Lanka had eliminated malaria.

But progress towards other key targets must be accelerated. The Strategy calls for a 40% reduction in malaria case incidence by the year 2020, compared to a 2015 baseline. According to the report, less than half (40) of the 91 countries and territories with malaria are on track to achieve this milestone. Progress has been particularly slow in countries with a high malaria burden.

An urgent need for more funding

Sustained and sufficient funding for malaria control is a serious challenge. Despite a steep increase in global investment for malaria between 2000 and 2010, funding has since flat-lined. In 2015, malaria funding totalled US$ 2.9 billion, representing only 45% of the funding milestone for 2020 (US$ 6.4 billion).

Governments of malaria-endemic countries provided about 31% of total malaria funding in 2015. The United States of America is the largest international malaria funder, accounting for about 35% of total funding in 2015, followed by the United Kingdom of Great Britain and Northern Ireland (16%).

If global targets are to be met, funding from both domestic and international sources must increase substantially.

Note to editors

RTS,S/AS01 malaria vaccine

Last month, WHO announced that the world’s first malaria vaccine would be rolled out through pilot projects in 3 countries in sub-Saharan Africa. Vaccinations will begin 2018. The vaccine, known as RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. Advanced clinical trials have shown RTS,S to provide partial protection against malaria in young children.

WHO multi-country evaluation on LLINs

On 16 November 2016, WHO released the findings of a 5-year evaluation conducted in 340 locations across 5 countries: Benin, Cameroon, India, Kenya and Sudan. The findings of this study reaffirm the WHO recommendation of universal LLIN coverage for all populations at risk of malaria.

Will major media cover this news? Will your local newspapers and broadcast outlets even make note?

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September 23, 1858: DON’T wash your hands!

September 23, 2015

Ignaz Semmelweiss

Dr. Ignaz Semmelweis

This is one of the classic stories of public health, an issue that most U.S. history and world history texts tend to ignore, to the detriment of the students and the classroom outcomes.

This is the story as retold by Christopher Cerf and Victor Navasky in The Experts Speak:

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.

More: 

Yes, this is mostly an encore post. Fighting ignorance requires patience.

Yes, this is mostly an encore post. Fighting ignorance requires patience.


Does “Twitchy” really just mean “knee jerk?” Correcting the record, deflecting the hoaxes, propaganda and Mau-Mauing about Rachel Carson and DDT

June 1, 2014

Or is there any “knee” in that at all? Maybe it’s just jerk.

You know the drill. Someone says something nice about Rachel Carson’s great work. Someone on the right can’t stand that a scientist gets spoken of well, comes unglued, and spills every lie about Rachel Carson anyone can find, including the big lie, that “millions of kids died unnecessarily because DDT was banned because Rachel Carson lied about DDT, which is really a lot like sugar water to humans and all other living things.”

For the record, each of those claims is false; in reverse order:

