World Malaria Report 2018: Quick blueprint for action, no standing still

December 27, 2018

No standing still with malaria, fighting the disease must continue or progress can be quickly lost. Still from WHO film on World Malaria Report 2018 call to action.

No standing still with malaria, fighting the disease must continue or progress can be quickly lost. Still from WHO film on World Malaria Report 2018 call to action.

World Health Organization’s (WHO) World Malaria Report 2018 dropped on November 19, a month earlier than usual (but about the same time as 2017). With an additional few weeks to plug it, it still sank without big ripples in world media.

WHO adds a shorter version, an “executive version” — that still doesn’t get the attention it should.

This is prelude to a tragedy if industrialized and wealthy nations of the world pay no heed, and continue to cut budgets to fight malaria for whatever bad reason some crabby, brown Earth policy maker invents.

Ever optimistic, WHO gives a plan for action to continue to reduce malaria deaths and infections, even with reduced funding. None of the proposed actions involves more DDT to poison poor people in poor countries, however, so it is unlikely to find favor with the crabby policy people now in charge of fixing world problems in the increasingly isolationist West (including the U.S.).

Please watch the video. What is your country doing to eradicate malaria? How can you prod politicians to do more?
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More:


Good news, or great challenge? U.S. could help eliminate malaria

December 13, 2016

World Malaria Report 2016, published December 13, offers great hope in progress made against malaria in the past 16 years.

But it also notes a severe challenge: Funding to beat malaria works well, but funding pledges sometimes are not met, and progress against the disease slowed some in 2016.

In 2000, nearly a million people died from malaria worldwide. In 2015, the death toll had been cut to ~470,000, a 50% reduction in 15 years.

In 2016, ~429,000 people died from malaria. It’s 40,000 fewer people than the year before. Malaria fighters had hoped for more.

Most deaths occur in Africa, most deaths occur to children, and most deaths occur in areas where distribution of insecticide-impregnated bednets has not been complete. Distribution was slowed in 2016 by lack of funds at steps in the process, from manufacturing the nets (now done significantly in Africa) to distributing the nets, to educating people how to use them. Nets are more effective than pesticide spraying, with DDT or the other 11 approved pesticides, and considerably less expensive.

A child shows off the mosquito bednet that keeps him malaria-free. Image from Nothing But Nets.

A child shows off the mosquito bednet that keeps him malaria-free. Image from Nothing But Nets.

WHO’s press release on the Report laid out the problem, with hints at a solution.

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%).

U.S. funding was just over $1 billion. That may sound like a lot, but it’s not even a drop in the U.S. federal budget bucket.

With a doubling of the U.S. contribution to $2 billion, the U.S. could again lead the world in fighting malaria, and set a good example of American democracy in action.

In doing that, another 100,000 lives might be saved each year.

Then, U.S. would have high moral ground to urge other nations to contribute to fighting malaria, either directly through WHO or through non-governmental organizations whose work goes too-often unsung, such as Malaria No More, Nothing But ‘Nets, and the Clinton Foundation.

$10 buys a net and distribution, and a net protects a child from malaria better than spraying dangerous insecticides, for two to five years.

What are the odds the Trump administration could be recruited to beat malaria? Let’s increase those odds.


How USA spends so much money to fight malaria in other nations

January 2, 2016

Fighting malaria is difficult, and complex, and expensive. No magic bullet can slow or stop malaria.

Reasonable people understand the stakes, not only for Africa, where $12 billion is lost every year to malaria illness and death, according to WHO records; but also for all nations who trade with Africa and other malaria endemic nations in the world.

What should we do about malaria?

Before we leap to solutions, let us look to see what the United States is already doing, according to USAID, the agency which has led U.S. malaria-fighting since the 1950s.

