There is arguably no pesticide more famous than DDT.
The insecticide developed a notorious reputation after biologist and conservationist Rachel Carson, in her 1962 book Silent Spring, outlined its disastrous impact on the iconic American bald eagle. After years of study and debate, the U.S. banned DDT in 1972.
Since then, DDT use has waned globally, thanks in large part to the Stockholm Convention on Persistent Organic Pollutants, in which the United Nations Environment programme called for the gradual phase out of DDT.
Created in 2001, the Convention went into effect in 2004, with 152 countries having signed on to date. Environment isn’t the only concern: the U.S. Centers for Disease Control notes that DDT exposure can impact a person’s reproductive, endocrine and nervous system and is a "reasonably anticipated to be a human carcinogen.”
But the Stockholm Convention includes a caveat, allowing DDT to be used for one key purpose: controlling malaria.
DDT "incredibly effective"
The World Health Organization promoted DDT for malaria control in the mid-20th century, but ceased doing so in the early 1970s, in part because mosquitoes had built up resistance to the insecticide.
In 2006, on the heels of a global resurgence in commitment to eradicating malaria and a rebound in malaria rates in some countries, the WHO again recommended DDT for malaria control as part of indoor residual spraying (IRS) programmes, in which small amounts of insecticides are sprayed in dwellings to keep mosquitoes at bay.
DDT falls under the organochloride class, one of four classes of insecticides recommended by the WHO for IRS. The WHO also recommends the simultaneous use of insecticidal bed nets, and scale-up of malaria diagnosis and treatment.
Abraham Mnzava, the WHO’s malaria vector control coordinator, says that IRS is essential to combating the disease in Africa, where a child dies every minute from malaria. Mnzava says that DDT can’t be singularly relied upon, as mosquitoes develop resistance to insecticides quickly. The WHO advocates for countries to rotate which pesticide they use every few years, and closely monitor resistance patterns. But he says when used correctly, DDT can be “incredibly effective.” In July of 2013, the African Union recommended that affected African countries consider using DDT for malaria control.
Efforts are working: as of 2012, malaria rates had dipped by 49% in Africa between 2000 and 2012. But the successes aren’t solely thanks to DDT. Globally, only six countries used DDT in 2012. Significant gains were made with IRS utilising other insecticides, as well as better malaria diagnosis and newer treatments.
Enviromental and health concerns
Given potential environmental and health impacts, concerned environmental and civil society groups say that countries should use DDT as a last resort, but that some are too quick to use the insecticide rather than looking for alternatives.
Ellady Muyambi of the Uganda Network on Toxic Free Malaria Control says that his country has baselessly and actively pursued its use, despite DDT being more expensive than alternative chemicals, and despite Ugandan mosquitoes actually being resistant to DDT.
He says that the government first considered DDT after a visit from the non-governmental organization Africa Fighting Malaria. On its website, AFM calls itself a "nonprofit health advocacy group that conducts social and economic research on malaria and strives to raise the profile of the disease globally." But not a single health practitioner is listed in its staff, several of which, along with board members, have ties to conservative think tanks like the Free Market Foundation and American Enterprise Institute. One board member, and another staff person, are linked to the European Science and Environment Forum, a group well documented as having ties to the tobacco industry and climate change deniers. It is also staunchly pro-DDT.
With global demand waning, only the Indian and Chinese governments produce the pesticide. Al Jazeera could find no evidence of links between AFM and DDT manufacturers. Medha Chandra of the Pesticide Action Network surmises that groups like AFM are pro-DDT because they seek to undermine the global environmental movement, and government regulation more generally.
"DDT is such an iconic pesticide, it's one of the few pesticides across the globe that people can actually name,” she says. “If they can show that there was a needless ban and this is not really a problematic chemical at all, then it sets up doubts about environmental protection, human health impacts of pesticides, and chemical regulation as a whole.”
Harm or help?
There is evidence to back up Chandra’s claims. Based on a publicly accessible letter written in 1998 by Roger Bate to the tobacco company Philip Morris, Bate (now an AFM board member and previously working with ESEF) saw potential divisions between northern environmental groups and southern public health efforts as a tool to aid a larger agenda to undermine environmental and regulatory movements. Asking for funding from Philip Morris to run a malaria campaign, Bate wrote “we need to . . . [p]ick issues on which we can divide our opponents and win…. [M]alaria prevention is a good example.” By showing that “environmental regulations often harm public health in the West and Western policies often harm health in Less Developed Countries,” the strategy would “create tensions…between public health and environment.”
There's no evidence that funding from Philip Morris ever materialized for Bate’s plan, which his 1998 letter said would include a new initiative called “Africa Fighting Malaria.” But within years, on the eve of the 2001 negotiations on the Stockholm Convention, AFM was born.
AFM is not alone. Other groups, like Rachel Was Wrong and Congress of Racial Equality, claim to strive to ensure that the public has proper scientific information on DDT, rather than emotional environmental claims. But they sometimes offer misinformation. For example, AFM claimed that the WHO discontinued DDT use in malaria control programmes in the 1970s because of environmental concerns (Mnzava says that mosquito resistance was a main issue), and that DDT single-handedly eradicated malaria in America in the mid 20th century (Mnzava notes that the chemical was used along with environmental control measures like draining swamps, and these, plus better living conditions and increased access to treatment, helped to keep malaria under control even before DDT was used).