  1. DDT is toxic to almost all living things, a long-lived and potent poison (which is why DDT was used to kill harmful insects and other vermin). While bed bugs and mosquitoes have evolved resistance and total immunity to the stuff, few other creatures have.
  2. Rachel Carson told all the truth about DDT that was known at the timeHer accuracy was confirmed by a panel of the nation’s top scientists, who reviewed her work for errors, and federal policy for usefulness and safety.  Since the 1962 publication of Silent Spring, and since Carson’s untimely death from cancer in 1964, we’ve learned that DDT is a carcinogen (though, we hope, a weak one); we’ve learned that DDT is an endocrine disruptor that fouls up sex organs and sexual maturity in more animals than anyone can count, including humans; and we’ve learned that  DDT causes birds to lay eggs with shells so thin the chicks cannot survive, even if the DDT doesn’t kill the chick outright.
  3. Carson didn’t urge a ban on DDT, nor did it happen until eight years after her death.  As I explain below, Carson fought to stop DDT abuses, to preserve DDT’s utility in the fight against disease.  She lost that fight, and as a resul tof DDT abuse by DDT advocates, the World Health Organization (WHO) had to scrap it’s ambitious program to eradicate malaria from the Earth — just as the campaign got to tropical areas of Africa.  DDT was banned for crops in the U.S. (health uses have never been banned here), after two different federal courts ordered EPA to do something because under the existing law they’d be required to ban DDT completely if EPA didn’t act, and after a rather adversary administrative law hearing that lasted nine months, featured testimony and document submissions from more than 30 DDT manufacturers, and compiled a record of DDT’s benefits and harms nearly 10,000 pages long.  It was science that got DDT banned, not Rachel Carson’s great writing.
  4. Almost every year since EPA banned DDT use on crops in the U.S., worldwide malaria deaths dropped, from peak-DDT use years (circa 1958-1963) levels of approximately 4 million deaths per year, to 2013’s approximately 627,000 deaths.  It’s unfair and grotesquely inaccurate to claim a reduction in deaths of about 84% is, instead, an increase.  Malaria was not close to eradication in 1965 when WHO stopped its campaign on the ground, nor in 1969 when WHO officially abandoned eradication as a goal, nor in 1972 when the U.S. banned DDT use in the U.S., and dedicated all U.S. production of DDT to export, mostly for fighting insects that cause disease.

In short, Rachel Carson is exactly as the history books present her, a very good scientist with a special gift for communicating science issues.

That’s exactly the stuff that galls the hell out of self-proclaimed conservatives, especially those who know they are the smartest person in any room, even an internet chat room with a few million people in it.  Say something good about a scientist, and they know that statement must be false, and what’s more  “. . .  let’s see, there should be something bad about this guy on Google . . . um, yeah . . . yessss! here, Lyndon Larouche’s magazine has some guy I’ve never heard of, but he’s smarter than any librul because he agrees with my bias! Take THAT you scurvy dog!”  And in short order they’ve scooped up all five or six nuts who said bad stuff about Rachel Carson and cross-cited each other, and they’ve copied the links to the three articles on the internet that obscure groups like CEI and AEI and Heritage have paid to raise in the Google searches, and . . .

Done deal.  “Good scientist!  Heh! No one will listen to old Rachel Carson any more!”

Unless good people stand up to the reputation lynch mobs, and stop them.  That’s why I’m telling you, so you’ll have the stuff you need to stand up.  I’m hoping you will stand up.

Shortly after dawn on May 27, Twitchy rose out of the mucky water and lobbed some mud balls at Google and especially Rachel Carson.  Twitchy is an interesting site.  It’s mostly composed of Tweets that support conservative causes and are snarky enough earn a snicker.  In short, there is no fact checking, and biases are preferred — whatever is the imagined conservative bias of the day (oddly enough, never is conservation of soil, water, nor human life ever a conservative-enough issue . . . but I digress).

It’s the nervous twitch of a knee-jerk mind and knee-jerk political mentality.

Twitchy opened up with a straightforward salvo from IowaHawk.

Note that, above, and again below, WHO records show that there were no “millions of malaria victims” of Rachel Carson.  IowaHawk, David Burge,  assumes — without a whit of real information — that DDT was the key to beating malaria, and so after the EPA ban on DDT, malaria must have risen, and so there must have been millions who died unnecessarily. Challenge the guy to put evidence to any part of that chain, and he’ll demur, probably suggest you’re mentally defective, and cast aspersions on what he assumes your political stand to be.  Or, he’ll ignore the challenge in hopes everybody will forget.   And another person will retweet Burge’s disinformative bit of propaganda — no facts, but what sounds like a nasty charge at someone who is presumed to be a liberal.  Burge’s erroneous Tweet had 504 retweets when I wrote this on June 1, great impact.

Eh. Truth wins in a fair fight, Ben Franklin said.  [I’m pretty sure it was Franklin; I’m still sourcing it, and if you have a correction, let me know!]

