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The reintroduction of a controversial pesticide to control malaria has drawn sharp reactions from many quarters but there could be more to the issue than meets the eye, writes Dann Okoth
The lifting of the ban on the controversial pesticide Dichlorodiphenyltrichloethene, commonly known as DDT, by the World Health Organisation has ruffled many feathers.
Just as the government was about to launch the Atermisinin Combination Treatment (ACT), which would offer big business for pharmaceuticals and NGOs on malaria-related missions, WHO announced lifting of the ban on the pesticide that has been known to fully eradicate malaria.
In fact, the Director of Medical Services, Dr James Nyikal, is said to have called off a Press conference in a huff following the announcement by WHO reintroducing the pesticide last week.
Already local and international NGOs are up in arms over what they term WHO’s "irresponsible and unfounded promotion of DDT" for malaria control. Their outrage, however, is not without basis and it is not surprising because malaria in Africa is big business and the NGOs are known to be behind the numerous so-called malaria intervention and prevention projects raking in billions of dollars every year.
The Africa Malaria Report of 2003 says since the launch of the Roll Back Malaria programme in 1998, international spending on the disease has more than doubled to approximately US$200 million per year. And although government spending in all healthcare is low in most African countries — typically less than Sh1,100 per person per year, the countries have been awarded a total of US$256 billion through the Roll Back Malaria programme for an initial two years to scale up malaria control activities.
Apart from the money, emanating from the Global Fund for Malaria, there are numerous other sources of cash for malaria control in Africa from international organisations that push the funds to colossal amounts.
Malaria, therefore, offers lucrative business for the various NGOs who stake their claim through an array of intervention measures including awareness creation and provision of mosquito-treated nets, some of which have achieved little. There is still a high mortality rate resulting in huge losses to the continent’s economy, now estimated US$800 million per year.
It is no wonder then that NGOs in their joint statement against WHO’s move to allow the use of DDT says that "malaria is a disease of poverty and we all know that its control requires long term strategies that address conditions of poverty?"
Impeccable medical sources say DDT is the biggest threat to the global malaria cartels, including medics, the pharmaceutical industry and NGOs, because the chemical is capable of completely wiping out malaria thereby pushing them out of business — the chemical had eradicated malaria in Europe before it was banned in that continent.
In Kenya the re-introduction of the pesticide has caused ripples in the medical and pharmaceutical industry with most medics and pharmacists fearing for their jobs.
"Doctors will lose their jobs en mass if malaria is wiped out and the effect on the pharmaceutical industry would be disastrous," says a pharmacist who requested anonymity.
He added that it was malaria that kept most doctors in the country busy adding that if the disease were to be wiped out the medics would be rendered redundant.
"Tell me how many people go to hospital because of a sore throat or flu. Not even the deadly HIV/Aids and Tuberculosis can rival malaria in hospital bed occupancy in this country," observes the source.
Indeed, in Kenya malaria causes an estimated 34,000 deaths a year among children under five and is the leading cause of illness among vulnerable groups such as pregnant women. Malaria also accounts for 75 per cent of hospital bed occupancy in the country.
But it is not only the medics and pharmaceutical giants who are upset. The move by WHO is said to have rubbed a few individuals at the Ministry of Health the wrong way after they felt they were not consulted by WHO before the decision to lift the DDT ban.
The Press conference was to announce the Atermisinin Combination Treatment (ACT) launch by President Kibaki in Makueni.
But Dr Nyikal downplayed the raging DDT debate saying the government would table the policy on the use of DDT next week. He also said the ministry would affirm its position on the same.
"We will release the policy framework next week as well as address all those nagging issues at the appropriate time," Nyikal told The Big Issue last week.
Other sources, however, say that ministry officials were angry that WHO had come up with new policy on DDT when the government was in the process of implementing the new malaria control programme based on Insecticide Treated Nets (ITNs) and the ACTs.
Dafra Pharma Business Manager Dr Tom Mboya Owino says the move to re-introduce DDT by WHO would jeopardise Kenya’s efforts to implement existing malaria control programmes.
"The regulatory bodies should give the government time to implement the new vector management through effective medication and the provision of mosquito treated nets," he says.
But the pharmaceutical companies are unhappy at the possibility of losing the multi-billion malaria drugs market should DDT be introduced. In fact, the industry is now positioning itself to either block the re-introduction of the pesticide or to influence the government to adopt a policy on DDT that would not drastically curtail the spread of malaria, sources reveal.
Exporters of horticultural produce who fear the re-introduction of the chemical could trigger an embargo on their products by the European Union are also engineering the push.
"Our main market share is malaria and if the disease is gone we are finished. DDT is capable of drastically reducing malaria or wiping it out completely, I am brutally honest about this," says a scientist at a leading multi-national pharmaceutical industry who declined to be named.
Dr Rogers Atebe, the chairman of Kenya Pharmaceutical Manufacturers, says malaria takes up much of the health expenditure in Kenya.
