World Health Organization (WHO) summary of the World Health Assembly #68, which met in Geneva last, May 18-26.
Not a peep about “more DDT to fight malaria.’
World Health Organization (WHO) summary of the World Health Assembly #68, which met in Geneva last, May 18-26.
Not a peep about “more DDT to fight malaria.’
World Malaria Report 2014 dropped this week. It’s the annual report from the World Health Organization (WHO) on the fight against malaria, the problems, critical needs — and this year, wonderful news of progress.
The World Malaria Report 2014 summarizes information received from malaria-endemic countries and other sources, and updates the analyses presented in the 2013 report.
It assesses global and regional malaria trends, highlights progress towards global targets, and describes opportunities and challenges in controlling and eliminating the disease. The report was launched in the United Kingdom Houses of Parliament on 9 December 2014.
Scale-up in effective malaria control dramatically reduces deaths
9 December 2014 ¦ Geneva – The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World malaria report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region – where about 90% of malaria deaths occur.
New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.
“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”
Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.
Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.
Moving towards elimination
Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific region by 2030.
In 2013, 2 countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Uzbekistan and Turkmenistan). Another 4 countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).
But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.
In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.
Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under 5 years of age and infants.
In addition, resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.
Dr Alonso believes, however, that with sufficient funding and commitment huge strides forward can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” he says.
While funding to combat malaria has increased threefold since 2005, it is still only around half of the US$ 5.1 billion that is needed if global targets are to be achieved.
“Against a backdrop of continued insufficient funding the fight against malaria needs a renewed focus to ensure maximum value for money,” says Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “We must work together to strengthen country ownership, empower communities, increase efficiencies, and engage multiple sectors outside health. We need to explore ways to do things better at all levels.”
Ray Chambers, who has served as the UN Secretary-General’s Special Envoy for Malaria since 2007, highlights the remarkable progress made in recent years. “While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable,” he says.
Gains at risk in Ebola-affected countries
At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the 3 countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.
Given the intense malaria transmission in these 3 countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.
Note to editors
Globally, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide (range 124-283 million), 82% of which were in the WHO African region. Malaria was responsible for an estimated 584 000 deaths worldwide in 2013 (range: 367 000 – 755 000), killing an estimated 453 000 children under five years of age.
Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015.
The World malaria report 2014 will be launched on 9 December 2014 in the United Kingdom Houses of Parliament. The event will be co-hosted by the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) and Malaria No More UK.
Contacts for press queries will be found at the link above.
You may note that the press release says nothing about DDT, the pesticide most famous in the malaria fight after World War II. WHO abandoned its ambitious campaign to eradicate malaria from the Earth, in the mid-1960s, when it was discovered that mosquitoes in central Africa and other malaria-endemic regions near the tropics were already resistant or immune to the pesticide. DDT had been used by super-mosquito fighter Fred Soper, in campaigns by the Rockefeller Foundation and WHO, to knock down mosquito populations temporarily, to get breathing room to beat malaria. While the populations were temporarily reduced, health workers would frantically work to diagnose and completely treat to a cure, malaria infections in humans. Then, when the mosquito populations came roaring back, the bugs would have no well of disease from which to draw parasites for new infections.
Soper’s methods used DDT sprayed on walls of homes, to specifically get those mosquitoes that bite humans. Anopheles spp. mosquitoes carry malaria parasites through a critical part of the parasites’ life cycle; those mosquitoes typically bite from about dusk to just after midnight. After a blood meal, mosquitoes pause to rest on nearby vertical structures — walls in this case — to squeeze out excess water from the blood they’ve ingested, so they’re light enough to fly. When the mosquito encounters DDT on the walls, the hope is that the DDT kills the mosquito, ending the transmission cycle.
A brutal public relations campaign in Africa, the U.S. and Europe through the late 1990s to now, has vilified science writer Rachel Carson for her indictment of DDT in Silent Spring, her brilliant book on the dangers of indiscriminate use of untested new chemicals.
So it’s important to note that the world’s leading organization that fights malaria makes no call for more DDT. Professional health care workers worldwide have not been hornswoggled by pro-DDT, anti-environment, anti-science, anti-WHO propaganda. That’s good news, too.
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.]
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.
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.
I get e-mail from Nothing But Nets, in preparation for World Malaria Day, April 25, 2014:
As you know, World Malaria Day is April 25, and supporters will be taking action throughout April to help us send 25,000 bed nets to families in Africa.
Megan Walter, our supporter from Richmond, Virginia, organized a unique event in her hometown. She partnered with her local trampoline park to jump for nets – and they raised $10 for every jumper who participated. The event was a huge success, raising more than $2,000 to send 200 bed nets to families in Africa. What made it even better is that Megan had fun doing it!
There are lots of ways to raise money and send nets while doing what you love. Every $10 you raise helps us purchase and distribute life-saving bed nets with our UN partners.
What sports challenge will you do this April?
Join us in sending nets and saving lives for World Malaria Day! Together, we can defeat malaria.
Senior Grassroots Officer, Nothing But Nets
P.S. Whether you run, swim, or play basketball, you can help raise critical funds and save lives. Take a challenge.
|© Copyright 2014 United Nations Foundation
1750 Pennsylvania Avenue NW, Suite 300,
Washington, DC 20006
You noted, of course: No call for more DDT. No slamming of science, scientists, medicine, medical workers, or Rachel Carson and environmental organizations.
This comes from people who fight malaria for a (meager) living, on non-profit basis, without political bias. In short, these people need help, and consequently have no use for the pro-DDT, anti-Rachel Carson, anti-WHO, anti-science hoaxes.