At length, more people chime in . . . and the level of misinformation in that discourse makes me crazy.

Occasionally I’ll drop in a correction, often a link to contrary information.  Then the abuse is astonishing. This conservative “hate information” machine is ugly.

CDC image of a child sleeping under an insecticide treated bednet (ITN) to prevent bites from malaria-carrying mosquitoes.

CDC image and caption: How do insecticide-treated nets work? People sleep under ITNs during the time when the mosquitoes that spread malaria like to feed. The insecticide on the nets helps reduce the numbers of mosquitoes that enter the house and works to kill the ones that do enter. In this way, the ITN protects the person or people sleeping under the net. If large numbers of people in the community sleep under an ITN, the numbers of mosquitoes, as well as their lifespan, will be reduced. When this happens, all members of the community receive some protection, whether or not they own or use an ITN.

From the Wellcome Trust malaria page, an explanation for why it's so important to stop bites in the home, at night, and why it's generally not necessary to kill mosquitoes out of doors, in daylight.

[Image link failed] From the Wellcome Trust malaria page, an explanation for why it’s so important to stop bites in the home, at night, and why it’s generally not necessary to kill mosquitoes out of doors, in daylight.

Sometimes I unload.  I was on hold for a more than an hour on a couple of phone calls that day.  Some guy working the handle OmaJohn took great exception to something I said — I think his complaint was that thought I knew what I was talking about — and of course, he knew better!  How dare I refer to facts!

Here’s my response.  I think OmaJohn may have gotten the message, or rethought the thing.

But others haven’t.

I list his statements, indented; my responses are not indented.  Links will be added as I can.  All images are added here.

Rachel Carson is still right, still a great scientist and an amazing writer.  DDT is still poisonous, still banned for agricultural use in the U.S., and still not the answer to “how do we beat malaria.”

OmaJohn said (double indent), and I responded (single indent):

Always with the crow’s lofty view to try and cherry-pick facts to paint a valid conclusion.

I wouldn’t know, Mr. Corvus. I’ve been looking at DDT professionally for science and policy, and as a hobby, and for law and history courses, for more than 30 years. I’m rather drowning in studies and statistics. A crow might be able to find some information that contradicts Rachel Carson’s writings and EPA’s rulings — but it’s not evident in this data ocean. You see some of those cherries? Do they outweigh the ocean they float in?

I do like how you use blogs to justify your condescension, though. [He complaining that I offered links to answers here, at this blog; how brazenly wrong of me to study an issue!]

I think your denigration of people who actually study a subject is ill-advised behavior. Research papers are printed on paper, just like comic books. It’s up to us to use the information to form cogent ideas about history, science, and make good policy as a result. The blogs I cite are often written by experts in the field — see especially Bug Girl, Tim Lambert and John Quiggen — and they most often provide links to the original sources.

(I gather you didn’t bother to read to see what was actually there. Your loss.)

I don’t like what appears to be your view that your non-informed opinion of something you really know little about is as valid as the work of people who devote their lives to getting the facts right. In the long run, your life depends on their winning that game, and always has.

Without having read a lot, I took a gander at a few of the folks ‘on the other side’ on this, and I was Jack’s complete lack of surprise to see you in here with your head high, throwing around blog references and talking down to people.

Much as you are talking down to me, from your position has head muckraker? I see.

I’m not sure what you mean by “folks on the other side.” If you mean on the other side of Rachel Carson, please note that in 52 years not a single science source she listed has ever been found to be in error, or fading as a result of changing science. Discover Magazine took a look at this issue in 2007, concluding Carson was right, and DDT use should be restricted as it was then and remains. The author wrote this, about claims that Carson erred on damage to birds from DDT:

In fact, Carson may have underestimated the impact of DDT on birds, says Michael Fry, an avian toxicologist and director of the American Bird Conservancy’s pesticides and birds program. She was not aware that DDT—or rather its metabolite, DDE—causes eggshell thinning because the data were not published until the late 1960s and early 1970s. It was eggshell thinning that devastated fish-eating birds and birds of prey, says Fry, and this effect is well documented in a report (pdf) on DDT published in 2002 by the Department of Health and Human Services’ Agency for Toxic Substances and Disease Registry (ATSDR). The report, which cites over 1,000 references, also describes how DDT and its breakdown products accumulate in the tissues of animals high up on terrestrial and aquatic food chains—a process that induced reproductive and neurological defects in birds and fish.