USAID explains on their website:

Fighting Malaria

A mother and child sit under the protection of malaria nets

A mother and child sit under the protection of malaria nets. Learn more about PMI’s contributions to the global fight against malaria. Maggie Hallahan Photography

Each year, malaria causes about 214 million cases and an estimated 438,000 deaths worldwide

While malaria mortality rates have dropped by 60 percent over the period 2000–2015, malaria remains a major cause of death among children. Although the disease is preventable and curable, it is estimated that a child dies every minute from malaria. In Asia and the Americas, malaria causes fewer severe illnesses and deaths, but antimalarial drug resistance is a serious and growing problem.

The U.S. Agency for International Development (USAID) has been committed to fighting malaria since the 1950s. Malaria prevention and control remains a major U.S. foreign assistance objective and supports the U.S. Government’s vision of ending preventable child and maternal deaths and ending extreme poverty. USAID works closely with national governments to build their capacity to prevent and treat the disease. USAID also invests in the discovery and development of new antimalarial drugs and malaria vaccines. USAID-supported malaria control activities are based on country-level assessments, and a combination of interventions are implemented to achieve the greatest public health impact – most importantly the reduction of maternal and child mortality. These interventions include:

  • Indoor residual spraying (IRS): IRS is the organized, timely spraying of an insecticide on the inside walls of houses or dwellings. It kills adult mosquitoes before they can transmit malaria parasites to another person.
  • Insecticide-treated mosquito nets (ITNs): An insecticide-treated mosquito net hung over sleeping areas protects those sleeping under it by repelling mosquitoes and killing those that land on it.
  • Intermittent preventive treatment for pregnant women (IPTp): Approximately 125 million pregnant women annually are at risk of contracting malaria. IPTp involves the administration of at least two doses of an antimalarial drug to a pregnant woman, which protects her against maternal anemia and reduces the likelihood of low birth weight and perinatal death.
  • Diagnosis and treatment with lifesaving drugs: Effective case management entails diagnostic testing for malaria to ensure that all patients with malaria are properly identified and receive a quality-assured artemisinin-based combination therapy (ACT).

The President’s Malaria Initiative (PMI) works in 19 focus countries in sub-Saharan Africa and the Greater Mekong Subregion in Asia. PMI is an interagency initiative led by USAID and implemented together with the U.S. Centers for Disease Control and Prevention. In 2015, PMI launched its next 6-year strategy for 2015–2020, which takes into account the progress over the past decade and the new challenges that have arisen. It is also in line with the goals articulated in the Roll Back Malaria (RBM) Partnership’s second generation global malaria action plan, Action and Investment to Defeat Malaria (AIM) 2016–2030: for a Malaria-Free World [PDF, 18.6MB] and The World Health Organization’s (WHO’s) updated Global Technical Strategy: 2016–2030 [PDF, 1.0MB]. The U.S. Government’s goal under the PMI Strategy 2015-2020 [PDF, 8.9MB] is to work with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity, toward the long-term goal of elimination. USAID also provides support to malaria control efforts in other countries in Africa, including Burkina Faso, Burundi and South Sudan, and one regional program in the Amazon Basin of South America. The latter program focuses primarily on identifying and containing antimalarial drug resistance.

Do you think the U.S. spends too much on foreign aid, even good aid to fight malaria? How much do you think is spent? Put your estimate in comments, please — and by all means, look for sources to see what the actual amount is.


U.S. spends $38 billion on foreign aid? (Not nearly enough)

May 22, 2014

Glenn Beck got all worked up over this chart, as if it revealed some great, cardinal sin:

Chart on foreign aid as a part of the U.S. budget, from http://www.financedegreecenter.com/foreign-aid/

Chart on foreign aid as a part of the U.S. budget, from http://www.financedegreecenter.com/foreign-aid/

FinanceDegreeCenter.com is a mysterious organization that does no-one-really-will-say what on the internet.  A few months ago I got a series of e-mails from the group, telling that they were changing their name from an earlier iteration and claiming my links to one of their charts jeopardized all the good work they did for people seeking higher education, merely by accurately citing where I got the chart.  That sounded fishy, so I asked them what they did, really, and I got a barrage of e-mails . . .

