Fact sheet for World Malaria Report 2016

December 16, 2016

A woman shows the mosquito net that protects her and her family from malaria transmission, in India. India remains the world's top DDT user, but is switching to nets in an effort to bring malaria rates down and set up malaria eradication before the end of DDT in 2020. WHO image.

A woman shows the mosquito net that protects her and her family from malaria transmission, in India. India remains the world’s top DDT user, but is switching to nets in an effort to bring malaria rates down and set up malaria eradication before the end of DDT in 2020. WHO image.

World Health Organization publishes an annual World Malaria Report, with the year appended to the title. It summarizes the state of the fight against malaria worldwide, recording progress and setbacks.

In the tally of progress we get a clear indication of what is needed to continue or increase that progress, with the ultimate goal of controlling malaria to the point it poses no great economic risk, or health risk, to any nation, or better that human malaria is eradicated.

World Malaria Report 2016 is 184 pages, shorter than some previous reports but packed with figures and history, some of which requires greater background to understand completely.

For example, the 2016 publication notes that about 412,000 people died from malaria in 2016. This is a shocking figure. Most of the news coverage of the report mentions this death toll in the first paragraph.

It’s too many deaths. But it’s a more than 50% reduction in deaths from 1990s rates, and it’s a more than 90% reduction from the annual death tolls that shocked the world to concerted action after World War II. Most estimates are that about 5 million people a year died from malaria through the 1950s, and into the 1960s.

WHO concentrates on the malaria fight, and plays down the political aspects to encourage international cooperation to help fight the disease. But there are political statements made, if one has the background to understand them. There remains controversy over the use of DDT, with many people yelling far and wide that if ‘bans on DDT were removed’ then malaria would quickly become an eradicated disease. This position ignores the facts, that there were still 5 million people dying each year during peak DDT use; that death tolls plunged after the U.S. banned DDT use on crops; that the U.S. ban covered only crop use, and that DDT use against disease has never been banned anywhere in the world; and that DDT use continued long after the U.S. banned DDT, around the world. DDT use never stopped.

Taken together, we would understand that the 90% reduction in malaria deaths from peak DDT use years, was accomplished mostly without DDT, and that therefore DDT is not a panacea.

World Malaria Report 2016 also tallies the slow demise of DDT. Mosquito resistance to pesticides, especially DDT, is a major problem in the fight against the disease. But more DDT can’t fix that problem now that every mosquito on Earth carries alleles that make them resistant and wholly immune to the stuff. DDT will probably never be a panacea, even were its manufacture not scheduled to stop very soon.

History, and a complete assessment of the science and current conditions in the frontlines of the malaria fight, can help us put these things in perspective.

So far, only the Los Angeles Times in the U.S. provided any in-depth reporting on World Malaria Report 2016. We hope other media will take up the challenge to inform. They will find WHO’s Fact Sheet useful.

With that warning in mind, it’s good to look at the broad outlines of the report, which WHO has packaged into a fact sheet for our convenience.

Fact Sheet: World Malaria Report 2016

13 December 2016

The World Malaria Report, published annually by WHO, tracks progress and trends in malaria control and elimination across the globe. It is developed by WHO in collaboration with ministries of health and a broad range of partners. The 2016 report draws on data from 91 countries and areas with ongoing malaria transmission.

Global progress and disease burden (2010–2015)

According to the report, there were 212 million new cases of malaria worldwide in 2015 (range 148–304 million). The WHO African Region accounted for most global cases of malaria (90%), followed by the South-East Asia Region (7%) and the Eastern Mediterranean Region (2%).

In 2015, there were an estimated 429 000 malaria deaths (range 235 000–639 000) worldwide. Most of these deaths occurred in the African Region (92%), followed by the South-East Asia Region (6%) and the Eastern Mediterranean Region (2%).

Between 2010 and 2015, malaria incidence rates (new malaria cases) fell by 21% globally and in the African Region. During this same period, malaria mortality rates fell by an estimated 29% globally and by 31% in the African Region.

Between 2010 and 2015, malaria incidence rates (new malaria cases) fell by 21% globally and in the African Region. During this same period, malaria mortality rates fell by an estimated 29% globally and by 31% in the African Region.

Other regions have achieved impressive reductions in their malaria burden. Since 2010, the malaria mortality rate declined by 58% in the Western Pacific Region, by 46% in the South-East Asia Region, by 37% in the Region of the Americas and by 6% in the Eastern Mediterranean Region. In 2015, the European Region was malaria-free: all 53 countries in the region reported at least 1 year of zero locally-acquired cases of malaria.

Children under 5 are particularly susceptible to malaria illness, infection and death. In 2015, malaria killed an estimated 303 000 under-fives globally, including 292 000 in the African Region. Between 2010 and 2015, the malaria mortality rate among children under 5 fell by an estimated 35%. Nevertheless, malaria remains a major killer of under-fives, claiming the life of 1 child every 2 minutes.

Trends in the scale-up of malaria interventions

Vector control is the main way to prevent and reduce malaria transmission. Two forms of vector control are effective in a wide range of circumstances: insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS).

ITNs are the cornerstone of malaria prevention efforts, particularly in sub-Saharan Africa. Over the last 5 years, the use of treated nets in the region has increased significantly: in 2015, an estimated 53% of the population at risk slept under a treated net compared to 30% in 2010.

Indoor residual spraying of insecticides (IRS) is used by national malaria programmes in targeted areas. In 2015, 106 million people globally were protected by IRS, including 49 million people in Africa. The proportion of the population at risk of malaria protected by IRS declined from a peak of 5.7% globally in 2010 to 3.1% in 2015.

Diagnostics

WHO recommends diagnostic testing for all people with suspected malaria before treatment is administered. Rapid diagnostic testing (RDTs), introduced widely over the past decade, has made it easier to swiftly distinguish between malarial and non-malarial fevers, enabling timely and appropriate treatment.

New data presented in the report show that, in 2015, approximately half (51%) of children with a fever who sought care at a public health facility in 22 African countries received a malaria diagnostic test compared to 29% in 2010. Sales of RDTs reported by manufacturers rose from 88 million globally in 2010 to 320 million in 2013, but fell to 270 million in 2015.

Treatment

Artemisinin-based combination therapies (ACTs) are highly effective against P. falciparum, the most prevalent and lethal malaria parasite affecting humans. Globally, the number of ACT treatment courses procured from manufacturers increased from 187 million in 2010 to a peak of 393 million in 2013, but subsequently fell to 311 million in 2015.

Prevention in pregnancy

Malaria infection in pregnancy carries substantial risks for the mother, her fetus and the newborn child. In Africa, the proportion of women who receive intermittent preventive treatment in pregnancy (IPTp) for malaria has been increasing over time, but coverage levels remain below national targets.

IPTp is given to pregnant women at scheduled antenatal care visits after the first trimester. It can prevent maternal death, anaemia and low birth weight, a major cause of infant mortality. Between 2010 and 2015, there was a five-fold increase in the delivery of 3 or more doses of IPTp in 20 of the 36 countries that have adopted WHO’s IPTp policy – from 6% coverage in 2010 to 31% coverage in 2015.

Insecticide and drug resistance

In many countries, progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance. To date, parasite resistance to artemisinin – the core compound of the best available antimalarial medicines – has been detected in 5 countries of the Greater Mekong subregion.