Don’t take my word for it. Go read for yourself. Check out PubMed, and read the first 50 citations you find on DDT and birds, the first 20 on DDT and human health, the first 50 on DDT and malaria. Check out the recent good books on the issue — William Souder’s great biography of Carson last year, On a Farther Shore, or Sonia Shah’s wonderful biography of malaria, [The Fever, How malaria has ruled humankind for 500,000 years].

Get real facts, in other words. Don’t talk down to people who might know what they’re talking about.

You wrote:

DDT use was officially stopped in most countries (perhaps all, I’ve not read anything I’d tout as even remotely conclusive, but I’ve not spent a substantial amount of time on this issue), but quickly (within a decade) was brought back to common use.

You should compost that, but it’s too green to do anything but foul things up indoors, here.

DDT was banned first in Sweden in 1971, then in the U.S. in 1972 — the U.S. ban was on crop use, only. About the only use that actually fell under that ban was cotton crops.

A few other European nations banned DDT.

DDT has never been banned in China, India, nor most of Asia, nor in any nation in Africa. Some African nations stopped using it when it stopped being effective; some African nations stopped using it when DDT runoff killed off food fishes and several thousands starved to death.

The World Health Organization never stopped using DDT, though its dramatic decline in effectiveness, especially in Africa, was key to the collapse and abandonment of WHO’s campaign to eradicate malaria. WHO stopped that campaign in 1965, and officially killed it off at the 1969 WHO meetings. You’ll note that was years before the 1972 ban in the U.S. — so the claims that the U.S. ban prompted a WHO to act is also false just on calendar terms.

If you check with the Wellcome Trust, they have several papers and PowerPoint presentations on the problems with malaria in Mexico, Central and South America — where DDT has been used constantly since 1948, with no ban. Unfortunately, malaria came back. Resistance to DDT in mosquitoes is real, and if malaria is not cured in the humans while the populations are temporarily knocked down, when the mosquitoes come back, they will find those humans with malaria, withdraw some of the parasites from that human, incubate them to the next part of the life cycle, and start a plague within a couple of weeks.

So, no, DDT was never banned in most places. There is a treaty, the Persistent Organic Pollutants Treaty (POPs), which names DDT as one of the dirtiest pollutants in the world. Though every other pollutant on the list is severely restricted or completely banned, DDT has a special carve out (Addenda D, if I recall correctly) which says DDT may be used by any nation to fight any vector-borne disease.

All a nation need do is send a letter to WHO explaining that it plans to use DDT, and when.

And, no, DDT was not brought back in haste to make up for a lack of the stuff.

Not sure where you’re getting your history, but it’s not exactly square with what’s happened.

That’s a pretty huge, expensive policy shift — twice.

Would have been, had it been done as you described. Not so.

There was a lot of pressure to make those changes.

So in the fight on Malaria, I think that scientists and bureaucrats generally agree that DDT plays an important role, particularly after seriously slowing or stopping use for a substantial amount of time.

Read the POPs treaty — go to the WHO site and you can still get some of the deliberative papers.

For almost all uses, DDT has much better alternatives available today.

Malaria is a special case because humans screwed up the eradication campaign, first, by abusing DDT and creating DDT resistance in the mosquitoes, and second, by completely abandoning most other parts of the program when DDT crapped out.

DDT doesn’t cure malaria. All it does is temporarily knock down the mosquitoes that carry the parasite through part of its life cycle. Better medical care is a very important part of beating the disease, and as in the U.S., improving housing cuts malaria rates dramatically, especially with windows that are screened roughly from sundown to early morning.

