All Set for DDT Use As Ban Lifted
By Gatonye Gathura
The Nation (Nairobi, Kenya)
September 20, 2006
Kenya is considering its options in the use of DDT to control malaria, following last week's lifting of a three decade ban on the chemical by the World Health Organisation.
The country's head of malaria control, Dr Willis Akhwale, says the responsible agencies are meeting and will make their stand known before the end of the week.
But there are strong indications that DDT (dichloro-diphenyl-trichloro-ethane) will get a favourable hearing from the Ministry of Health. Experts in malaria control have always talked well of the chemical at individual level, though the official position was that the drug had been banned.
"New studies have shown earlier accusations of DDT to be largely incorrect. The pesticide is safe for use in malaria control if, like other chemicals, it is used responsibly," Dr Akhwale said yesterday. "We shall let you know our position in the next few days."
Now that WHO has lifted the ban, and considering that the US government had promised to fund malaria control programmes using DDT, then the ministry has both science and money behind it.
While lifting the ban last Friday, Dr Arata Kochi, head of malaria programme at WHO, was flanked by Adm. R Timothy Ziemer, who leads President Bush's $1.2 billion (about Sh90 billion) malaria undertaking.
Adm. Timothy said the insecticide was a tool "that must be deployed as robustly and strategically as possible."
In a WHO press statement, Senator Tom Coburn, Republican of Oklahoma and a medical doctor, said: "Finally, with WHO's unambiguous leadership on the issue, we can put to rest the junk science and myths that have provided aid and comfort to the real enemy - mosquitoes."
That the Americans are fully behind the unbaning is significant as they are the major donors to the malaria war in Kenya. The biggest bednets programme in Kenya is spearheaded by American non-governmental organisation Population Services International (PSI), through a social marketing strategy.
But if Dr Koch has his way, PSI's social marketing approach to malaria control could also change. Dr Kochi wants to standardise mosquito nets so that, instead of a welter of competing styles that must be home-dunked in pesticide, a few makers of factory-coated nets, which kill insects for years longer, are left to compete on price. He dismisses the "social marketing," concept, in which nets are branded and sold cheaply, instead of being given away.
But a Yes vote by the Ministry of Health for DDT could be just the beginning of a bruising battle with the ministries responsible for the country's horticultural produce to Europe.
European countries are not expected to ban agricultural produce from countries using DDT to control malaria, but individual importers could.
Several European countries are major donors to the Global Fund in the fight against TB, malaria and Aids, which is also a major source of funds to local malaria programmes. In the deliberations, the ministry of Health will have to weigh the pros and cons seriously.
It also has to consider that Kenya and other African countries have just handed to a Swiss company, Novartis Pharma, a huge tender for the procurement of a first line malaria drug - Coartem.
But the main battle will be fought in Nairobi, in case European countries indicate that they may shun Kenyan produce. This will be between health authorities - for the poor malaria casualties - and the ministries of agriculture and of trade - on behalf of rich horticultural exporters.
This has already happened in Uganda, where the ministry of Trade has threatened to take that of Health to court if the latter goes ahead and uses DDT to control malaria.
Malaria victims are normally the poor. If staked against big horticultural farmers and exporters, they may lose out.
Already the new developments have claimed casualties. Dr Allan Schapira, a senior member of the WHO malaria team who oversaw its approach in insecticide spraying, resigned last week for what colleagues say was his discomfort with the new approach to DDT spraying.
In an interview reported by the New York Times on Saturday, Dr Kochi - an abrasive administrator - said that half the professional staff on WHO's malaria programme had left, "one way or the other," since he took over in October.
Dr Kochi acknowledged that he had told members of staff in meetings that they were stupid. "The malaria community hates me. I said, basically, 'You are stupid.' Their science is very weak. The community is small and inward-looking and fighting each other.'"
In January, he took on powerful malaria drug companies - including a leading drug manufacturer in Kenya - for selling some forms of a new medicine he believed could speed up drug resistance. He threatened to disrupt sales of their other medicines if they did not comply within 90 days.
After the end of the ultimatum, Dr Kochi said all the big companies had changed their policies. "That war is over," he was reported to have boasted. "We won."
Koch, knowing the positions of countries in Europe and elsewhere could be hardened if powerful environmental groups campaign against DDT use, has extended an olive branch to such groups.
"I am here today to ask you, please help save African babies as you are helping to save the environment. African babies do not have a powerful movement to champion their well-being," Dr Kochi was reported in the Daily Telegraph on Saturday.
Friends of the Earth and the World Wildlife Fund both indicated that they would not be campaigning against the WHO position, said the paper.
There are 17 African countries using at least some indoor spraying of insecticides to combat malaria. Only 10 of them use DDT - Eritrea, Madagascar, Ethiopia, Swaziland, South Africa, Mauritius, Mozambique, Zimbabwe, Namibia and Zambia - according to the WHO.
Tanzania and Uganda have announced their intentions to follow suit, though the latter is experiencing a bureaucratic standoff between the ministry of health and that of trade.
Dr Kochi, a 57-year-old graduate of Japanese medical schools and Harvard School of Public Health, previously headed TB programmes at WHO, but was removed for alienating key partners with his abrasive approach.
"The scientific and programmatic evidence clearly supports this reassessment," says Dr Anarfi Asamoa-Baah, WHO assistant director-general for HIV/AIDS, TB and malaria.
"Indoor residual spraying is useful in reducing the number of infections caused by malaria-carrying mosquitoes. It has proven to be as cost effective as other malaria prevention measures. DDT presents no health risk when used properly - that is, in small amounts on the inner walls of people's homes."
Teams of sprayers typically visit endemic areas once a year, spraying the chemical on the inside walls of houses. Mosquitoes landing there absorb it and die.
Some African countries have continued to use DDT, though most have switched to other kinds of insecticide or pursued a strategy of issuing insecticide-impregnated bednets. Some aid agencies have policies of not funding programmes involving DDT.
"Of the dozen insecticides WHO has approved as safe for house spraying, the most effective is DDT," said Dr Kochi. For about $5 per house (about Sh375), indoor spraying with DDT is a cost-effective response to malaria, which kills about a million people annually, most of them children under five.
In parts of Africa and Asia where malaria-carrying mosquitoes spread the disease, 85 per cent of home dwellers approached by health workers allow their houses to be sprayed, global health officials said at a news conference.
Meanwhile, Kenyan and UK researchers have developed a new treatment, which can cure 80 per cent of for severe malaria in children.
An eight-year study by Kenya Medical Research Institute-Wellcome Trust Research Programme in Kilifi and the Imperial College London, shows that when a blood protein called albumin is administered to children with severe malaria, the recovery rate is remarkable.
Released simultaneously in London and Kenya on Friday - and now published in the journal PLOS Clinical Trials - the study is seeking funds for a larger trial involving over 1,000 children in Ghana, Gambia and Kenya.
Using sophisticated, intensive care methods usually available only on paediatric intensive care units in developed countries, the researchers showed that children with severe malaria also suffer from low fluids in the body.
Such children have previously been denied additional fluids for fear they might exacerbate brain swelling associated with malaria. The new treatment avoids this problem by including albumin - a molecule which holds water inside blood vessels - in resuscitation fluids given to children.
Senator Tom Coburn
Subcommittee on Federal Financial Management, Government Information, and International Security
340 Dirksen Senate Office Building Washington, DC 20510
Phone: 202-224-2254 Fax: 202-228-3796
|
|