Mosquito resistance to insecticides is another growing concern. Since 2010, 60 of the 73 countries that monitor insecticide resistance have reported mosquito resistance to at least 1 insecticide class used in nets and indoor spraying; of these, 50 reported resistance to 2 or more insecticide classes.

Progress towards global targets

To address remaining challenges, WHO has developed the Global Technical Strategy for Malaria 2016-2030 (GTS). The Strategy was adopted by the World Health Assembly in May 2015. It provides a technical framework for all endemic countries as they work towards malaria control and elimination.

This Strategy sets ambitious but attainable goals for 2030, with milestones along the way to track progress. The milestones for 2020 include:

  • Reducing malaria case incidence by at least 40%;
  • Reducing malaria mortality rates by at least 40%;
  • Eliminating malaria in at least 10 countries;
  • Preventing a resurgence of malaria in all countries that are malaria-free.

Progress towards the GTS country elimination milestone is on track: In 2015, 10 countries and areas reported fewer than 150 locally-acquired cases of malaria. A further 9 countries reported between 150 and 1000 cases.

However, progress towards other GTS targets must be accelerated. Less than half (40) of the 91 malaria-endemic countries are on track to meet the GTS milestone of a 40% reduction in malaria case incidence by 2020. Progress has been particularly slow in countries with a high malaria burden.

Forty-nine countries are on track to achieve the milestone of a 40% reduction in malaria mortality; this figure includes 10 countries that reported zero malaria deaths in 2015.

Funding trends

In 2015, malaria funding totalled US$ 2.9 billion, representing only 45% of the GTS funding milestone for 2020. Governments of malaria-endemic countries provided 32% of total funding. The United States of America and the United Kingdom are the largest international funders of malaria control and elimination programmes, contributing 35% and 16% of total funding, respectively. If the 2020 targets of the GTS are to be achieved, total funding must increase substantially.

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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.


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

August 29, 2015

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

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

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

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

As a journalist, this guy has a piece of a world-wide scoop.

India is probably the last nation on Earth producing DDT.  In the last decade other two nations making the stuff got out of the business — North Korea and China. For several years now India has been the largest manufacturer of DDT, and far and away the greatest user, spraying more DDT against malaria-carrying mosquitoes, sand flies, and agricultural and household pests than the rest of the world combined.

As if an omen, India’s malaria rates did not drop, but instead rose, even as malaria rates dropped or plunged in almost every other nation on Earth.

Under the 2001 Stockholm Convention on Persistent Organic Pollutants (POPs) signed by more than 150 nations (not including the U.S.), DDT was one of a dozen chemicals targeted to be phased out due to its extremely dangerous qualities, including long-term persistence in the environment and bioaccummulation, by which doses of the stuff increase up the food chain, delivering crippling and fatal doses to top predators.

A perfect substitute for DDT in fighting some disease-carrying insects (“vectors”) has never been developed. Health officials asked, and the Stockholm negotiators agreed to leave DDT legally available to fight disease. Annex B asked nations to tell the World Health Organization if it wanted to use DDT. Since 2001, as DDT effectiveness was increasingly compromised by resistance evolved in insects, fewer and fewer nations found it useful.

The site Mr. Nazakat linked to is up and down, and my security program occasionally says the site is untrustworthy. It’s obscure at best. Shouldn’t news of this type be in some of India’s biggest newspapers?

I found an article in the Deccan Herald, confirming the report, but again with some

India-United Nations pact to end DDT use by 2020

India-United Nations pact to end DDT use by 2020

New Delhi, August 26, 2015, DHNS:

It would be better to switch to another insecticide, says expert

India is the lone user of DDT, though only in the malaria control programme, while rest of the world got rid of the chemical that has a lasting adverse impact on the environment. DH file photo

India is the lone user of DDT, though only in the malaria control programme, while rest of the world got rid of the chemical that has a lasting adverse impact on the environment. DH file photo

India has launched a $53 million project to phase out DDT by 2020 and replace them with Neem-based bio-pesticides that are equally effective.

India is the lone user of DDT, though only in the malaria control programme, while rest of the world got rid of the chemical that has a lasting adverse impact on the environment.

India on Tuesday entered into a $53 million (Rs 350 crore) partnership with the United Nations Industrial Development Organisation (UNIDO), United Nations Environment Programme and the Global Environment Facility to replace DDT with safer, more effective and green alternatives.

“As per the plan, the National Botanical Research Organisation, Lucknow, tied up with a company to produce Neem-based alternatives for the malaria programme. The production will start in six months,” Shakti Dhua, the regional coordinator of UNIDO told Deccan Herald.

Till last year, the annual DDT requirement was about 6,000 tonnes that has now been cut down to 4,000 tonnes as the government decided to stop using it in the Kala-Azar control programme.

A recent study by an Indo-British team of medical researchers found that using DDT without any surveillance is counter-productive as a vector control strategy as sand flies not only thrive but are also becoming resistant to DDT.

“It would be better to switch to another insecticide, which is more likely to give better results than DDT,” said Janet Hemingway, a scientist at the Liverpool School of Tropical Medicine. While the Health Ministry wanted to bring in synthetic pyrethroids, the United Nation agencies supports the bio-pesticides because of their efficacy and long-lasting effects.

“The new initiative would help check the spread of malaria and other vector-borne diseases. These include botanical pesticides, including Neem-based compounds, and long-lasting insecticidal safety nets that will prevent mosquito bites while sleeping,” Dhua said.

Ending the production and use of DDT is a priority for India as it is a signatory to the Stockholm Convention on Persistent Organic Pollutants (POP) of 2002 that seeks to eliminate the use of these chemicals in industrial processes, drugs and pesticides. DDT is one of the POPs.

The clock is counting down the last years of DDT.  Good.

If events unroll as planned, DDT making will end by 2020, 81 years after it was discovered to kill bugs, 70 years after it was released for civilian years, 70 years after problems with its use was first reported by the U.S. Fish and Wildlife Service, 58 years after the publication of Rachel Carson’s Silent Spring, 50 years after European nations banned some uses, 48 years after the famous U.S. ban on agricultural use, 19 years after the POPs Treaty.

When will the news leak out?

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Highlights from the World Health Assembly #68, in graphic form

May 26, 2015

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.’

Graphic from the World Health Organization on major actions of the World Health Assembly 68, in Geneva, Switzerland, May 18-26, 2015

Graphic from the World Health Organization on major actions of the World Health Assembly 68, in Geneva, Switzerland, May 18-26, 2015

 

 


WHO’s malaria fact sheet, April 2015 edition

May 17, 2015

Progress against the diseases we know as malaria — parasitic infections — is dramatic and rapid since several non-governmental organizations (NGOs) entered the fight seriously at the turn of the last century. But problems arise and also rapidly become serious.

Bednets prove the best single method of preventing the spread of malaria. Distribution of bednets in malaria-prone regions greatly aided the 47% reduction in malaria deaths since 1999.  WHO photo.

Bednets prove the best single method of preventing the spread of malaria. Distribution of bednets in malaria-prone regions greatly aided the 47% reduction in malaria deaths since 1999. WHO photo.

For political reasons often obscure, there is an industry in creating misinformation and propaganda against malaria-fighting groups like the World Health Organization, the Bill and Melinda Gates Foundation, and other groups who advocate bednet preventive measures. The propagandists often make absurd and false claims against medical workers, against scientists and activists including people they pejoratively call environmentalists, and in favor of the deadly poison DDT.

Factual matter takes longer to spread — truth has a smaller public relations budget.

What are the facts about malaria?