Please give. Every $10 can save a life.
World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing
11 December 2013 | Geneva/Washington DC – Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the “World malaria report 2013” published by WHO.
An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.
The large majority of the 3.3 million lives saved between 2000 and 2012 were in the 10 countries with the highest malaria burden, and among children aged less than 5 years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.
But more needs to be done.
“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”
In 2012, there were an estimated 207 million cases of malaria (uncertainty interval: 135 – 287 million), which caused approximately 627 000 malaria deaths (uncertainty interval 473 000 – 789 000). An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.
Long way from universal access to prevention and treatment
Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.
In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.
There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.
Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.
Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under 5 and pregnant women – has also been slow in recent years.
“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”
Global funding gap
International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$ 0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.
Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.
“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”
WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.
“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”
Notes for editors:
The “World malaria report 2013” summarizes information received from 102 countries that had on-going malaria transmission during the 2000-2012 period, and other sources, and updates the analyses presented in 2012.
The report contains revised estimates of the number of malaria cases and deaths, which integrate new and updated under-5 mortality estimates produced by the United Nations Inter-agency Group for Child Mortality Estimation, as well as new data from the Child Health Epidemiology Reference Group.
Contrary to science denialist claims, DDT is not harmless. Users and abusers of DDT, abandoned stocks of DDT and other pesticides around the world, after the stuff had become essentially useless against insect or other pests originally targeted.
In the U.S., EPA moves in to clean up DDT dumps, under the Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA), or Superfund. In much of the world, various UN agencies find the old pesticides, and clean them up as funding allows.
The Food and Agricultural Organization (FAO) documents its cleanup efforts with photos of sessions training technicians to find and catalog dump sites, repackaging of old drums when necessary, extraction, packing and shipping to a disposal site.
Photos tell a story words on paper cannot.
Sometimes the toxic wastes did not stay neatly stacked.
DDT use against insect vectors of disease essentially halted in the mid-1960s. The Rockefeller Foundation’s and UN’s ace mosquito fighter, Fred Soper, ran into mosquitoes in central Africa that were resistant and immune to DDT. Farmers and businesses had seized on DDT as the pesticide of choice against all crop pests, or pests in buildings. By the time the UN’s malaria-fighting mosquito killers got there, the bugs had evolved to the point DDT didn’t work the malaria eradication campaign.
Also, there were a few DDT accidents that soured many Africans on the stuff. Around lakes where local populations caught the fish that comprised the key protein in their diet, farmers used DDT, and the runoff killed the fish.
Use of DDT ended rather abruptly in several nations. Stocks of DDT that had been shipped were abandoned where they were stored.
Prevention and disposal of obsolete chemicals remains as a thorny problem throughout much of the world. Since 2001, under the Persistent Organic Pollutants Treaty, (POPs), the UN’s World Health Organization (WHO) has coordinated work by WHO and a variety of non-governmental organizations (NGOs), as well as governments, to make safe the abandoned pesticides, and detoxify or destroy them to prevent more damage. FAOs efforts, with photos and explanation, is a history we should work to preserve.
DDT provided powerful insect killing tools for a relatively short period of time, from about 1945 to 1965. In that short period, DDT proved to be a deadly killer of ecosystems to which it was introduced, taking out a variety of insects and other small animals, on up the food chain, with astonishing power. One of DDT’s characteristics is a long half-life — it keeps on killing, for months or years. Once that was thought to be an advantage.
Now it’s a worldwide problem.
Another question of mine that will probably never see the light of day. This group has no answer, so why would they allow the question?
I stumbled across a blog-looking page from the American Council on Science and Health, an industry apologist propaganda site, on World Malaria Day, which was April 25. You may recognize the name of the group as one of the industry-funded sites that constantly attacks Rachel Carson, and often the World Health Organization, with the unscientific and false claims that environmentalists bannned DDT and thereby condemned millions of Africans to die from malaria — which, ASCH claims, could have easily been eradicated with more DDT poisoning of Africa.
On World Malaria Day, ASCH took note, flirted with the facts (that DDT doesn’t work as it once was thought to work), but then backed away from the facts — that the ban on DDT in the U.S. came years AFTER WHO suspended the malaria eradication campaign in Africa when it was discovered DDT couldn’t kill DDT-adapted mosquitoes, already subject to years of abuse of DDT by agriculture and other industries. ASCH said:
DDT kills mosquitoes, although not as well as it did 60 years ago. But it also irritates them and repels them, so the small amount sprayed inside homes effectively reduces the transmission of the malarial microbe substantially. The banning of DDT, based upon political anti-chemical bureaucrats and “environmentalists” inspired by Carson’s “Silent Spring” who ran our EPA in 1972, helped to impede the malaria control program led by the UN’s WHO.
Impede? Impossible for a 1972 ban to have been responsible for the earlier suspension of the WHO campaign, not to mention EPA’s ban ended at the U.S. borders. So I asked:
June 19, 2013 at 5:16 am
Your comment is awaiting moderation.
I would be very interested in just how the 1972 ban on DDT in the U.S. “impeded” the UN’s antimalaria campaign, which stopped using DDT heavily seven years earlier, and was suspended in 1969.
After the ban on U.S. use of DDT, all of U.S. manufacture was dedicated to export to Africa and Asia, which greatly increased DDT supplies available there.
How did this impede?
Want to wager a guess as to whether they’ll ever allow the comment to see the light of day at their site, let alone answer it?
Wall of Shame – Sites that continue to spread the pro-DDT hoax as fact: