DDT no silver bullet; environmentalists, medical care not monsters

Paul Driessen wrote a book, Eco-Imperialism, that in essence blames environmentalists for every case of malaria in Africa since 1962. It is possible, that overreaction to environmental concerns by African governments and by Africans in the path of malaria parasites has indeed caused some delay in decreasing malaria infections. I have not seen any convincing evidence to make that case.

But it is untrue that environmentalists advocate policies intended to hurt Africans. It is untrue that DDT is a silver bullet that meanie environmentalists refuse to let African governments use — environmentalists do not have the power to tell African governments what the governments can or cannot do. Plus, it’s unfair to the point of gross distortion to blame environmentalists for the many problems which still exist that prevented the eradication of malaria 40 years ago and continue to frustrate efforts to reduce the frequency and mortality of the disease.

I assume Driessen is well-intentioned, though I have no first hand information about his motivations.

With that assumption, let me ascribe to simple error the many problems of his recent column for an on-line magazine perhaps aptly named spiked.

Driessen calls for an “all-out war on malaria.” That would be good.

But then he accuses environmentalists of standing in the way of such a war.

False blame calling cures not a single case of malaria, nor kills a single malaria-carrying mosquito. If Driessen wishes to fight malaria, there are a lot of people who would like to help. We can start to fight malaria, any time. [More after the fold.]

Dreissen’s opening gambit telegraphs the tone and outcome of his article. He writes:

If an accident kills wildlife or people, punishment is meted out and restitution made. A host of regulators, lawyers, judges, activists, journalists and politicians help bring the wrongdoers to justice.

But when it comes to policies and programmes that sicken and kill millions of parents and children a year, these ethics cops and eco-warriors are not just silent. They refuse to hold government agencies and activist groups to the same honesty and accountability standards they apply to for-profit companies. They even oppose programmes that would reduce disease and save lives.

Generally we should agree, when someone commits a wrong, they are punished. But we understand this is not wholly accurate.

For example, when DDT nearly killed off the American bald eagle, the symbol of our nation, no one was punished. Moreover, Mr. Driessen fails even to acknowledge the events occurred. No significant restitution was made by the manufacturers of the poisons that killed the birds, nor from those who ordered the application of the poisons nor those who applied the poisons. Instead American citizens as a whole footed the bill for eagle recovery, just as we have done with all other major accidents and kills from DDT. Cleanup costs have been covered by the Superfund, that is, at the expense of American taxpayers.

The Superfund bill did not exist when DDT was banned. Since the Superfund bill, which attaches liability for major environmental disasters as closely to the people at fault as possible, a couple of DDT dump sites have been tagged for clean up by the Environmental Protection Agency, which administers the law.

It is not clear that there is enough money from the responsible parties to do the jobs. The clean up of the massive DDT dump off the coast of California, near Santa Barbara, will be done, with your tax money first, and restitution then sought from any responsible parties. Many of the companies who manufactured the pesticides at fault declared bankruptcy, to avoid liability (the Montrose Company, responsible for much of the pollution in Santa Barbara, did provide funds in a settlement, please note).

Apart from those few latter-day cases, DDT manufacturers and users have not been called to account. Those accountable have not been held to account.

Driessen is incorrect in laying blame for deaths to “eco-warriors.” The hoax claim that environmentalists rule the world and tell Idi Amin not to fight malaria shouldn’t get the time of day. But then, Driessen doesn’t lay it out that clearly.

Driessen wrote:

More than two billion people worldwide are at risk of getting malaria, and 350-500 million contract it every year, mostly in Sub-Saharan Africa. The disease kills up to a million African children annually, making it the continent’s greatest executioner of children under age five. In Uganda alone, 60million cases of malaria caused 110,000 deaths in 2005 (1). In its Apac District, a person is likely to be bitten 1,560 times a year by mosquitoes infected with malaria parasites. The disease also perpetuates poverty (sick people can’t work) and increases deaths from HIV/AIDS, tuberculosis, diarrhoea and malnutrition.