Here is WHO’s fact sheet on malaria, current as of the first of this month 2015.

WHO’s fact sheet is almost dull in its recitation of the facts.  What you don’t see recorded here is that the death toll of over 500,000 last year, is the lowest death toll from malaria since World War II, the lowest death toll estimated in the past 120 years, and perhaps the lowest death toll in recorded human history.  Similarly, while nearly 200 million malaria infections seems an enormous number, that number records a dramatic reduction from the 500 million estimated in the 1960s.

Malaria is not Rachel Carson’s fault. DDT is not a magic cure for the disease. It’s beatable, but beating a disease requires constant vigilance, militant prevention and treatment — and that costs money. The propagandists won’t tell you those facts, and malaria wins when bad information chases out the good.

For the record:

Malaria

Fact sheet N°94
Reviewed April 2015


Key facts

  • Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes.
  • In 2013, malaria caused an estimated 584 000 deaths (with an uncertainty range of 367 000 to 755 000), mostly among African children.
  • Malaria is preventable and curable.
  • Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places.
  • Non-immune travellers from malaria-free areas are very vulnerable to the disease when they get infected.

According to the latest estimates, released in December 2014, there were about 198 million cases of malaria in 2013 (with an uncertainty range of 124 million to 283 million) and an estimated 584 000 deaths (with an uncertainty range of 367 000 to 755 000). Malaria mortality rates have fallen by 47% globally since 2000, and by 54% in the WHO African Region.

Most deaths occur among children living in Africa where a child dies every minute from malaria. Malaria mortality rates among children in Africa have been reduced by an estimated 58% since 2000.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected Anopheles mosquitoes, called “malaria vectors”, which bite mainly between dusk and dawn.

There are four parasite species that cause malaria in humans:

  • Plasmodium falciparum
  • Plasmodium vivax
  • Plasmodium malariae
  • Plasmodium ovale.

Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.

In recent years, some human cases of malaria have also occurred with Plasmodium knowlesi – a species that causes malaria among monkeys and occurs in certain forested areas of South-East Asia.

Transmission

Malaria is transmitted exclusively through the bites of Anopheles mosquitoes. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

About 20 different Anopheles species are locally important around the world. All of the important vector species bite at night. Anopheles mosquitoes breed in water and each species has its own breeding preference; for example some prefer shallow collections of fresh water, such as puddles, rice fields, and hoof prints. Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. For example, the long lifespan and strong human-biting habit of the African vector species is the main reason why about 90% of the world’s malaria deaths are in Africa.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Symptoms

Malaria is an acute febrile illness. In a non-immune individual, symptoms appear seven days or more (usually 10–15 days) after the infective mosquito bite. The first symptoms – fever, headache, chills and vomiting – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness often leading to death. Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria endemic areas, persons may develop partial immunity, allowing asymptomatic infections to occur.

For both P. vivax and P. ovale, clinical relapses may occur weeks to months after the first infection, even if the patient has left the malarious area. These new episodes arise from dormant liver forms known as hypnozoites (absent in P. falciparum and P. malariae); special treatment – targeted at these liver stages – is required for a complete cure.

Who is at risk?

Approximately half of the world’s population is at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected. In 2014, 97 countries and territories had ongoing malaria transmission.

Specific population risk groups include:

  • young children in stable transmission areas who have not yet developed protective immunity against the most severe forms of the disease;
  • non-immune pregnant women as malaria causes high rates of miscarriage and can lead to maternal death;
  • semi-immune pregnant women in areas of high transmission. Malaria can result in miscarriage and low birth weight, especially during first and second pregnancies;
  • semi-immune HIV-infected pregnant women in stable transmission areas, during all pregnancies. Women with malaria infection of the placenta also have a higher risk of passing HIV infection to their newborns;
  • people with HIV/AIDS;
  • international travellers from non-endemic areas because they lack immunity;
  • immigrants from endemic areas and their children living in non-endemic areas and returning to their home countries to visit friends and relatives are similarly at risk because of waning or absent immunity.

Diagnosis and treatment

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission.

The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).

WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 15 minutes or less. Treatment solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the “Guidelines for the treatment of malaria” (second edition). An updated edition will be published in 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1970s and 1980s, undermining malaria control efforts and reversing gains in child survival.

In recent years, parasite resistance to artemisinins has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Laos, Myanmar, Thailand and Viet Nam. While there are likely many factors that contribute to the emergence and spread of resistance, the use of oral artemisinins alone, as monotherapy, is thought to be an important driver. When treated with an oral artemisinin-based monotherapy, patients may discontinue treatment prematurely following the rapid disappearance of malaria symptoms. This results in incomplete treatment, and such patients still have persistent parasites in their blood. Without a second drug given as part of a combination (as is provided with an ACT), these resistant parasites survive and can be passed on to a mosquito and then another person.

If resistance to artemisinins develops and spreads to other large geographical areas, the public health consequences could be dire.

WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.

More comprehensive recommendations are available in the “WHO Global Plan for Artemisinin Resistance Containment (GPARC)”, which was released in 2011. For countries in the Greater Mekong subregion, WHO has issued a regional framework for action titled “Emergency response to artemisinin resistance in the Greater Mekong subregion” in 2013.

Prevention

Vector control is the main way to reduce malaria transmission at the community level. It is the only intervention that can reduce malaria transmission from very high levels to close to zero.

For individuals, personal protection against mosquito bites represents the first line of defence for malaria prevention.

Two forms of vector control are effective in a wide range of circumstances.

Insecticide-treated mosquito nets (ITNs)

Long-lasting insecticidal nets (LLINs) are the preferred form of ITNs for public health distribution programmes. WHO recommends coverage for all at-risk persons; and in most settings. The most cost effective way to achieve this is through provision of free LLINs, so that everyone sleeps under a LLIN every night.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly reduce malaria transmission. Its full potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3–6 months, depending on the insecticide used and the type of surface on which it is sprayed. DDT can be effective for 9–12 months in some cases. Longer-lasting forms of existing IRS insecticides, as well as new classes of insecticides for use in IRS programmes, are under development.

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. In addition, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine for pregnant women living in high transmission areas, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine is recommended delivered alongside routine vaccinations. In 2012, WHO recommended Seasonal Malaria Chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-Region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Much of the success to date in controlling malaria is due to vector control. Vector control is highly dependent on the use of pyrethroids, which are the only class of insecticides currently recommended for ITNs or LLINs. In recent years, mosquito resistance to pyrethroids has emerged in many countries. In some areas, resistance to all 4 classes of insecticides used for public health has been detected. Fortunately, this resistance has only rarely been associated with decreased efficacy, and LLINs and IRS remain highly effective tools in almost all settings.

However, countries in sub-Saharan Africa and India are of significant concern. These countries are characterized by high levels of malaria transmission and widespread reports of insecticide resistance. The development of new, alternative insecticides is a high priority and several promising products are in the pipeline. Development of new insecticides for use on bed nets is a particular priority.

Detection of insecticide resistance should be an essential component of all national malaria control efforts to ensure that the most effective vector control methods are being used. The choice of insecticide for IRS should always be informed by recent, local data on the susceptibility target vectors.