I think they get paid to steer people to for-profit, on-line schools.  That doesn’t mean their charts are inaccurate, though it does mean I don’t post them without a lot of checking first (this is the first one I’ve posted since then).

Which is a long way of saying, Beck sure has crumby sources.

Bad as the source may be, the information isn’t far off.  But there’s the problem.

Beck’s audience probably believes, as Beck has told them, that the U.S. pays way too much in foreign aid.  Polls repeatedly show most people think we spend anywhere from ten times to a hundred times what we do.  A great little article with charts at the Washington Post explained:

The poll result that seems to most frustrate budget analysts is the apparent belief among Americans that foreign aid is a huge cost to the federal government. The latest poll that my colleague Ezra Klein cites finds that the average American thinks the United States spends 28 percent of the federal budget on aid to foreign governments — more than the country spends on Social Security or Medicare or defense.

In reality, we spend only 1 percent on foreign aid.

This gap between perception and reality is ridiculously large. That’s depressing, but it also presents an opportunity. The case that 28 percent of the budget should go to foreign aid is very strong. And if Americans already think we give that much — well, the least we could do is accommodate them!

We don’t spend enough.  Yes, we spend $38 billion.  That’s less than 1% of total U.S. outlays, and it’s been declining as a share of our Gross National Income and Gross Domestic Product since 1960.

Glenn Beck gets outraged, and shouts away, “$38 billion,” hoping that his shouting will make the number appear larger than it is.  He thinks, and says, it’s too much.

$38 billion?  Less than 1% of the budget.  Less than one penny of every dollar.

As a nation, the U.S. does not spend enough on foreign aid.  We should spend more.

Think of the good that could be done, if our nation actually did increase foreign aid to equal 25% of the federal budget (without taking it out of the hides of poverty-struck, homeless newborn babies and baby ducks as GOP legislators would insist).  How would the world be different?

More, and resources: 


World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing (but not DDT)

March 21, 2014

News release from the World Health Organization:

World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing

News release

Cover of World Malaria Report 2013

Cover of World Malaria Report 2013

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.


We don’t spend enough on foreign aid; U.S. should spend more

July 18, 2012

All that bellyaching about Obama’s out of control spending?  Bunk.

All that ballyhoo about how the U.S. spends way too much on foreign aid?  Dangerous anti-American propaganda; we don’t spend enough.

For evidence, look at the Congressional Budget Office‘s non-partisan analysis of the State Department reauthorization act for the coming year, Fiscal 2013.  And please, get the facts before you start to complain.

H.R. 6018, Foreign Relations Reauthorization Act, Fiscal Year 2013

Page 1 of CBO’s analysis:

H.R. 6018 would authorize appropriations for the Department of State and related agencies, the Peace Corps, and international broadcasting activities. CBO estimates that implementing the bill would cost $15.8 billion over the 2013-2017 period, assuming appropriation of the specified and estimated amounts.

We’re talking actual outlays for the State Department, for all of our diplomatic efforts to prevent war, secure and strengthen peace, represent U.S. interests in trade and defense and culture, and manage the provision of about $37 billion in aid to other nations, of a total around $9.3 billion for FY 2013.  (See page 2)

That’s a pittance.

Even if we include the $37 billion in foreign aid payouts, that’s less than $50 billion a year to manage and maintain our vital relationships in the world.

You can get the country-by-country breakdown of foreign aid, from the horse’s mouth, at this site.

Less than 1% of our national budget goes to foreign aid.

Less than 1 penny of every dollar you pay in taxes, goes to foreign aid.

How much would be enough?  We could double foreign aid without any significant effect to the deficits, but with huge effects in good will and actual production of peace overseas.

Most people think a “fair” percentage of the budget to dedicate to foreign aid would be about 10%.