AFM also heavily publicised a 2011 paper written by two AFMers and published in the journal Research and Reports in Tropical Medicine, which highlights concerns over UNEP's environmentally friendly malaria control efforts. Research and Reports is an open access journal run by Dove Press, one of the dozens of publishers found to be dubious in its selection methods in a 2013 sting operation headed by writer John Bohannon of the journal Science.
"Dove Press was revealed to be a fraudulent publisher by my sting,” notes Bohannon. “As a consequence, Dove Press was expelled from OASPA, the professional organization of open access publishers. Any journal published by Dove Press should be treated with skepticism."
AFM did not respond to Al Jazeera's request for interview.
The WHO's Mnzava said he's "never heard of" AFM, and Julie Wallace of President’s Malaria Initiative, a large funder of malaria programmes supported by USAID and the CDC, says the organization "makes decisions not based on outside influence but based on the technical recommendations from the global level and from the national malaria programme's decision on approach, and resistance patterns." Citing tight environmental restrictions set by the Stockholm Convention, concern over long term effects of spraying, and a rise in DDT-resistant mosquitoes, the WHO and PMI make it clear that they support DDT only if it’s used discriminately, and only if it will be the most effective way to combat the disease. Governments and global health actors should consider mosquito resistance, cost, environmental monitoring, and public perception before implementation.
But AFM may have some close ties with at least one national department of health. In its 2011 annual report, AFM boasts that it “continues to have a close relationship with the South African National Malaria Control programme,” where it sits on the NMCP’s Malaria Advocacy Group and attends annual meetings. It also says it was invited by the department to assist in writing funding proposals and assists with research in one of the country’s malaria-heavy provinces.
DDT "hailed as successful" in SA
South Africa is the poster child for DDT use in combatting malaria. Relying on the chemical to control mosquitoes through the mid-1990s, the country briefly discontinued its use in 1996 because of international pressure and concerns over environmental contamination. As a result, mosquitoes were given a one-up on the human population: malaria boomed, with the national department of health noting a six-fold increase in disease rates between 1996 and 2000.
Panicked, South Africa began using DDT again in 2000—six years before the WHO condoned it. The intervention led to a drastic reduction in the number of cases: the department of health notes that in 2000, 460 people died of malaria, compared to only 70 in 2012. Patrick Moonasar, malaria director at the department, says that the country is a particularly reliant on DDT when compared to other African countries, as the mosquitoes most prominent in the northern part of South Africa--the region most susceptible to malaria--have built up resistance to other pesticides. In order to protect its porous borders from malaria, the country has teemed up with Mozambique, Zimbabwe, Namibia and Botswana, which host much higher rates of the disease, to promote IRS at bordering areas.
Moonasar did not want to comment on the department's connection to outside groups, seeing it as irrelevant to the country's use of DDT. Save for the country’s programme at its borders, its malaria efforts are almost entirely funded by national funding, and not external programmes.
Regardless of the health department’s potential connections to AFM, the country’s health community has largely hailed the South Africa’s use of DDT as successful. Andy Gray, a pharmacist with the country’s University of KwaZulu-Natal, the province boasting the country’s highest malaria rate, says “it's absolutely essential that we use something like [DDT]. We've had great success in KwaZulu-Natal with vector control as well as treatment…I think that DDT is important part of that success. How long we can use it and whether we're selling ourselves out in the long run is another question.”
Gray notes that there are practically no alternatives to DDT, given that mosquitoes have developed resistance to other insecticides.
Despite it's success in some areas the use of the pesticide is becoming increasingly scarce. PMI notes that while four of fourteen countries the programme supports have used DDT in the past, currently none of them use it because of a global supply shortage, skyrocketing cost, and increased mosquito resistance.
With only two producers, Mnzava says that the cost of DDT has increased six- or seven-fold within the last decade, making it more expensive than other chemicals, and given limited health budgets, severely restricting the number of households protected by IRS.
The WHO is worried. "We have very few alternative products, industry has not come up with new products, and unless there is concerted effort to encourage and come up with new insecticides, I think we'll rely on these insecticides for a very long time," Mnzava says. "The gains we've seen are threatened by insecticide resistance, so working with industry to come up with an alternative product is a main goal."
PAN's Chandra says that programmes like the UNEP's, which are looking for alternative, community-based solutions to malaria control, are essential not only from an environmental and human health perspective, but because "it's inevitable that there's going to be a roll-back in funding for malaria. It's happened before, it'll happen again, so we're hoping for a focus on solutions that are not so dollar heavy but can be taken forward by communities and still be protective and very effective."
"The End Game" is the third episode in the Lifelines: The Quest for Global Health series. It profiles the health heroes in Tanzania on the frontline of eliminating malaria. It premiers 24 April 2014 and will be availble online.