In order to ensure a timely and coordinated global response to the threat of insecticide resistance, WHO has worked with a wide range of stakeholders to develop the “Global Plan for Insecticide Resistance Management in malaria vectors” (GPIRM), which was released in May 2012. The GPIRM puts forward a five-pillar strategy calling on the global malaria community to:

  • plan and implement insecticide resistance management strategies in malaria-endemic countries;
  • ensure proper and timely entomological and resistance monitoring, and effective data management;
  • develop new and innovative vector control tools;
  • fill gaps in knowledge on mechanisms of insecticide resistance and the impact of current insecticide resistance management approaches; and
  • ensure that enabling mechanisms (advocacy as well as human and financial resources) are in place.

Surveillance

Tracking progress is a major challenge in malaria control. In 2012, malaria surveillance systems detected only around 14% of the estimated global number of cases. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

Elimination

Malaria elimination is defined as interrupting local mosquito-borne malaria transmission in a defined geographical area, i.e. zero incidence of locally contracted cases. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by a specific agent; i.e. applies to a particular malaria parasite species.

On the basis of reported cases for 2013, 55 countries are on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly targets for 2015. Large-scale use of WHO-recommended strategies, currently available tools, strong national commitments, and coordinated efforts with partners, will enable more countries – particularly those where malaria transmission is low and unstable – to reduce their disease burden and progress towards elimination.

In recent years, 4 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), and Armenia (2011).

Vaccines against malaria

There are currently no licensed vaccines against malaria or any other human parasite. One research vaccine against P. falciparum, known as RTS, S/AS01, is most advanced. This vaccine has been evaluated in a large clinical trial in 7 countries in Africa and has been submitted to the European Medicines Agency under art. 58 for regulatory review. A WHO recommendation for use will depend on the final results from the large clinical trial and a positive regulatory review. The recommendation as to whether or not this vaccine should be added to existing malaria control tools is expected in late 2015.

WHO response

The WHO Global Malaria Programme (GMP) is responsible for charting the course for malaria control and elimination through:

  • setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
  • keeping independent score of global progress;
  • developing approaches for capacity building, systems strengthening, and surveillance;
  • identifying threats to malaria control and elimination as well as new areas for action.

GMP serves as the secretariat for the Malaria Policy Advisory Committee (MPAC), a group of 15 global malaria experts appointed following an open nomination process. The MPAC, which meets twice yearly, provides independent advice to WHO to develop policy recommendations for the control and elimination of malaria. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy setting process.

WHO is also a co-founder and host of the Roll Back Malaria partnership, which is the global framework to implement coordinated action against malaria. The partnership mobilizes for action and resources and forges consensus among partners. It is comprised of over 500 partners, including malaria endemic countries, development partners, the private sector, nongovernmental and community-based organizations, foundations, and research and academic institutions.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

WHO provides a short video summary of many of these facts.


November is National Malaria Awareness Month in Philippines

November 9, 2014

Education is still a key tool in the fight against malaria.  In that spirit, the President of the Philippines declares November as National Malaria Awareness Month.

Philippines President Gloria Macapagal-Arroyo

Philippines President Gloria Macapagal-Arroyo – Wikipedia image

Hope it works.

Proclamation from the President of the Philippines:

MALACAÑANPALACE

MANILA

BY THE PRESIDENT OF THE PHILIPPINES

PROCLAMATION NO. 1168

DECLARING THE MONTH OF NOVEMBER OF EVERY YEAR AS MALARIA AWARENESS MONTH

WHEREAS, Malaria is the 8th leading cause of morbidity in the Philippines, affecting most Filipinos of productive age group, and vulnerable groups which includes pregnant women, children and indigenous population groups, and continue to be a major impediment to human and economic development in area where it persists;

WHEREAS, Malaria remains endemic in 65 of the 79 provinces affecting 12.5 million Filipinos, with pockets of high endemicity along municipal/provincial borders, in far flung remote areas and barangays populated by indigenous cultural groups and areas with socio-political conflicts;

WHEREAS, Malaria, with morbidity rate of 55 per 100,000 population and mortality rate of 0.17 per 100,000 population, has to be reduced and controlled by effective malaria prevention and treatment measures, such as increase in the use of insecticide-treated mosquito nets and early diagnosis and prompt treatment in malaria risk areas;

WHEREAS, Goal six of Millennium Development Goals aims to combat HIV/AIDS, malaria and other diseases, with the target of halting and reversing the incidence of malaria and other diseases by 2015;

WHEREAS, the WHO/UNICEF Regional Child Survival Strategy focuses on the implementation of an Essential Package for Child Survival, one of which is the use of insecticide-treated mosquito nets of children 0-59 months in malarious areas;

WHEREAS, Malaria is one of the 5 diseases to be targeted under the disease-free zones initiative of service delivery component of “FOURmula One for Health”, an implementation strategy for health reforms;

WHEREAS, recent advances in the field of diagnosis, treatment and vector control makes the disease preventable and curable despite increasing trends of drug and insecticide resistance;

WHEREAS, the main strategies to reduce morbidity and mortality against malaria are through early diagnosis and prompt treatment, vector control through the use of insecticide treated mosquito nets supplemented by indoor residual spraying of insecticides, and early detection and management of epidemics;

WHEREAS, Republic Act No. 7160, otherwise known. as the Local Government Code, devolves the provision of basic health services to prevent and control malaria to the local government units. Enhancement on the program management capacity of the LGUs will be one of the major thrusts of the Department of Health and its partners;

WHEREAS, to facilitate program management and inculcate better health-seeking behaviors among the general population especially the high risk population on prevention and control of malaria, the National Malaria Control Program in consultation with the Regional Coordinators, Provincial Health Offices, LGUs, and other stakeholders, recommends that the month of November of every year be declared for the creation of awareness on the prevention and control of malaria.

NOW, THEREFORE, I, GLORIA MACAPAGAL-ARROYO, President of the Republic of the Philippines, by virtue of the powers vested in me by law, do hereby order:

SECTION 1.            Lead agency. — The Department of Health (DOH) shall lead in the implementation of the Malaria Awareness Month every November of the year starting 2006. As such, it shall call upon all government agencies/organizations for assistance in the implementation of this Proclamation, including but not limited to the following:

a.              Department of the Interior and Local Government

b.              Department of Education

c.              Department of National Defense

d.              National Disaster and Coordinating Council

e.              Department of Tourism

f.               Local Government Units/Organizations

1.              Liga ng mga Barangay

2.              League of Municipalities

3.              League of Provinces

g.              Philippine Information Agency

h.              National Commission on Indigenous Peoples

As the lead agency, the Department of Health shall formulate and disseminate guidelines and procedures on the implementation of the campaign, provide technical assistance to LGUs and/or implementing units or organizations, conduct national/regional advocacy and social mobilization in endemic provinces, augment local logistics for malaria prevention and control, and monitor LGU activities in all phases of the campaign. The DOH will also coordinate activities with major donor funded programs such as Global Fund to Fight AIDS, Tuberculosis and Malaria — Malaria Component and Australian Agency for International Development — WHO-RBM [Roll Back Malaria] projects.

SECTION 2.            Responsibilities of the. Department of the Interior and Local Government (DILG). — The DILG, through its Secretary, shall issue and disseminate appropriate memorandum, circulars to all local chief executives, mobilize field offices, and assist in the supervision and monitoring of malaria awareness campaign and other prevention and control activities.

SECTION 3.            Responsibilities of the Department of Education (DepEd). — The DepEd, through its Secretary, shall incorporate or integrate malaria prevention and control into the school curriculum, provide a venue in schools for treatment or re-treatment of mosquito nets through school children (each pupil will bring their mosquito net for re-treatment) in coordination with local health officials. The DepEd shall issue and disseminate appropriate circulars for the purpose.