DDT is one of 12 chemicals WHO approves for use in Indoor Residual Spraying (IRS), in areas where there are outbreaks of the disease. If any one chemical were used alone, it would be ineffective within months, or weeks.

When tobacco farmers in Uganda sued to stop DDT spraying in the early years of the 21st century, WHO issued a press release saying it still believes in DDT. Well, WHO always did. But as of 2010, DDT’s effectiveness is even less, and many nations use only the other 11 chemicals for IRS against malaria.

DDT is still there, if it works, and if it helps; bednets alone are more than double the effectiveness of DDT in preventing malaria. We could probably phase out DDT completely without anyone noticing. DDT is not a panacea. There is no shortage of DDT anywhere today. No one dies for a lack of DDT — though many may die from a lack of bednets or appropriate medical care, problems DDT cannot touch

I believe that Rachel Carson championed her cause very successfully. I believe there was sizeable, if not perfectly tangible, fallout that would only be measurable in human livesand misery thanks to her efforts. And in the end, things were as they should have been, despite her best efforts to force them where they
shouldn’t be.

I see. You don’t know what Rachel Carson said about DDT.

Carson said that DDT was — in 1962 — a pesticide without a clear replacement. She said it was absolutely critical to the then-existing WHO campaign to fight malaria.

And because of that, she urged that use of DDT on crops, or to kill cockroaches, or to kill flies at picnic sites, be stopped — because unless it were stopped, the overuse could not fail to leak into the rest of the ecosystem. Mosquitoes would quickly develop resistance to DDT — that had been a key problem in Greece in 1948, and Carson cites several other places where anti-typhus and anti-malaria campaigns were scuttled when the insects started eating DDT — and once that resistance developed, Carson said, beating malaria would be set back decades at a minimum, and maybe centuries.

She wrote that in 1962.

Fred Soper was the super mosquito fighter in the employ of the Rockefeller Foundation who developed the DDT-based malaria eradication program. He was loaned to WHO to take the campaign worldwide. Soper thought Carson was too tough on DDT in her book, but he had already calculated that DDT resistance would develop by 1975. He had just more than a dozen years to eliminate malaria, he wrote. (This is chronicled in Malcom McDowell’s 2001 profile of Soper in The New Yorker; you can read it at McDowell’s website.)

WHO’s campaign had mopped up pockets of malaria left in temperate zone nations; he had massive successes in sub-tropical nations, and he was poised to strike at the heart of malaria country, in equatorial Africa, in 1963.

The first campaign launched there fizzled completely. When they captured some mosquitoes, they found the mosquitoes were highly resistant to DDT already. Turns out that farmers in Africa wanted spotless fruit, too, and were using tons of DDT to get it.

For the health workers, what that meant was they had no tool at all to knock down mosquitoes even temporarily, to then finish the medical care, housing improvement and education components of the malaria eradication campaign.

It is also true that many of those nations had unstable governments. Soper’s formula required that 80% of the homes in an affected area be treated. That required highly trained, very devoted workers, and a willing population. Those things were difficult to find in nations with unstable governments, or worse, civil war. So there were other complicating factors. But Soper had faced those, and beaten them, behind the Iron Curtain, in Asia, in the Pacific and in South America.

When DDT quit on him, as Carson predicted it would without official action to save its potency, Soper called it quits.

Soper ended his campaign without approaching most of equatorial Africa in 1965. WHO officially ended the program in 1969.

Carson died in 1964. She would have been saddened that DDT stopped working in the malaria fight so early. She had written about it occurring in some future year — she probably knew of Soper’s calculation in the 1970s.

The public relations smear campaign against Carson, costing the chemical companies $500,000, generated some doubt among the public, but the President’s Science Advisory Council published its report saying Carson was accurate on the science, and calling for immediate action against DDT — in 1963.