This is no time for austerity in federal spending.

What’s changed in this chart from 2010?  Not much:


An observation on cutting budgets, and my beliefs

March 8, 2011

This probably deserves a longer, more thought-out post.

Maybe later.

Right now I just want to get this off my chest:

I do not believe, as the Republican budget insists, that America is no longer a great nation, that our greatest days are long past, and that America needs to hunker down and join the Second- or Third-World. I do not believe that America can afford to give up leadership in foreign affairs, nor leadership in education. I do not believe God will step in to save us from our own stupidity. America is an exceptional place because people chose to act, to make the things that make a great nation.

I believe we need to answer when the certain trumpets blow, and they are sounding now.  I do not believe the full-scale retreat proposed by the Republican budget is the proper, best, nor American response.

Back to regular programming now.


USAID policy statement on DDT and malaria control

February 16, 2011

USAID-paid tools and pesticides used to prevent malaria in a campaign coordinated with the government in Tanzania. USAID photo.

USAID-paid tools and pesticides used to prevent malaria in a campaign coordinated with the government in Tanzania. USAID photo.

 

The U.S. Agency for International Development (USAID) issued a statement on their support for the use of DDT, where appropriate.  I don’t have a date — if you know the date, please let me know — but for the record, here’s the statement.

Those who claim the U.S. discourages the use of DDT to the detriment of African and Asians, are incorrect in their claims, once again.

USAID Support for Malaria Control in Countries Using DDT

USAID and Malaria

USAID activities for malaria control are based on a combination of internationally-accepted priority
interventions and country-level assessments for achieving the greatest public health impact, most importantly, the reduction of child mortality (deaths).

Contrary to popular belief, USAID does not “ban” the use of DDT in its malaria control programs. From a purely technical point of view in terms of effective methods of addressing malaria, USAID and others have not seen DDT as a high priority component of malaria programs for practical reasons. In many cases, indoor residual spraying of DDT, or any other insecticide, is not cost effective and is very difficult to maintain. In most countries in Africa where USAID provides support to malaria control programs, it has been judged more cost-effective and appropriate to put US government funds into preventing malaria through insecticide-treated nets, which are every bit as effective in preventing malaria and more feasible in countries that do not have existing, strong indoor spraying programs.

USAID country missions provide support to national malaria control programs in about 21 countries in sub-Saharan Africa, where the burden of malaria deaths is the highest. This support covers a broad range of activities, according to local priorities, resource availability and complementary activities by other donors and multinational institutions in each country.

International efforts to fight malaria are largely coordinated by Roll Back Malaria (RBM), a global partnership that includes leaders from across Africa, African health institutions, the World Health Organization (WHO), UNICEF, World Bank, UNDP, multi-lateral agencies, international, national and local NGOs, and the private sector. USAID is a key RBM partner. RBM has identified three priority interventions to reduce deaths and illness from malaria. These are consistent with USAID ’s priority areas for investment in malaria. These are:

1. Insecticide-Treated Nets (ITNs) for young children and pregnant women.
2. Prompt and Effective Treatment with an anti-malarial drug within 24 hours of onset of fever
3. Intermittent Preventive Therapy (IPT) for pregnant women as a part of the standard ante –
natal services.

Each of these interventions is backed by solid evidence of effectiveness under program conditions and effective in reducing the sickness and death from malaria, especially in Africa. For example, proper use of ITNs can reduce overall child deaths by up to 30% and significantly reduce sickness in children and pregnant women.

DDT in Malaria Programs

DDT is only used for malaria control through the spraying of interior house walls – Indoor Residual Spraying, or (IRS). A number of other insecticides can also be used for IRS, and are in many countries when those alternative insecticides are safer and equally effective. IRS, when efficiently conducted in appropriate settings, is considered to be as efficacious as ITNs in controlling malaria.

