Africa’s most repressive tyrant

United States President George W Bush’s recent trip to Africa may have catapulted Charles Taylor’s Liberia to front-page headlines across the world, but a more serious, Africa-wide problem has been tragically overlooked.

Malaria — not persistent military conflict or pandemic civilian violence — most threatens the security of millions of Africans, but remains largely ignored by Western nations.

Fortunately, in the months after Africa Malaria Day on April 25, a renewed focus and energy has been brought to the malaria epidemic. Much of the attention is due to the World Health Organisation’s Roll Back Malaria campaign, which has succeeded in heightening international awareness about the continuing crisis in sub-Saharan Africa. There more than 90% of malaria deaths occur each year and nearly 3 000 children die each day from the disease.

Unfortunately, the success of Roll Back Malaria, which promotes malaria-prevention through the use of insecticide-treated sleeping nets, has been minimal at best.

Cost has proved to be a major limitation. The nets are relatively expensive, about R40 each, or a typical week’s pay in most countries, and are not a high priority on the average rural African family’s shopping list.

Moreover, experts are unclear how effective the nets have been in reducing malaria transmission. Limited clinical trials have shown the nets save only one in five children in households that use them. In larger countrywide studies, the results have been only marginally encouraging: use of the nets in Tanzania and Gambia, for example, has resulted in a 30% reduction in mortality for children younger than four.

Though saving three more lives among every 10 children is certainly an improvement, these data show that the nets have fallen woefully short of the mark: the fight against malaria demands a zero tolerance of malaria deaths, not merely a modest reduction.

Complete eradication of the disease was once the benchmark for public- health initiatives targeting malaria, but that was during a different time — the age of DDT. Before the publication of Rachel Carson’s Silent Spring in 1962 and the ensuing worldwide environmental movement in the 1970s, indoor spraying of DDT was the primary means of controlling and eliminating malaria worldwide.

DDT helped North America and Europe rid themselves of malaria for good in the late 1930s and stopped potentially devastating outbreaks across India and Sri Lanka in the early 1940s.

Even the World Health Organisation (WHO) examined the effects of DDT in Uganda in the early 1960s. Commenting on the Uganda Malaria Eradication Pilot Project in the January 1961 edition of the East African Medical Journal, WHO malaria specialist J de Zulueta wrote: “A reduction of this magnitude in such a short space of time has seldom, if ever, been seen in tropical countries.”

DDT’s effectiveness was proven again in 2000, when South Africa broke ranks with environmental standards and implemented indoor residual spraying of DDT to end a malaria scare along its border with Mozambique.

Perhaps it is time to rethink our old prejudices against DDT and reconsider it as a cheap and useful weapon against malaria. We should remember that the much-publicised environmental problems linked to DDT 30 years ago were from high-volume use in the agricultural industry, not anti-malaria public-health programmes.

Recent studies have shown that DDT is less toxic than aspirin for humans and the minimal amount needed for protective indoor spraying will likely have little, if any, environmental effect.

But the gains from substantially reducing the number of malaria deaths in Africa each year cannot be overstated. If DDT proves as effective today in fighting malaria as it did 60 years ago there seems to be no good reason not to use it.

Just as activists rightly argue that life-saving anti-retroviral medication should be made available to those at risk from HIV/Aids, so too should DDT be made available to the millions of Africans at risk from malaria.

The Roll Back Malaria campaign should reconsider the role DDT can play in the fight against malaria. If saving as many lives as possible is what truly matters, then prevention protocols emphasising the use of insecticide-treated nets and DDT must be adopted and implemented across the region.

Vague appeals to environmental integrity and unfounded warnings of human harm do not justify the needless deaths of so many, especially when a solution is near at hand.

The tyranny of malaria can no longer be ignored or tolerated, but must be brought to a quick and final end. Effective peace-building requires more than resolution of internal political strife, and steps towards eliminating malaria and improving Africa’s public health are needed now more than ever. Otherwise there can be no lasting stability in Liberia and the rest of Africa, with or without Charles Taylor.

Jason Lott is a Marshall Scholar at Oxford University and former Visiting Fellow in the division of bioethics at the University of the Witwatersrand.

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