Controlling and eradicating this serial killer ought to be a global priority. But far too many organisations fail to take sufficient measures, while others actively oppose critically needed interventions.

Should we include among those who “actively oppose critically needed interventions,” those agencies, like the U.S. government, which have demanded that bed nets be distributed only with a charge, and not free? Nets are the key to reducing bites in many African nations where people live in homes without working doors or windows, or air conditioning to allow the windows to stay closed, or screens where windows are open and the building will support it. Repeated studies show nets work. They work amazingly well when impregnated with an insecticide (this is one legitimate use for DDT), they work well without insecticides.

Pro-DDT people run down the concept of bed nets, saying they are not 100% effective. Of course, DDT is much less than 100% effective, too. It’s an odd sort of hypocrisy.

Large scale tests by the Gates Foundation suggest that distributing the nets free can achieve a huge reduction in the number of malaria infections, greater than achieved with DDT in some places.

So, just who is it who is opposed to helping Africans here? The issue of bed nets suggests that perhaps it’s the DDT advocates who are standing in the way. DDT advocates rarely emphasize bed nets, and DDT spraying does nothing to improve the distribution and use of bed nets.

Does Driessen comprehend what he’s saying here?

UNICEF partners with Malaria No More to raise money from donors, distribute educational materials and long-lasting insecticide-treated bednets (LLINs), provide anti-malarial drugs, and save lives. ‘Sometimes’ they organise teams to spray insecticides on the inside walls of houses, to ‘kill the female mosquito after she feeds on a person’ (and frequently infects him or her). Under ‘some special circumstances’, they support treating mosquito-breeding sites, if the larvacides are ‘environmentally friendly’.

All these interventions will help reduce disease and death tolls. They will garner plaudits from environmental activists. But these limited measures will not result in No More Malaria. Unless and until their programmes include regular use of larvacides and insecticides to control mosquitoes, and DDT in selected cases to keep the flying killers out of houses, UNICEF and MNM will not even come close to reducing malaria cases and deaths to what a moral person would deem tolerable levels: close to zero – not 50 per cent or even 25 per cent of current levels.

Use of DDT in place of the environmentally-friendly larvacides killed the fish the local people ate. People starved, and malaria rates were not significantly reduced. What is Driessen advocating here? DDT is not a good larvacide, and it’s very destructive when used as a larvacide. Larvacides kill the mosquitoes before they mature, before they bite to get infected with malaria from a human, and way before they bite to pass on the parasites.

Killing the fish food stocks of the local population doesn’t appear on first blush to be a good idea, either.

DDT alone, then, is not a good solution. DDT can be wonderfully effective when used as WHO calls for it to be used, in a carefully developed program of integrated pest management that features nets to stop mosquitoes physically, draining breeding pools around homes to stop the reproduction of mosquitoes, appropriate application of larvacides to stop larva from becoming mosqitoes, and spraying indoors with appropriate insecticides including DDT sometimes, to help stop mosquitoes that survive the other hurdles — and not used until mosquitoes become resistant or immune to it.

Again, research shows one of the best ways to treat pools where mosquitoes breed is to drain them. We’re not talking about huge ponds or rivers, where fish (which would be killed by DDT) eat the mosquito larvae. We’re talking about potholes in unpaved roads, discarded tires, plugged rain spouts, cans, discarded cans and bottles — especially those near homes. No larvacide is required in a drained pool.

People can do this draining for themselves, especially when they are educated to do it. This is inexpensive, very effective, and environmentally friendly. DDT can’t do it.

Look hard at what Driessen is arguing for. Is he asking for a change in current programs, or is he just stabbing out at environmentalists, for no good reason?