It was 7 years after her death that EPA was organized, and 8 years before EPA moved against DDT.

Carson pleaded for a dramatic reduction in unnecessary DDT use — to make spotless apples, for example — in order to save people from malaria.

What did you think she said? What things were back where they should have been — poor kids dying of malaria is as it should be?

We could have done better, had we listened to Rachel Carson in 1962.

You’ve offered nothing that logically refutes those conclusions.

You should have read those blogs.

More:

  • David Burge, Iowahawk, whose post started the Twitchy twitches, several years ago revealed that a young boy his family had been sponsoring in Africa through a private charity, had died from malaria.  Death from malaria is a tragic reality.  Burge urged people to speak out for more DDT, and to donate money to Africa Fighting Malaria.  Readers of my blog may recall that AFM is the astro-turf organization founded by Roger Bate years ago, from all appearance to pay Roger Bate to say nasty things about Rachel Carson.  We could find on their IRS 990 form no evidence that the organization does anything to fight malaria, anywhere.  One might wonder how much anti-malaria activity Roger Bate’s $100,000/year salary would have purchased, in any of the several years he headed the non-help group, or since.  Adding insult to tragedy, Burge noted at his blog that “environmental groups” opposed Indoor Residual Spraying in Africa, and especially the use of DDT.  But it turns out that the chief opposition at that time came from tobacco growers and tobacco organizations — the groups from whom Roger Bate solicited money to start up AFM.  Wouldn’t it be easier just to stick with the facts?
  • If you want to do something, to save a life from malaria, send $10 to Nothing But Nets.  In stark contrast to AFM, NbN sends almost all its money to buy bednets to give away to people in malaria-endemic areas of Africa.  While AFM ridicules nets, they are much more effective at preventing malaria than IRS, especially IRS with DDT alone.  Nets are much cheaper, too.  NbN acts in partnership with the NBA and the United Methodist Church in the United States, and is one of the most upstanding charities anywhere.  They do not say nasty things about Rachel Carson — probably wouldn’t if they thought to, because they are so busy fighting malaria.

Yes, malaria is still a plague; it’s not Rachel Carson’s fault, and your saying so probably kills kids

May 30, 2014

May 27’s Google Doodle honoring Rachel Carson brought out a lot of those people who have been duped by the anti-Rachel Carson hoaxers, people who are just sure their own biased views of science and the politics of medical care in the third world are right, and Carson, and the people who study those issues, are not.

So comes “The Federalist,” what appears to me to be a reactionary site, which yesterday got great readership for a story from Bethany Mandel.  Mandel tells a story of a child in Cambodia suffering from malaria.  The suffering is horrible and the child most likely died.  It’s a tragic story of poverty and lack of medical care in the third world.

Erroneously, Mandel up front blames the suffering all on Rachel Carson, in a carp about the Google Doodle.

Here was my quick response between bouts in the dentist’s chair yesterday [links added here]:

[Bethany Mandel wrote:] Using faulty science, Carson’s book argued that DDT could be deadly for birds and, thus, should be banned. Incredibly and tragically, her recommendations were taken at face value and soon the cheap and effective chemical was discontinued, not only in the United States but also abroad. Environmentalists were able to pressure USAID, foreign governments, and companies into using less effective means for their anti-malaria efforts. And so the world saw a rise in malaria deaths.

Don’t be evil?

Start by not telling false tales.

1.  Carson presented a plethora of evidence that DDT kills birds.  This science was solid, and still is.

2.  Carson did not argue DDT should be banned.  She said it was necessary to fight disease, and consequently uses in the wild, requiring broadcast spraying, should be halted immediately.

3.  Scientific evidence against DDT mounted up quickly; under US law, two federal courts determined DDT was illegal under the Federal Insecticide, Fungicide, and Rodenticide Act; they stayed orders to ban the chemical pending hearings under a new procedure at the new Environmental Protection Agency.