SECTION 4.            Responsibilities of the Department of National Defense (DND). — The DND, through its Secretary, shall issue and disseminate appropriate memorandum circulars to its regional and provincial units to conduct activities in raising the awareness on malaria prevention and control among their personnel and staff especially in endemic areas. The Armed Forces of the Philippines, through the Surgeon General, must ensure that military personnel assigned to endemic areas should undergo the pre- and post- malaria smear test. Provide assistance in terms of transportation and security support to local health personnel in the implementation of the campaign. Strengthen management of severe malaria to prevent deaths in its hospitals in partnership with DOH.

SECTION 5.            Responsibilities of the National Disaster Coordinating Council (NDCC). — The NDCC, through the Office of Civil Defense (OCD), shall coordinate the implementation of the malaria awareness month activities with the LGUs through the Barangay/Municipal/City Disaster Coordinating Councils, Regional Disaster Coordinating Councils, and Provincial Disaster Coordinating Councils.

SECTION 6.            Responsibilities of the Philippine Information Agency (PIA). — The PIA, through its Director-General, shall guide, integrate and supervise the public communication activities including advertisements of the malaria awareness communication campaign.

SECTION 7.            Responsibilities of the Local Government Units (LGUs). — The LGUs shall lead the local implementation of the malaria awareness campaign and allocate appropriate resources for the purpose. Ensure that basic quality health, services on the diagnosis, treatment, vector control (distribution of treated mosquito nets, re-treatment, indoor residual spraying) are sustained until 2015. Further, the LGUs shall coordinate with partner NGOs and/or private sectors in the conduct of the campaign and establish a network of all partners at the local level. The concerned LGUs shall issue appropriate local ordinances, resolutions, memorandum circulars and other relevant orders.

SECTION 8.            Responsibilities of the League of Provinces/Municipalities/Barangays. — Through their presidents, shall issue circulars, memoranda and other issuances to their members on the local implementation of malaria awareness activities.

SECTION 9.            Responsibilities of the National Commission on Indigenous Peoples (NCIP). — The NCIP, through their Chairperson, shall issue memorandum circulars to the field offices to participate actively in the conduct of malaria awareness campaign among tribal minorities/indigenous communities in coordination with local health officials. The NCIP shall likewise support and help in coordinating field activities and help in the translation of IEC materials.

SECTION 10.         Responsibilities of the Department of Tourism (DOT). — The DOT, through its Secretary, shall issue and disseminate appropriate memorandum circulars to its regional field offices to conduct activities, in coordination with the Provincial Health Offices, in raising the awareness of tourists on malaria prevention especially in endemic areas.

SECTION 11.         Participation of the Civil Societies. — All non-government organizations, members of the civil societies, professional groups, business sectors and other concerned groups are encouraged to contribute to the success of the malaria awareness campaign through information dissemination, social mobilization, providing donations and other appropriate means.

SECTION 12.         Bilateral and multilateral agencies. — All donor partners will be encouraged to support malaria control program in line with the goals of Millennium Development Goal No. 6: Combat HIV/AIDS, malaria and other diseases at all levels. Integrated programs shall be encouraged.

IN WITNESS WHEREOF, I have hereunto set my hand and caused the seal of the Republic of the Philippines to be affixed.

DONE in the City of Manila, this 10th day of November, in the year of Our Lord, Two Thousand and Six.

(Sgd.) GLORIA MACAPAGAL-ARROYO


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.


Resources for World Malaria Day 2013

April 25, 2013

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

More:

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

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


April 25 is World Malaria Day — right, Bill?

April 24, 2013

He’s absolutely right.

English: World Malaria Day Button (english)

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

What are you doing to fight malaria today?

More:


Rachel Carson/DDT hoaxing from the Ayn Rand Institute

April 21, 2013

Welcome, refugees and truth-seekers from WUWT:  If this site seems a little unusual to you, you should know that at Millard Fillmore’s Bathtub we try to stick to science, and we don’t censor opposing opinions.  Genuinely interested in the DDT/Malaria issue?  See this collection.

______________

A couple of physicists get together in a podcast from the Ayn Rand Institute, Poke in Your Eye to Eye, and demonstrate that they don’t know biology well, they know less about history, but they don’t hesitate to tell whoppers about Rachel Carson and the value of DDT“Silent Spring 50 Years Later [a special Earth Day podcast].

English: An image of the main entrance of Rach...

A better indication of the legacy of Rachel Carson: Schools across America named after the woman, to inspire children to explore science, and to read and write. Here, the main entrance of Rachel Carson Middle School in Herndon, Virginia. (Photo: Wikipedia)

Earth Day must be coming up.  The usual suspects trot out their usual disinformation and hoax campaigns — and it will continue through Earth Day on April 22, International Malaria Day on April 25, through Rachel Carson’s birthday, and probably all summer.

Mencken warned us that hoaxes, once out of the bottle, can’t be put back.  Twain (and others) remind us that whopping falsehoods travel around the world “while truth is getting its boots on.”  Amanda Maxham, who is listed as an astrophysicist at the Rand site, interviewed physicist Keith Lockitch — and they repeat almost all the hoary old false fables invented by Gordon Edwards and Steven Milloy about malaria, DDT, and Rachel Carson.

A few of the errors committed by the polemicists at the Ayn Rand Institute:

  • ‘DDT doesn’t breed mosquitoes more resistant to the stuff, but instead weakens the population through reducing diversity.’  Absolutely wrong.  Turns out the new alleles mosquitoes pick up that makes them resistant and immune to DDT, are ALSO the alleles that make mosquitoes resistant to the whole class of chemicals, and thereby foul up efforts to develop new pesticides.

    Tanzania - Removing DDT

    Cleaning up DDT in Africa: 40 tons of 50 year old DDT were found in Menzel Bourguiba Hospital, Tanzania – FAO photo

  • ‘Rachel Carson didn’t account for the value of DDT in eradicating malaria.’  They start out claiming DDT ended malaria in the U.S. (it didn’t; CDC had won the fight will just mop up operations left, by 1939; DDT wasn’t even available for another seven years), and run through the false claim that DDT alone had almost eradicated malaria from Sri Lanka, but listening to Rachel Carson, the nation stopped spraying and malaria roared back (the nation stopped ALL of its malaria fighting efforts due to costs and civil war; when the fight was taken up again, DDT was not useful; largely without DDT, Sri Lanka has once again nearly wiped out malaria).
  • ‘Because of a lack of DDT use, malaria continues to ravage the world killing a million people a year.’  Actually, malaria is at the lowest level in human history, killing less than a million a year, with great progress being made against the disease using the methods Rachel Carson urged in 1962.  Had we listened to Carson earlier, we could have saved a few million more lives, and perhaps have eradicated malaria already.  Also, it’s important to remember that DDT was never banned in Africa nor Asia; the ban on use of DDT on cotton crops in the U.S. did not cause any increase in malaria anywhere; since the ban on DDT use in the U.S. malaria has constantly declined in incidence and deaths.
  • ‘DDT is very effective because it’s ALSO repellent to mosquitoes, after it ceases to kill them.’  So in the end, they urge the use of a poisonous-to-wildlife, mildly carcinogenic substance, because it repels mosquitoes?  Bednets are more effective, cheaper, not-poisonous to wildlife, and they aren’t even suspected of causing cancer.