In most countries in Africa where USAID provides support to malaria control programs, it has been judged more cost-effective and appropriate to put US government funds into other malaria control activities than IRS. USAID has funded non-IRS support to malaria control programs in countries in which DDT is being used, for example, Eritrea, Zambia, Ethiopia and Madagascar.

USAID regulations (22 CFR 216) require an assessment of potential environmental impacts of supporting either the procurement or use of pesticides in any USAID assisted project, but if the evidence assembled in preparing such an environmental review indicates that DDT is the only effective alternative and it could be used safely such as interior wall spraying undertaken with WHO application protocols, then that option would be considered. The U.S. government is signatory to the Stockholm Convention on Persistent Organic Pollutants (the POPS treaty), which specifically allows an exemption for countries to use DDT for public health use in vector control programs, as long as WHO guidelines are followed and until a safer and equally effective alternative is found. The US voted in favor of this exemption.

There are a few situations in which IRS with DDT is generally found to be appropriate. For example, in South Africa when certain mosquitoes developed resistance to the major alternative class of insecticides, the synthetic pyrethroids, DDT was used. Such situations are relatively rare, however, and demonstrate the value of the provisions of the POPs Treaty, which restrict and document use of DDT, but provide for its use when appropriate.

USAID Interventions

USAID is emphasizing prevention via mosquito nets dipped in pyrethriods – a synthetic insecticide originally found in chrysanthemums. USAID is supporting an innovative Africa regional public-private venture for the commercial distribution of ITNs. In 2003 USAID’s NetMark Project launched insecticide-treated net products in Zambia, Senegal, Ghana, and Nigeria selling more than 600,000 nets and 500,000 insecticide re-treatments during its first five months of operation. In 2004, NetMark will launch in at least five more countries in Africa.

USAID also invests in development of new tools for malaria control, particularly vaccine development and the response to increasing drug resistance. USAID is funding projects to discover and dispense new drugs such as Arteminisin-based combination therapies (ACT), which have proven to be more effective against malaria than the traditional drugs chloroquine and mefloquine. USAID also supports the development of new policies and strategies for use of these new therapies, as well as the improvement of both public and private health systems. Since 1998, the agency has aggressively supported the development of the combination therapy as a safe and effective alternative treatment.  In addition, USAID and its global partners in RBM are working to ensure sustained financing of the drugs. USAID has played a critical role in drawing attention to the spread of drug resistance in Africa and in assisting countries in effectively treating malaria, including the use of combination therapy.

In summary, USAID directs its support for malaria control programs based on evidence for maximum impact on reducing child deaths. Based on this criterion, for most countries with USAID support for malaria control in sub-Saharan Africa, indoor residual spraying (regardless of the choice of insecticide) has not been judged to be the most effective use of US government funds. USAID continues to plan its support for national malaria control programs in sub -Saharan Africa on a country by country basis, and will continue to strive to use US taxpayer funds as efficiently and effectively as possible with the most appropriate tools at our disposal to reduce deaths from malaria.

I suspect that statement is dated.  Here is a site at USAID that details the policy on DDT, malaria and mosquitoes, and includes a different statement under the same title as the above:

USAID and Malaria

USAID activities for malaria control are based on a combination of internationally accepted priority interventions and country-level assessments for achieving the greatest public health impact, most importantly, the reduction of child mortality (deaths).