EPA held hearings, adversary proceedings, for nine months. More than 30 DDT manufacturers were party to the hearings, presenting evidence totaling nearly 10,000 pages.  EPA’s administrative law judge ruled that, though DDT was deadly to insects, arachnids, fish, amphibians, reptiles, birds and mammals, the labeled uses proposed in a new label (substituted at the last moment) were legal under FIFRA — indoor use only, and only where public health was concerned.  This labeling would allow DDT to remain on sale, over the counter, with few penalties for anyone who did not follow the label.  EPA took the label requirements, and issued them as a regulation, which would prevent sales for any off-label uses.  Understanding that this would be a severe blow to U.S. DDT makers, EPA ordered U.S. manufacture could continue, for the export markets — fighting mosquitoes and malaria being the largest export use.

This ruling was appealed to federal courts twice; in both cases the courts ruled EPA had ample scientific evidence for its rule.  Under U.S. law, federal agencies may not set rules without supporting evidence.

4.  DDT was banned ONLY for agriculture use in the U.S.  It was banned in a few European nations.  [Addition, December 30, 2014: In fact, the U.S. action against DDT by EPA specifically called for DDT use in any fight against a vector borne disease, like malaria.]

5.  DDT has never been banned in Africa or Asia.

6.  USAID’s policy encouraged other nations to use U.S.-made DDT, consistent with federal policy to allow manufacture for export, for the benefit of U.S. business.

7.  U.S. exports flooded markets with DDT, generally decreasing the price.

Fred Soper, super malaria fighter, whose ambitious campaign to erase malaria from the Earth had to be halted in 1965, before completion, when DDT abuse bred mosquitoes resistant and immune to DDT.

Fred Soper, super malaria fighter, whose ambitious campaign to erase malaria from the Earth had to be halted in 1965, before completion, when DDT abuse bred mosquitoes resistant and immune to DDT.

8.  Although WHO had been forced to end its malaria eradication operation in 1965, because DDT abuse had bred mosquitoes resistant to and immune to DDT, and though national and international campaigns against malaria largely languished without adequate government funding, malaria incidence and malaria deaths declined.  Especially after 1972, malaria continued a year-over-year decline with few exceptions.

Note that the WHO campaign ended in 1965 (officially abandoned by WHO officials in 1969), years before the U.S. ban on DDT.

Every statement about DDT in that paragraph of [Mandel’s] article, is wrong.

Most important, to the purpose of this essay, malaria did not increase.  Malaria infections decreased, and malaria deaths decreased.

I’m sure there are other parts of the story that are not false in every particular.  But this article tries to make a case against science, against environmental care — and the premise of the case is exactly wrong.  A good conclusion is unlikely to follow.

Mandel was hammered by the full force of the anti-Rachel Carson hoaxers.  I wonder how many children will die because people thought, “Hey, all we have to do is kill Rachel Carson to fix malaria,” and so went off searching for a gun and a bullet?

You are not among them, are you?

Update: This guy, a worshipper of the Breitbart, seems to be among those who’d rather rail against a good scientist than lift a finger to save a kid from malaria. If you go there, Dear Reader, be alert that he uses the Joe Stalin method of comment moderation:  Whatever you say, he won’t allow it to be posted.  Feel free to leave comments here, where we practice First Amendment-style ethics on discussion.


Resources for World Malaria Day 2013

April 25, 2013

Not a word about condemning Rachel Carson.  No plea to use DDT to try to poison Africa or Asia to health.  That’s a great start.

More:

Mother and son under a protective bednet, the most efficient method to prevent malaria.  Columbia University MVSim image

Mother and son under a protective bednet, the most efficient method to prevent malaria. Columbia University MVSim image


April 25 is World Malaria Day — right, Bill?

April 24, 2013

He’s absolutely right.

English: World Malaria Day Button (english)

English: World Malaria Day Button (english) (Photo credit: Wikipedia)

What are you doing to fight malaria today?

More:


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