Rachel Carson’s life is a model for budding scientists, aspiring journalists, and teachers of ethics.  That so many people spend so much time making up false claims against her, in favor of a deadly toxin, and against science, tells us much more about the subrosa intentions of the claim fakers than about Rachel Carson.

Want the facts about Rachel Carson?  Try William Souder’s marvelous biography from last year, On a Farther Shore.  Want facts on DDT?  Try EPA’s official DDT history online (or look at some of the posts here at Millard Fillmore’s Bathtub). Want the facts about malaria?  Check with the world’s longest running, most ambitious malaria fighting campaign operated by the good people at the World Health Organization, Roll Back Malaria,  or see Sonia Shah’s underappreciated history, The FeverHow malaria has ruled mankind for 500,000 years.

More:

Roll Back Malaria, World Malaria Day logo for 2013

Roll Back Malaria, World Malaria Day logo for 2013

Wall of Shame (hoax spreaders to watch out for this week):


Laissez Faire Today, lazy and unfair as yesterday on issues of DDT

September 25, 2012

In June [2012] I drew encouragement that Henry I. Miller, the musty old anti-science physician at the Hoover Institution, had not renewed his annual plea to bring back DDT.  Miller is just one of the most predictable trolls of science and history; most years he waits until there are a number of West Nile virus victims, and then he claims we could have prevented it had we just jailed Rachel Carson and poisoned the hell out of America, Africa, Asia and the Moon with DDT.  For years I’ve reminded him in various fora that DDT is particularly inappropriate for West Nile . . .

Rachel Carson Homestead Springdale, PA

Rachel Carson Homestead Springdale, Pennsylvania (Photo credit: Wikipedia)

Since June, Miller popped up and popped off in Forbes, but using the event of the 50th anniversary of Rachel Carson’s brilliant book Silent Spring.  Brilliance and science and history aside, Miller still believes that protecting wildlife and humans from DDT’s manifold harms is a threat to free enterprise — how can anyone be expected to make a profit if they can’t poison their customers?

Miller is not the only throwback to the time before the Age of Reason, though.  It’s time to put the rebuttals on the record, again.

Comes this morning Jeffrey Tucker of Laissez Faire Today, complaining that the resurgence of bedbugs in America is an assault on democracy, apple pie, free enterprise, and Rachel Carson should be exhumed and tortured for her personal banning of DDT worldwide.  You can read his screed.  He’s full of unrighteous and unholy indignation at imagined faults of Carson and imagined benignity of pesticides.

I responded (links added here):

I’m shocked by your mischaracterizations of Rachel Carson, her great book Silent Spring (which it appears to me you didn’t read and don’t know at all), and pesticide regulation. Consequently, you err in history and science, and conclusion. Let me detail the hub of your errors.

You wrote:

Carson decried the idea that man should rule nature. “Only within the moment of time represented by the present century has one species — man — acquired significant power to alter the nature of the world.” This anthropocentrism she decried.

Carson was concerned that we were changing things that would have greater effects later, and that those effects would hurt humans. Her concern was entirely anthropocentric: What makes life worth living? Should we use chemicals that kill our children, cripple us, and create havoc in the things we enjoy in the outdoors, especially if we don’t know the ultimate effects?

Exactly contrary to your claim, her book was directed at the quality and quantity of human lives. She wanted long, good lives, for more people. How could you miss that, if you read any of her writings?

She suggested that killing a bedbug is no different from killing your neighbor: “Until we have the courage to recognize cruelty for what it is — whether its victim is human or animal — we cannot expect things to be much better in this world… We cannot have peace among men whose hearts delight in killing any living creature.”

Carson never wrote that there should be difficulty in killing bedbugs. The passage you quote, but conspiratorially do not cite, comes not from Silent Spring, but from a commentary on a compilation of hunting stories.* She’s referring to killing for the sake of killing, in that passage. I think it’s rather dishonest to claim she equates fighting biting bedbugs with killing animals unsportingly. I worry that you find it necessary to so grossly and dishonestly overstate your case. Is your case so weak?

In fact, she spoke of animals in patently untrue ways: “These creatures are innocent of any harm to man. Indeed, by their very existence they and their fellows make his life more pleasant.”

She did not write that about bedbugs. That’s a false claim.**

I guess she never heard of the Black Death.

I guess you never heard of accuracy. On page 266 of Silent Spring Carson directly addressed plague in a list of insect- and arthropod-borne diseases; Carson wrote:

“The list of diseases and their insect carriers, or vectors, includes typhus and body lice, plague and rat fleas, African sleeping sickness and tsetse flies, various fevers and ticks, and innumerable others.

“These are important problems and must be met. No responsible person contends that insect-borne disease should be ignored. The question that has now urgently presented itself is whether it is either wise or responsible to attack the problem by methods that are making it worse.” (Silent Spring, page 266)

Carson describes abuse of pesticides — such as DDT on bedbugs — that actually makes the insects stronger and tougher to get rid of. That appears to be your stand, now, to do whatever Carson said not to do, in order to poke a thumb in her eye, even if it means making bedbugs worse.

[Tucker continued:] In short, she [Rachel Carson] seemed to suggest that bedbugs — among all the millions of other killer insects in the world — enjoy some kind of right to life. It was a theory that could be embraced only in a world without malaria and bedbugs. But embraced it was.

That’s total fiction. What you write is completely divorced from fact.

By 1972, DDT was banned. And not only DDT. The whole enterprise of coming up with better and better ways to further human life and protect its flourishing was hobbled.

By 1960, DDT had ceased to work against bedbugs — this was one of the things that worried Carson*** and would worry any responsible person [see Bug Girl’s blog]. In her book, Carson warned that indiscriminate use and abuse of DDT would render it useless to fight disease and other insects and pests. By 1965, super mosquito-fighter Fred Soper and the World Health Organization had to stop their campaign to eradicate malaria when they discovered that abuse of DDT in agriculture and other uses had bred malaria-carrying mosquitoes in central and Subsaharan Africa that were resistant and immune to DDT. Keep in mind that the U.S. ban on DDT applied only in the U.S., and only one other nation in the world had a similar ban. DDT has never been banned in Africa, nor Asia.

Carson sounded the warning in 1962. By 1972, when the U.S. banned use of DDT on agricultural crops (and only on crops), it was too late to preserve DDT as a key tool to wipe out malaria.

Was the pesticide industry “hobbled?” Not at all. EPA’s order on DDT explicitly left manufacturing in the U.S. available for export — keeping profits with the pesticide companies, and multiplying the stocks of DDT available to fight disease anywhere in the world that anyone wanted to use it.

The fact is that DDT was a fortunate find, a bit of a miracle substance, and we overused it, thereby cutting short by decades its career as a human life-saver. That was exactly what Carson feared, that human lives would be lost and made miserable, unnecessarily and prematurely, by unthinking use of chemical substances. Pesticide manufacturers have been unable to come up with a second DDT, but not because regulation prevents it. Carson understood that.

There is no shortage of science-ignorant, and science-abusive websites that claim Rachel Carson erred. But 50 years out, the judgment of the President’s Science Advisory Council on her book remains valid: It’s accurate, and correct, and we need to pay attention to what she wrote. Not a jot nor tittle of what Carson wrote in 1962 has proven to be in error. Quite the contrary, as Discover Magazine noted in 2007, thousands of peer-reviewed studies reinforce the science she cited then.