USAID backs a comprehensive approach to prevent and treat malaria. This includes:

  • Spraying with insecticides (“indoor residual spraying,” or IRS) in communities: IRS is the organized, timely spraying of an insecticide on the inside walls of houses or dwellings. It is designed to interrupt malaria transmission by killing adult female mosquitoes when they enter houses and rest on the walls after feeding, but before they can transmit the infection to another person. IRS has been used for decades and has helped eliminate malaria from many areas of the world, particularly where the mosquitoes are indoor-resting and where malaria is seasonally transmitted. USAID and the President’s Malaria Initiative (PMI) activities include conducting environmental assessments, training spray teams, procuring insecticide and equipment, and developing and evaluating spraying activities.
  • Insecticide-treated mosquito nets (ITNs): Bednets treated with insecticide have been proved highly effective in killing mosquitoes. In addition, the netting acts as a protective barrier.  Consistently sleeping under an ITN can decrease severe malaria by 45 percent, reduce premature births by 42 percent, and cut all-cause child mortality by 17 to 63 percent. PMI is expanding access to free and highly subsidized nets while also creating commercial markets in African countries.
  • Lifesaving drugs: Artemisinin-based combination therapies (ACTs) are the most effective and rapidly acting drugs currently available for treating malaria.  PMI activities include purchasing ACT drugs; setting up management and logistics systems for their distribution through the public and private sectors; and training health care workers and community caregivers in their use.
  • Intermittent preventive treatment for pregnant women (IPTp): Each year, more than 30 million African women living in malaria-endemic areas become pregnant and are at risk for malaria. IPTp involves the administration of at least two doses of sulfadoxine-pyrimethamine (SP) to a pregnant woman through antenatal care services.  The treatment helps to protect pregnant women against maternal anemia and low birthweight, which contributes to between 100,000 and 200,000 infant deaths annually in Africa.  PMI activities include purchasing SP, training health care workers in administering the drug, and providing information about IPTp to pregnant women.

USAID and DDT

USAID supports indoor residual spraying (IRS) with DDT as an effective malaria prevention strategy in tropical Africa in those specific situations where it is judged to be the best insecticide for IRS both epidemiologically and entomologically and based on host-country policy. Its use for IRS to prevent malaria is an allowable exception under the Stockholm Convention – also known as the Persistent Organic Pollutants Treaty or POPs Treaty – when used in accordance with WHO guidelines and when safe, effective, and affordable alternatives are not available. For a variety of reasons, some countries do not conduct IRS or have not registered DDT for use in their malaria control programs.  The reasons may include the epidemiological situation of the country, the organizational capacity of the program, or in some cases, concerns related to their agricultural export market.  The Stockholm Convention aims to eventually end the use of all POPs, including DDT.

The determination of which of the WHO-approved insecticides to use for USAID’s IRS programs is made in coordination with the host-country malaria control program, with the primary objective of preventing as many malaria infections and deaths as possible.  That determination is based on cost-effectiveness; on entomological factors; on local building materials; and on host-country policy.  USAID adheres to strict environmental guidelines, approval processes, and procedures for the use of DDT and all other WHO-approved insecticides in its malaria control programs. As part of our environmental assessments and safer use action plans, we help countries build capacity for safe and judicious use of all chemicals used in their malaria control programs, including DDT

The fact is that DDT is more effective and less expensive than many other insecticides in many situations; as a result, it is a very competitive choice for IRS programs.   DDT specifically has an advantage over other insecticides when long persistence is needed on porous surfaces, such as unpainted mud walls, which are found in many African communities, particularly in rural or semi-urban areas.

USAID has never had a “policy” as such either “for” or “against” DDT for IRS.  The real change in the past two years has been a new interest and emphasis on the use of IRS in general – with DDT or any other insecticide – as an effective malaria prevention strategy in tropical Africa.  (Recent successful applications of IRS, particularly in the southern Africa region, have also contributed to the keen interest among donors and among African malaria control programs.)  For example, in Fiscal Year 2005, USAID supported less than $1 million of IRS in Africa, with programs utilizing insecticides purchased by the host government or another donor.  For fiscal year 2007, in the PMI and in other bilateral programs, USAID will support over $20 million in IRS programs in Africa, including the direct purchase of insecticides.  This dramatic increase in the scale of our IRS programs overall is the greatest factor in DDT’s recent prominence in USAID programs.