Kenya claims widespread distribution of insecticide-treated nets cut malaria deaths in half, in the short run anyway, when regular compliance was monitored. But that means 15,000 people are still dying each year. For Uganda, a 50 per cent reduction via nets would mean 30million cases of malaria and 55,000 deaths. Uganda’s Ministry of Health recently studied 410 children who had been given LLINs and instructed in how to use them. Within two to three weeks, 52 per cent of the children were again infected with malaria. ‘The use of nets relies greatly on behavioral change and compliance, while indoor spraying eliminates that factor and protects everyone in the sprayed house’, noted malaria programme director John Rwakimari.

Kenya’s experience shows malaria infection rates can be cut in half. DDT can’t improve much on that rate, if at all. That’s a good, solid achievement. The barriers to distributing nets, and the barriers to getting people to use them, would improved the numbers significantly. Expanding the use of nets would help prevent the additional 15,000 deaths Driessen mentions.

Nets work for about five years before they have to be replaced. DDT spraying may work for six months or a year, but not at all against mosquitoes that are immune. DNA testing of mosquitoes would be required to see if immunity exists. Capture and testing of mosquitoes should be done to determine species and infection before spraying is done. Safe DDT use can be done, but is unlikely to be done. If done ineffectively, DDT spraying is a waste of money — it doesn’t work against mosquitoes immune to it, it doesn’t help if mosquitoes are of a different species that doesn’t carry the disease parasites, it only works when mosquitoes stop on the walls AFTER biting a victim (studies over the past 40 years show that DDT-forced artificial selection has bred that instinct out of many populations of mosquitoes that spread malaria).

And yet misguided aid agencies, radical environmentalists and pseudo ethicists are telling African nations they should be happy with nets, use of limited insecticides ‘sometimes’, and a 50 per cent reduction in malaria cases and deaths – because these activists in malaria-free countries dislike chemicals.

Equally unacceptable, 60 per cent of African child malaria victims are still being ‘treated’ with chloroquine, which no longer kills African plasmodium parasites. The typical justification is that chloroquine is much less expensive than Artemisia-based combination therapies (ACT drugs) that do work. In other words, medical malpractitioners are saying it is better to give millions of children cheap drugs that don’t work, and let thousands of them die, than it is to give fewer children more expensive drugs that work, and ensure that they live. By failing to support chemical mosquito killers and repellants, they are also guaranteeing tens of millions of needless malaria cases every year, continued shortfalls of effective medicines, and countless unnecessary deaths.

That is unforgivable, unconscionable and immoral.

Mr. Driessen hints that this is the fault of anti-DDT forces — but again, it is the pro-DDT people who put up the barriers here. Chloroquine doesn’t work because the parasites become immune to it. The artemisinin-based drugs are more expensive. They require an effective medical care delivery system to make them work at all, and they work best if used in a program that is designed using a variety of pharamaceuticals and treatments to prevent the parasites from developing immunity.

The U.S. Congress appropriated money to spend for these treatments, but the Bush administration delayed the spending.

No DDT ban is to blame for that. No spraying of DDT can make up the difference — and, if chloroquine is ineffective, DDT spraying will only exacerbate the problems.

To achieve moral levels of malaria, countries need comprehensive, integrated programmes that include every weapon in the arsenal. None is appropriate in all places, at all times. But all must be available, so that they can be employed at the proper time and place. That is why the US Agency for International Development, the US President’s Malaria Initiative and the World Health Organisation determined that these chemical weapons are vital in the war on malaria, and safe for people and the environment.

Larvacides, insecticides and DDT – in conjunction with nets and other interventions – can reduce the number of malaria victims dramatically, and ensure that people who still get malaria can be treated with ACT drugs like Coartem. These truly integrated strategies have enabled South Africa, Botswana, Swaziland and Zanzibar to largely eradicate malaria.

So, after slamming environmentalists and falsely blaming them for the rise in malaria, Dreissen argues for the program that Rachel Carson advocated in 1962. This is hypocrisy writ large.

