Plea For DDT
Fiona Kobusingye
 I have been struck down by malaria dozens of times. The vomiting, high
fevers, dehydration, headaches, joint pain and disorientation were beyond
belief.
If doctors hadn’t helped me even when I couldn’t pay, I would have been dead
long ago – like my son, two sisters and three nephews, all victims of this
vicious disease. Like the husbands and children of women who work with me,
making beautiful purses to earn money for malaria medicines. Like 50 of the
500 orphan children who attended the school that my husband and I help
sponsor – all dead in a single year!
It is an unspeakable tragedy. Malaria infects 400 million Africans every
year, leaving them unable to work, attend school, cultivate fields, care for
their families or build our nations. It costs Uganda over US$700 million
annually in lost productivity, millions of hours spent caring for sick
children and parents, countless potential Einsteins, Beethovens and Martin
Luther Kings.
We could end this suffering and death, if we use every available weapon –
not just insecticide-treated bednets, but insecticides, too, especially DDT.
Unfortunately, too many politicians, environmental activists and bureaucrats
promote programs that don’t work and tell Africans they can’t use DDT, which
keeps deadly anopheles mosquitoes out of our homes for six months or more,
with just one spraying on their inside walls.
Thankfully, President Bush and the U.S. Congress and Agency for
International Development have begun spending more money – and using DDT and
other insecticides in Uganda, Tanzania and Angola. Other agencies are also
revising their policies and programs. But one is dragging its feet.
Six years ago, the World Bank promised to spend $300-500 million on malaria
control in Africa. However, according to a study in The Lancet, the Bank has
bungled the job.
The malaria experts who conducted the study said the Bank actually spent
perhaps $100 million worldwide, and cut the number of recipient countries in
half, and claimed progress where there was none. By counting eight months as
a year, the Bank made it look like its programs had suddenly slashed malaria
cases by 60% in Brazil. Refusing to provide evidence to support claims that
are sharply contradicted by other data, it also said Bank programs had
“dramatically” reduced India’s malaria deaths in just one year.
It refuses to spend Bank money on DDT in Eritrea, where thousands die from
malaria every year, even though this chemical has reduced malaria by 75% in
at least four African countries.
The Bank bought 100 million doses of chloroquine for use in India, where
this drug fails to work 15-45% of the time – and children die as a result.
Just imagine the malpractice charges and criminal indictments that would
result if doctors did something like that in the United States. World Bank
staff then argued that “chloroquine is 10-20 times cheaper” than
Artemisia-based combination drugs – when even Bank documents specifically
acknowledge that “artemisinin-based drugs are the only first-line
anti-malarial drugs appropriate for widespread use that still work against
chloroquine-resistant malaria parasites.”
The study also states that the Bank eliminated its entire malaria staff, but
says it now has “three full-time professionals working on malaria” – for all
of sub-Saharan Africa! This is completely inadequate and does nothing to
alter the incompetent policies that continue to sicken and kill Africans.
Another study found that indoor spraying with DDT slashed malaria rates by
nearly 75% in just a few years in Madagascar’s highlands. Indoor DDT
spraying, combined with insecticide-treated curtains had similar results
elsewhere in the country.
Despite this life-saving success, the World Bank and Roll Back Malaria have
pressured Madagascar to “progressively phase out DDT” and replace it with an
“environmentally friendly” insecticide, even though no chemical has yet been
found that is nearly as effective as DDT. I can only conclude that, in their
minds, environmental considerations and “international criticism” about DDT
take precedence over African lives. Against all this and more damning
evidence, the Bank’s Lancet response asserts that its “approach is driven by
results.” Just imagine what would happen to doctors and corporate CEOs who
got such “results.”
The Bank’s Lancet response did get one thing right. It said that, compared
to the Global Fund for the Prevention of Malaria, Tuberculosis and HIV/AIDS,
the Bank has a “comparative advantage in development economics, financing …
capacity building and … implementation support.”
Put another way, the Global Fund is more competent than the Bank in disease
control, and more transparent about its funding and results. It has superior
staff, policies, programs and therapies. And it gives grants, which are
attractive to African countries already saddled with debt – instead of loans
like the Bank does.
Instead of pretending to be a disease expert, the Bank should focus on its
comparative advantages. It should build new hospitals and clinics, get them
electricity and clean water, support Global Fund malaria programs, and
provide stipends for doctors and nurses, to keep them from leaving Africa
for countries where salaries are higher, and obstacles less overwhelming.
Let the Global Fund handle malaria control.
World Bank president Paul Wolfowitz has an opportunity to change this dismal
situation, end the Bank’s shamefully defective malaria programs, refocus it
to what it does best, improve healthcare delivery, and save lives.
I’m not a doctor or politician. I’m just an African woman with a dream: that
we finally end a disease that is wiping out the future of Africa – our
precious children. I truly hope Mr. Wolfowitz will rise to the occasion.
Fiona Kobusingye-Boynes is coordinator of the Congress of Racial Equality’s
Uganda office. A farmer and businesswoman, she is a tireless advocate for
human life, human rights and effective malaria programs.
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