USAID Issue Briefs

President’s Malaria Initiative (PMI)

Tanks of pesticide (DDT?) used for Indoor Residual Spraying (IRS) against malaria in Africa bear the labels to indicate USAID paid for the tools and the pesticide, contrary to hoaxsters' claims.

Tanks of pesticide (DDT?) used for Indoor Residual Spraying (IRS) against malaria in Africa bear the labels to indicate USAID paid for the tools and the pesticide, contrary to hoaxsters’ claims.

Update: If you’re here from a religious discussion group that veered off into malaria and DDT, you’d do well to use this site’s search feature, and search for DDT.  Most of the statements from those favoring DDT in your discussion are pure, buncombe, junk science, as this site and several others reveal.


Straight talk: Berenbaum on DDT and malaria

August 12, 2009

Plus, she’ll answer your questions.

But hurry.

One of the world’s great authorities on mosquitoes, May Berenbaum at the University of Illinois Urbana-Champaign, spends this week talking about mosquitoes and malaria, and answering your questions.

Public Radio International runs a feature this week with Dr. Berenbaum answering questions.

(Hey, Beck!  Are you decent this week?)

(Steven Milloy?  Got the guts to ask a real scientist a question?)

You should see these first:

Life Cycle of Malaria, WHO and Campaign to Roll Back Malaria

Life Cycle of Malaria, WHO and Campaign to Roll Back Malaria

You like straight talk – why not share it with others?

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Beating malaria without DDT

November 3, 2008

I told you so.

Recent research and assessments of anti-malaria campaigns in Africa show dramatic results from the use of bed nets and other non-DDT spraying methods.

Rachel Carson was right.

I was compelled to jump into this issue when Utah’s U.S. Rep. Rob Bishop made a silly and incorrect statement against Rachel Carson, after his failed attempt to derail a bill to rename a post office in her honor on the 100th anniversary of her birth.  The slam-Rachel-Carson effort turned out to include Oklahama U.S. Sen. Tom Coburn (who has since recanted), and an array of anti-science types who rail against “environmentalists” and made astoundingly false claims against Carson’s work and Carson herself.

In those cases, Carson’s critics called for a return of massive spraying of DDT.  Eventually most of them backed off of calling for outdoor spraying.  Eventually Sen. Coburn lifted his hold on the post office renaming legislation (and it passed).

The calumny continued on the internet, however, with an active hoax campaign for DDT and against environmental protection and Rachel Carson.  Steven Milloy joined Lyndon Larouche in promoting the anti-Carson screeds of the late Dr. Gordon Edwards, a UC Davis entomologist who argued against science that DDT was harmless to humans and animals.

Enough about history.  Look at the real results on the ground, today:

First, note the study published in Lancet that documents a dramatic decrease in malaria in Gambia, using “low-cost” strategies that include bed netsAgence France Presse carried a summary of the study. [Another link to the same AFP article.]

Incidence of malaria in Gambia has plunged thanks to an array of low-cost strategies, offering the tempting vision of eliminating this disease in parts of Africa, a study published Friday by The Lancet said.

At four key monitoring sites in the small West African state, the number of malarial cases fell by between 50 percent and 82 percent between 2003 and 2007, its authors found.

The tally of deaths from malaria, recorded at two hospitals where there had been a total of 29 fatalities out of 232 admissions in 2003, fell by nine-tenths and 100 percent in 2007. A fall of 100 percent means that no deaths attributed to malaria occurred that year.

“A large proportion of the malaria burden has been alleviated in Africa,” the study concludes.

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Second, note that malaria rates also fell in Kenya, with a shift in infections away from young children, a very good sign. TropIKA.net carried a summary of that study.

Toronto’s Globe and Mail carried a longer story on Kenya’s experience, “Malaria a rare public-health success story in Africa.”

“We had to stay home and tend the sick – you can never leave them to go and work in the fields – and then there was no income and we were hungry. So truly, that 100 shillings was a great investment.”