"The current budget for malaria treatment stands at approximately Sh1.5 billion a year, but this figure could be higher. When the treatment regime consisted of sulphur based drugs the cost was about Sh130 million a year," he says.
But there are claims from independent sources that the malaria drugs market in the country could have hit the Sh60 billion mark.
"The cost soared especially following the introduction of the ACTs. The officials will always be conservative with the figures because they know what they are getting and are keen to hide this from wananchi," he says.
The example from South Africa shows that the country was able to achieve an 80 per cent reduction in malaria infections and death rates using DDT alone. Thereafter the country was able to administer the ACT to a significantly reduced number thereby drastically cutting down its expenditure on malaria treatment.
In Uganda it is estimated that the country could save over US$60 million (Sh4.3 billion) annually as well as many lives if it used DDT to control malaria.
Currently the country spends an estimated US$30 million (Sh2 billion) on 15.5million doses of ACT annually and has so far spent US$32 million on distribution of ITNs.
Locally, however, the debate has revolved around the use of ACTs and ITNs in tackling resistant malaria strains versus the re-introduction of DDT. The NGOs under the auspices of Physicians for Social Responsibility, Pesticide Action Network, members of International POPs Elimination Network and the International Society of Doctors for the Environment say decades of scientific evidence show that DDT is harmful to humans adding that human reproductive disorders associated with DDT are well documented, including poor sperm quality.
T
he experts claim that one recent study found clear neurological effects — including developmental delays — among babies and toddlers exposed to DDT in the womb. Researchers in Mexico and South Africa, they say, found elevated levels of DDT in the blood of people living where DDT was used to control malaria, and breastfed children in those areas received more DDT than the amount considered ‘safe’ by WHO and Food and Agricultural Organisation (FAO).
"Studies have also linked exposure to increased risk of breast cancer, and the International Agency for Research on Cancer lists DDT as a possible human carcinogen," they further argue.
"We strongly support the Stockholm Convention that calls for elimination of DDT, allowing short term use of the persistent and bio cumulative pesticide in the few countries that demonstrate need for it. While the international community mobilises resources to help these countries put safer and more effective alternatives in place," they say.
The WHO’s September 15 Press statement described a ‘new’ approach to malaria control with DDT as the centrepiece of an aggressive effort to eradicate the disease. But the NGOs now claim that there has been no reassessment of DDT risk and no official revision of WHO’s policy, which already allowed minimal use of DDT in accordance with the Stockholm Convention.
They claim that one of WHO’s chief malaria experts, Dr Allan Schapira, resigned abruptly prior to the announcement promoting DDT use by the controversial new head of WHO’s global malaria programme, Dr Arata Kochi.
The groups claimed Dr Kochi’s announcement has strong support from the Bush Administration, which recently changed the policy of the US Agency for International Development to increase reliance on DDT in its malaria programmes.
They further said that a recent statement on the matter by a staunch Bush supporter, Senator Tom Coburn was released from Washington DC rather than WHO headquarters in Geneva. "The recent shift in US policy reflects a concerted DDT promotion campaign by a handful of aggressive advocates," says Kristin Schafer, Programme Coordinator for Pesticide Action Network.
"This effort is supported by conservative organisations and think tanks with funding from the US pesticide industry, including Monsanto," he adds
On the local scene, angry multi-national pharmaceutical manufacturers have also claimed that WHO is now shifting goal posts in malaria control in order to remain in business.
"They know that once the current programme on malaria control in Kenya takes off they will have no work to do around. They are now shifting goal posts to remain in business," charged a pharmacist working with a leading drugs manufacturer.
He added: "WHO also receives 10 per cent in every contract they award and this is another way of securing more business."
The NGOs observe that more effective and safer approaches to malaria control are now being used in many countries, adding: "For example, Vietnam reduced malaria deaths by 97 per cent and malaria cases by 59 per cent when they switched in 1991 from trying to eradicate malaria using DDT to a DDT-free malaria control programme involving distribution of drugs and mosquito nets along with widespread health education organised by village leaders. Mexico phased out DDT use in 2000 and implemented a successful integrated and community-based approach."
Dr Paul Saoke, Director of Physicians for Social Responsibility in Kenya, says it is criminal that WHO should make a politically motivated announcement like this under the guise of protecting the health of children in Africa.
"We need real solutions to malaria in Africa, not a return to widespread reliance on a failed silver bullet that risks the health of communities already battling this deadly disease," he says.
The NGOs say that the international community must listen to the voices of people directly affected by DDT, whether in India where DDT is produced or African countries where its use is being promoted.
"We join in demanding that WHO reverse this irresponsible promotion of DDT, and we urge the international community to investigate how politics managed to triumph over science and common sense at WHO," they say.
But the so-called safer intervention measures for malaria control do not seem to contribute much in respect to reducing infections and deaths even as the huge resources allocated disappear in a seemingly bottomless pit.
According to Dr Owino, only 20 per cent of the money goes to the patient as 80 per cent is swallowed in the so-called logistics, conferences and meetings.