Driessen’s suggestions are solid — if we assume he doesn’t mean we need broadcast spraying of DDT. But then, there is near-unanimity among environmental groups that limited DDT use is called for, and all the “bans” specifically allow for DDT to be used in a limited fashion in an integrated pest management program.

The only thing current law does not allow is broadcast spraying of DDT, which has proven time and again to be destructive to the environment and frustrating to malaria fighting programs, over more than 50 years.

So we must wonder: Is Driessen calling for current policy, and just making gratuitous swipes at environmentalists for the heck of it, or is he calling for environmental destruction?

Uganda, where I just spent a week on an anti-malaria mission, is using larvacides, insecticides, nets and other interventions. It has sprayed 95 per cent of households in the Kabale District (with the pesticide Icon) – and slashed the prevalence of malaria parasites in residents from 30 per cent before spraying to 3 per cent afterwards.

Three other districts have also been sprayed, and Uganda’s Ministry of Health plans to spray another 15 highly endemic areas in 2008, including the Apac District. In January, it will add DDT to its programme, for indoor residual spraying that will keep at least 70 per cent of mosquitoes from entering homes for up to eight months, with a single application.

Uganda is one of those nations where DDT was not sprayed prior to about 1970, and not much afterward. Idi Amin wasn’t exactly anxious to create a working health care system to systematically fight malaria.

Now, Uganda has had great success using the Rachel Carson-promulgated methods of IPM, improved medical care, and bed nets.

So, what is Driessen calling for? More of Rachel Carson’s program, or something different? If he’s endorsing Carson’s program, why doesn’t he have the honesty to say so?

Radical environmentalists are trying to stir up opposition to DDT and other spraying programmes, and some people in USAID and WHO continue undermining efforts to utilise chemical interventions. However, Uganda is adamant about ending the needless slaughter of its children and parents. President Yoweri Museveni, director general of health services Sam Zaramba and other leaders know DDT will save lives.

Actually, opposition comes from local people who understand DDT to be damaging to health (well-grounded fears), and, oddly, from tobacco companies who finance the anti-environmentalist screeds Driessen subscribes to. The tobacco companies fear people will be reluctant to purchase tobacco from areas where DDT is used.

Who wins if wages are kept down, people are kept poor, malaria is still a problem, and DDT is not used? Environmentalists lose, the people lose — tobacco companies who want cheap labor, win.

Anti-pesticide activists claim insecticide spraying is not sustainable. They are wrong – on financial, practical, public health and moral grounds. What are not sustainable are nothing-but-nets programmes that require constant monitoring to ensure daily use and moderate success – while raising the risk that mosquitoes will become resistant to pyrethroid pesticides that impregnate the nets, and parasites will become resistant to drugs that by default become the primary weapon in the war on malaria.

No one argues for “nothing but nets.” Mr. Driessen should be ashamed for setting up such a straw-man argument.

Nor does he note that DDT use requires constant monitoring to make it non-deadly or completely ineffective. Hypocrisy raises its head again.

What are truly not sustainable are unconscionable malaria tolls that result from politically correct policies that are best described as lethal experimentation on African children.

Paul Driessen is senior policy adviser for the Congress of Racial Equality and Committee For A Constructive Tomorrow, and author of Eco-Imperialism: Green Power, Black Death.

Every expert in the field, the World Health Organization (WHO), and major environmental organizations are agreed on the ways to fight malaria: Education to drain pools where mosquitoes breed, and otherwise to avoid exposure to the mosquitoes; improvements in health care to deliver ABC treatments to malaria victims; better screening to keep mosquitoes out of homes at night, including especially the very effective bednets, which are effective treated with pesticides or untreated; and an integrated pest management program that includes hut spraying, with DDT or another appropriate pesticide.

Driessen criticizes WHO, the experts, and those environmental organizations, and calls for a change — but a change to what?

The effective programs are exactly those that the environmental agencies advocate. Is it too much to ask Driessen to be a happy winner, and join in the fight against malaria, instead of fighting the people who want to fight malaria?

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