Malaria deaths today are at the lowest level in human history, largely without DDT, and much due to malaria fighters having adopted the methods of fighting the disease that Carson advocated in 1962. Unfortunately, those methods were not adopted for nearly 40 years. Still, the reductions in malaria are remarkable. At peak DDT use in 1959 and 1960, a half-billion people in the world got malaria every year, one-sixth of the world’s people. 4 million died from the disease. In 2009, about 250 million people got malaria — a reduction of 50% in infections — and fewer than 800,000 people died — a dramatic reduction of more than 75% in death toll. This is all the more remarkable when we realize that world population more than doubled in the interim, and at least a billion more people now live in malaria-endemic areas. Much or most of that progress has been without DDT, of necessity — every mosquito on Earth today now carries the alleles of resistance and immunity to DDT.

You impugn a great scientist and wonderful writer on false grounds, and to damaging effect. I hope you’re not so careless in other research.

Rachel Carson was right. The re-emergence of bedbugs, 50 years after she wrote, is not due to anything Carson said, but is instead due to people who petulantly refused to listen to her careful and hard citations to science, and exhortations to stick to what we know to be true to protect human health and the quality of life.

_____________

* Rachel Carson: Legacy and Challenge, by Lisa H. Sideris, Kathleen Dean Moore, citing another of Carson’s writings, a critique of a collection of Aldo Leopold’s essays on hunting, Round River.

**  Here is the full quote, from pages 99-100 of Silent Spring, highlights added here:

Incidents like the eastern Illinois spraying raise a question that is not only scientific but moral. The question is whether any civilization can wage relentless war on life without destroying itself, and without losing the right to be called civilized. These insecticides are not selective poisons; they do not single out the one species of which we desire to be rid. Each of them is used for the simple reason that it is a deadly poison. It therefore poisons all life with which it comes in contact: the cat beloved of some family, the farmer’s cattle, the rabbit in the field, and the horned lark out of the sky. These creatures are innocent of any harm to man. Indeed, by their very existence they and their fellows make his life more pleasant. Yet he rewards them with a death that is not only sudden but horrible. Scientific observers at Sheldon described the symptoms of a meadowlark found near death: ‘Although it lacked muscular coordination and could not fly or stand, it continued to beat its wings and clutch with its toes while lying on its side. Its beak was held open and breathing was labored.’ Even more pitiful was the mute testimony of the dead ground squirrels, which ‘exhibited a characteristic attitude in death. The back was bowed, and the forelegs with the toes of the feet tightly clenched were drawn close to the thorax…The head and neck were outstretched and the mouth often contained dirt, suggesting that the dying animal had been biting at the ground.’

***  See page 273 of Silent Spring.

More:


NIH notes progress against malaria on World Malaria Day 2012

April 28, 2012

Press release from the National Institutes of Health, for World Malaria Day (April 25, 2012):

For Immediate Release
Tuesday, April 24, 2012

NIH statement on World Malaria Day – April 25, 2012

B. F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D.
National Institute of Allergy and Infectious Diseases

On World Malaria Day, we stand at a critical juncture in our efforts to control a global scourge. This year’s theme “Sustain Gains, Save Lives: Invest in Malaria” stresses the crucial role of continued investment of resources to maintain hard-won gains. Lives have indeed been saved. According to World Health Organization (WHO) estimates, annual deaths from malaria decreased from roughly 985,000 in 2000 to approximately 655,000 in 2010. Improvements were noted in all regions that WHO monitors, and, since 2007, four formerly malaria-endemic countries — the United Arab Emirates, Morocco, Turkmenistan and Armenia — have been declared malaria-free. However, about half of the world’s population is at risk of contracting malaria, and the disease continues to exact an unacceptably high toll, especially among very young children and pregnant women.

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), is committed to maintaining the research momentum needed to eradicate this mosquito-borne parasitic disease. Our investments include programs designed to strengthen research capacity in those countries most affected by malaria. For example, through the 2010 International Centers of Excellence for Malaria Research initiative, NIAID has established 10 research centers in malaria-endemic regions around the world. NIAID also provides access for U.S. and international scientists to multiple research resources as well as training for new investigators. Additionally, NIAID supports the Global Malaria Action Plan (GMAP), an international framework for coordinated action designed to control, eliminate and eradicate malaria.

NIAID’s research portfolio includes an array of projects aimed at better understanding the disease process and finding new and improved ways to diagnose and treat people with malaria, control the mosquitoes that spread it, and prevent malaria altogether through vaccination.

Earlier this month, an international team including NIAID-funded investigators reported that resistance to artemisinin — a frontline malaria drug — has spread from Cambodia to the border of Thailand and Burma, underscoring the importance of continued efforts to detect artemisinin resistance and slow its spread. Other grantees have identified a major region of the malaria parasite genome associated with artemisinin resistance, raising the possibility that scientists will have a new way to monitor the spread of drug resistance in the field.

The spread of artemisinin-resistant malaria highlights the need for new and improved malaria drugs. Two recently completed drug screening projects offer some hope. In one project, NIH scientists screened nearly 3,000 chemicals, and found 32 that were highly effective at killing numerous genetically diverse malaria parasite strains. Another screening project identified a new class of compounds that inhibits parasites in both the blood stage and in the liver. The research could lead to the development of malaria drugs that attack the parasite at multiple stages in its lifecycle, which would hamper the parasite’s ability to develop drug resistance.

Work continues on a novel anti-malaria compound, NITD609, first described by NIAID-supported researchers in 2010. A mid-stage clinical trial to assess NITD609’s activity in people began in Thailand this year. Research on NITD609 is a continuing collaboration among NIH-funded scientists, the pharmaceutical company Novartis, and the nonprofit Medicines for Malaria Venture.

Because the risk of childhood malaria is related to exposure before birth to the malaria parasite through infected mothers, NIAID scientists recently initiated a program on malaria disease development in pregnant women and young children that could yield new preventive measures and treatments for these most vulnerable groups.

The mosquitoes that spread malaria are also the target of NIAID-supported science. In 2011, researchers identified bacteria that render mosquitoes resistant to malaria parasites. Further study is needed, but it may one day be possible to break the cycle of infection by reducing the mosquito’s ability to transmit malaria parasites to people.

A vaccine to prevent malaria has been frustratingly elusive, and so initial positive results reported last year by the PATH Malaria Vaccine Initiative, GlaxoSmithKline Biologicals and their collaborators came as welcome news. In a late-stage clinical trial in approximately 6,000 African children, the candidate vaccine, known as RTS,S, reduced malaria infections by roughly half. Currently, eight other vaccine candidates are being tested in NIAID-supported clinical trials. One of them uses live, weakened malaria parasites delivered intravenously to prompt an immune response against malaria. An early-stage clinical trial of this vaccine candidate began at NIH earlier this year.

Whether the remarkable returns on investment in malaria control will continue in years ahead depends on our willingness to commit needed financial and intellectual resources to the daunting challenges that remain. On World Malaria Day, we join with our global partners in affirming that commitment and rededicating ourselves to the efforts to defeat malaria worldwide.

For more information on malaria, visit NIAID’s malaria Web portal.

Lee Hall, M.D., Ph.D., is Chief of the Parasitology and International Programs Branch in the NIAID Division of Microbiology and Infectious Diseases. Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health


April 25 is World Malaria Day

April 25, 2012

From the World Health Organization, for World Malaria Day 2012:

World Malaria Day

25 April 2012

In 2010, about 3.3 billion people – almost half of the world’s population – were at risk of malaria. Every year, this leads to about 216 million malaria cases and an estimated 655 000 deaths. People living in the poorest countries are the most vulnerable.