The family heard about the importance of using a bed net to fend off malaria in a sermon at church, and then on the radio. Now, a year later, they would be able to get them for free, as Kenya ramps up its efforts to get every single citizen sleeping under a net.

Already, two-thirds of Kenyan children are sleeping beneath them and, as a result, child malaria deaths have fallen by 40 per cent in the past two years.

This remarkable success story has been repeated across much of Africa: Deaths of children under 5 declined 66 per cent in Rwanda from 2005 to 2007 and by 51 per cent in Ethiopia.

“This really is the one global public-health story that is simply and straightforwardly positive,” said Jon Lidén, spokesman for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been behind much of the push.

“It’s not a gradual change. It’s a fundamental change in the fight against malaria.”

Yet the decidedly unglamorous innovations responsible for the change – spraying houses, treating standing water to kill larvae, mass distribution of cheap polyester nets and better drugs, and simple public education on the need to treat suspected malaria quickly – receive almost no attention.

“We never make the headlines with this stuff,” said Shanaaz Sharif, head of disease control for Kenya’s Ministry of Health, which has thus far given out 11 million nets at a cost to the government of $6 each.

Sulay Momoh Jongo, 7, is seen inside a mosquito net in a mud hut is seen inside a mosquito net in a mud hut in Mallay village, southern Sierra Leone, on April 8, 2008. Although free treatment is sometimes available in Sierra Leone to fight the mosquito-borne disease -- whose deadliest strain is common in the countrys mangrove swamps and tropical forests -- many cannot get to health clinics in time. Worldwide, more than 500 million people become severely ill with malaria every year. One child dies of the disease every 30 seconds. Picture taken April 8, 2008. (Katrina Manson/Reuters)

From the Toronto Globe and Mail: “Sulay Momoh Jongo, 7, is seen inside a mosquito net in a mud hut is seen inside a mosquito net in a mud hut in Mallay village, southern Sierra Leone, on April 8, 2008. Although free treatment is sometimes available in Sierra Leone to fight the mosquito-borne disease — whose deadliest strain is common in the country’s mangrove swamps and tropical forests — many cannot get to health clinics in time. Worldwide, more than 500 million people become severely ill with malaria every year. One child dies of the disease every 30 seconds. Picture taken April 8, 2008. (Katrina Manson/Reuters)”

Despite pledges from the U.S. to signficantly increase funding to fight malaria, money has not flowed from the U.S., especially for bed nets.  Ironically, Canada is the chief donor of the nets.

Canada has had a key role in this success: The Canadian International Development Agency is the single largest donor of bed nets to Africa – nearly 6.4 million by the end of last year. In addition to government support, Canadian individuals and charities – notably the Red Cross – have embraced the issue by making donations and fundraising.

“Canadians … haven’t got the credit they deserve,” said Prudence Smith, head of advocacy for Roll Back Malaria, a partnership between key global-health agencies and donors such as the Bill and Melinda Gates Foundation.

Not all news is good. In Zimbabwe, dictator Robert Mugabe misused $7.3 million in malaria-fighting money from the Global Fund to Fight AIDS, Tuberculosis and Malaria. So far, he has not repaid the Global Fund. Politics continues to kill Africans, not an absence of DDT.

In India, where DDT use is untallied, manufacture massive, and use virtually uncontrolled, malaria is resurgent. According to The Telegraph in Calcutta, malaria is epidemic among people living in poorer sections of the city, often with fatal results.  ExpressIndia.com’s headline tells the story:  “Malaria puts city on the edge:  toll rises to 8.”

Public health officials in India will step up information and education campaigns, and urge residents “not to panic.”

See also:

In the Philippines, the government’s press agency promotes malaria prevention steps.

Science Daily reports progress in the long march for a malaria vaccine.

Public health officials warn the U.S. is completely unprepared for a malaria outbreak, according to The Orlando Sentinel, via the Houston Chronicle.

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