World Malaria Day Button (english)

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

World Malaria Day – which was instituted by the World Health Assembly at its 60th session in May 2007 – is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity:

  • for countries in the affected regions to learn from each other’s experiences and support each other’s efforts;
  • for new donors to join a global partnership against malaria;
  • for research and academic institutions to flag their scientific advances to both experts and general public; and
  • for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked.

Related links

Fewer than 700,000 deaths?  That’s significantly fewer than most reports of more than a million per year — significant progress has been made it fighting malaria.  Keep up those efforts, whatever they are.

Watch your news outlets.  Will the pro-DDT, anti-Rachel Carson hoaxsters hold sway, or will the facts on fighting malaria, from the malaria fighters, get top billing?


WHO, DDT and the Persistent Organic Pesticides Treaty: Historic view from the inside

March 19, 2011

Rollback Malaria (RBM) was established in 1998 in part to reinvigorate the worldwide fight against malaria, and in part to facilitate the negotiations for what became the Stockholm Convention, the Persistent Organic Pesticides Treaty of 2001.

RBM World Malaria Day 2011

That’s about the time the ungodly assault on WHO and Rachel Carson started, by hysterical DDT advocates.  We now know that Roger Bate, Richard Tren, Donald Roberts and their comrades in pens are stuck in that 1998 fight.

Here’s a short account, from RBM, about just what happened:

The DDT Controversy

In 1999 the RBM Secretariat was called upon to help resolve a controversy emerging from intergovernmental negotiations to establish an international environmental treaty. At the centre of this controversy was DDT, former hero of the malaria eradication campaign and current totemic villain of the environmental movement. The treaty being negotiated was intended to eliminate the production and use of twelve persistent organic pollutants. DDT, still used for malaria control in over 20 countries, was included among ‘the dirty dozen’ chemicals slated for elimination, eliciting a strong reaction from public health activists and malaria specialists who claimed that its elimination would result in unacceptable increases in malaria morbidity and mortality. Environmental specialists and others claimed that environmentally friendly alternatives to DDT, although more expensive, could easily be deployed to guard against such a negative impact.

The controversy over the role of DDT in malaria vector control and the dangers posed to the environment escalated and attracted considerable media attention. The controversy was perpetuated in part because of a relatively weak evidence base on the human toxicity of DDT, the cost-effectiveness of proposed alternatives, and the probable impact of public health use of DDT (compared to agricultural use) on the environment. Resolution was also hampered by the relative lack of public health expertise among the Intergovernmental Negotiating Committee delegates, who were primarily active in the fields of foreign and environmental policy.

The challenges presented to the RBM Secretariat in responding to the controversy were many and varied. They included: evaluation of the evidence base and the drafting of policy guidance (a WHO normative role); a major communications effort; and the establishment of new cross-sectoral partnerships and working relationships. In the process, RBM formed new and highly effective ‘partnerships’ or ‘working relations’ with the United Nations Environment Programme (UNEP), the US Environmental Protection Agency, the environmental policy apparatus of core RBM partners, as well as a variety of health and environmental NGOs. RBM conducted country and informal expert consultations and convened and chaired a special working group on DDT which was able to establish a position on the use of the insecticide in public health and the process for evaluating and moving to alternatives. The weight of WHO’s technical authority contributed greatly toward establishing the credibility of the working group. Information about the treaty negotiations and the WHO position on DDT was disseminated to health specialists via the WHO regional networks and to treaty focal points via UNEP.

The RBM Secretariat led the WHO delegation to all meetings of the Intergovernmental Negotiating Committee and prepared information and media events for each, supporting the participation of health/malaria specialists from a number of countries. The RBM Secretariat also served as the media focal point on malaria and DDT and provided interviews and information to all major media, as well as presentations to professional meetings and interest groups.

RBM’s objectives throughout this process were:

  • to establish consensus on the present and future role of DDT and alternatives in malaria control;
  • to encourage greater involvement of public health specialists in country-level discussions about the treaty and in country delegations to the negotiating sessions;
  • to provide information to negotiators and others that would reduce controversy and result in a win-win situation for public health and the environment (in which the longer term goal of DDT elimination is achieved through strengthened, more robust malaria control);
  • to benefit from the media attention to inform the public about malaria; and
  • to mobilize resources to support malaria control from outside the health sector.

All of these objectives have been met and the final treaty, known as the ‘Stockholm Convention on Persistent Organic Pollutants’ provides for the continued public health use of DDT and international assistance for the development and implementation of alternatives.

Resources to support the initial work of the RBM Secretariat were provided by environmental agencies/offices. In addition, the Pan American Health Organization (PAHO) and the WHO Regional Office for the Americas (AMRO) and most recently the WHO Regional Office for Africa (AFRO) have been awarded project development grants from the Global Environment Facility (GEF) to promote regional efforts to strengthen malaria control and reduce reliance on DDT.

From Final Report of the External Evaluation of RBM, Roll Back Malaria to Date, Chapter 2, page 15 (circa 2001).


DDT hoaxsters predictably spinning India/malaria deaths story — wrongly

October 28, 2010

People so wedded to a hoax, or just wrong, view of events cannot be swayed away from their convictions easily.

Elizabeth Whelan’s hoax science policy group, the American Council on Science and Health (ACSH), put out a press release taking note of the study published in Lancet that calls into question the count of malaria deaths in India promulgated by the World Health Organization (WHO).  You remember, the study suggests the malaria death toll among adults in India may be as high as 200,000 annually, compared to the 15,000 estimated by WHO.

ACSH can’t resist the spin.  Implicit the debunking may be, but the study thoroughly debunks ACSH’s claim that more DDT will help defeat malaria.  India is the world’s greatest user of DDT, using more than all the rest of the world together.  Clearly a surplus usage of DDT has not created the miracle end to malaria that ACSH and other hoaxsters claim it would.

Still, ACSH sticks to their views, even when those views are grossly wrong.  ACSH said, “ACSH has called for resumed use of indoor residual spraying of small amounts of DDT to prevent mosquito bites, repel mosquitoes, and reduce malaria deaths.”

No word from India on whether it will dramatically reduce DDT use to meet ACSH’s call for “small amounts.”

ACSH’s press release calls attention to a Wall Street Journal Blog article describing WHO’s response to the Lancet-published study of India malaria deaths — WHO questions the “verbal autopsy” methodology, and says it stands by its estimates of malaria deaths in the nation:

“The new study uses verbal autopsy method which is suitable only for diseases with distinctive symptoms and not for malaria,” WHO’s India representative Nata Menabde said in an email statement Thursday.

The WHO says it takes into account only confirmed cases of malaria and surveys those using healthcare facilities.

Malaria symptoms include fever, flu-like illness and muscle aches. Malaria is endemic to parts of India, where many people live in mosquito-infested areas. Confirming the presence of malaria requires tests like the “Peripheral Smear for Malarial Parasite” and “Rapid Malaria Antigen”.

Lancet said the determinations made by its field researchers were reviewed by two of 130 trained doctors for all the 6,671 districts who determined whether or not the person had died from malaria.

The data concluded that 205,000 deaths before the age of 70, mainly in rural areas, were caused by malaria each year – 55,000 in early childhood, 30,000 among children ages five to 14 and 120,000 people 15 and older.

The WHO called for further review of the study.

“Malaria has symptoms common with many other diseases and cannot be correctly identified by the local population,” Dr. Menabde said, adding: “The findings of the study cannot be accepted without further validation.”


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