The Uganda's government proposal in 2005 to combat malaria with the insecticide DDT has sparked international debates about the dangers that this chemical might impose on an environmental and human scale.
Credit: The Global Fund/John Rae
Malaria is Uganda’s number-one killer disease. According to the World Health Organisation (WHO), the parasite-borne illness kills between 70,000 and 100,000 children in Uganda annually, and at least one million people worldwide every year. Every day, 400 people in the East African country die of malaria, mainly young children and pregnant women.

However the government’s proposal in 2005 to combat malaria with the controversial insecticide DDT (dichloro-diphenyl-trichloroethane) has sparked a heated debate and considerable concern among Uganda’s international development partners.

This method uses the strategy of applying the chemical DDT to dwellings through a process called individual residual spraying (IRS). Many countries have already agreed to ban the use of DDT through an international convention – except in “public health crises” .

Advocates of the use of DDT to eradicate malaria argue that it is a cost-effective measure that tackles the cause of the disease, rather than simply reacting to its effects. Because it breaks down slowly, DDT also provides long-lasting protection, they contend. They consider the fears of the impact of DDT to be exaggerated and see the massive proliferation of Malaria as partly due to the successes of the DDT-activists in preventing affected countries using the chemical.

Since the 1960s green activists have pushed bans of the substance around the world based largely on claims about its health affects. DDT’s detractors caution about its dangers on human health and on the environment after finding from massive agricultural use.

Those supporting the use of DDT claim it has a proven record of effectiveness. Many nations, including the United States, eradicated malaria-carrying mosquitoes using DDT. South Africa nearly did the same, but it stopped using DDT under political pressure. After halting DDT use, cases rose from about 4,100 in 1995 to more than 27,000 by 1999, according to a study conducted by researchers Amir Attaran and Rajendra Maharaj. According to the NGO Africa Fighting Malaria in recent years, South Africa resumed DDT use, and cases have dropped 85 percent.

Gabriel Bimenya, chief researcher in a clinical study of residents in southwest Uganda, where DDT was used to eradicate malaria during the later years of British colonial administration, advocates controlled use of the insecticide. The outcry against DDT is “unfounded and without scientific backing,” he said.

“Our results indicate there is no direct link between DDT and human defects like cancers, impotence and infertility. It’s true we found traces of DDT in the blood, but not at harmful levels,” he said. “In fact, blood samples provided last year by European ministers gave concentration levels of the chemical that were far higher.”

Bimenya observations echo other reports recently published in the Ugandan capital, Kampala, also rejected claims of damaging side effects and recommended controlled use of the insecticide.

Sigurd Illing, the European Union’s ambassador to Uganda, however, responded to Uganda’s proposed use of DDT with a warning of “dire consequences”. He threatened an EU ban on agricultural and horticultural products from the country.

The World Wildlife Fund (WWF) has also cautioned against using DDT, citing its long-term environmental implications. The organisation state in one report “Because DDT can travel long distances and accumulate in the body, millions of humans and animals worldwide have build-ups of the chemical in their tissue even though it may have been used on another continent.”

Environmentalists claim the insecticide’s long half-life results in the chemical remaining in the food chain for decades, with harmful effects on wildlife, including the thinning of eggshells in birds exposed to the insecticide.

Jim Muhwezi, Uganda’s minister of health, said his country only intends to use DDT indoors and under strict guidelines stipulated by WHO, which recommends the use of DDT only when safe, effective and affordable alternatives are not locally available.

Supporters of IRS with DDT point to the successes of other sub-Saharan countries like South Africa, where use of the insecticide against malaria-infected mosquitoes has helped cut morbidity rates by up to 80 percent.

In Uganda, whose malaria-prevention campaign focuses primarily on insecticide-treated bed nets (ITNs), the incidence rate has increased from 5.5 million to more than 16 million since the start of the Roll Back Malaria Partnership in 1998.

John Rwakimari, head of the country’s malaria-control programme, said financial shortfalls were limiting the project’s success. “The objective was to have 80 percent coverage of the population nationwide, but at the moment we are only at 25 percent because of funding shortages,” he said.

Bimenya believed that concentrating on the provision of ITNs was misguided. “Focusing on mosquito nets is a joke policy. A mosquito net will only protect you for as long as you are underneath it. Get out of that net and you expose yourself to the mosquitoes,” he said.

“Our challenge should be to try and reduce mosquito-man contact, and that is where DDT comes in,” Bimenya said. “DDT not only kills mosquitoes, it also repels mosquitoes from areas that have been sprayed.”

Advocates of IRS with DDT insist it would help redress the current imbalance between prevention and treatment in Uganda’s malaria policy. They claim that Western countries – which themselves are free from the burden of malaria – are standing in the way of Uganda’s fight against the parasite.

“DDT is now banned, yet it is the one sure method of quickly eradicating malaria and at a far lower cost than other alternatives. As soon as you spray the protection starts,” Rwakimari said.

UGANDAN health officials estimate that it would cost US $8 million per year to carry out IRS with DDT in Uganda’s 15 epidemic-prone districts, most of which lie in the east and southwest of the country. Uganda’s ministry of health currently spends $34 million annually on anti-malarial medicine, or approximately 20 percent of its total budget, according to officials of the Malaria Control Programme.

Uganda recently secured a $66 million grant from the Global Fund to Fight HIV, Tuberculosis and Malaria to be spent on more effective drugs.

Concerns have been expressed in Uganda that large pharmaceutical companies hold too much influence over government and officials that could cause decisions to be taken that may profit pharmaceutical manufacturers and distributors more than the affected people themselves. By all accounts this is a problems far wider than Uganda.

"It's utterly disgraceful for powerful [pharmaceutical] companies to put commercial interests above human life,” said Richard Tren, South African director of Africa Fighting Malaria referring to the efforts by companies to stop the use of DDT against malaria.

Tren, an advocate of the judicious use chemicals explained that “DDT is sprayed in tiny amounts on the inside walls of dwellings, in carefully controlled programmes that save countless thousands of lives, mainly children, every year.”

WHO agree that in certain scenarios the use of DDT can be considered but that ultimately what is needed is a coherent, integrated policy in relation to malaria and the use of the chemical.

Edith Lyimo, preventative measures officer for the WHO, told IRIN it is normal to focus on treatment where malaria is highly endemic and budgets are a concern. “Where resources are low,” she said, “governments and international donors will look for the visible quick-fix solution, but we need preventative measures alongside.”

“Malaria is not a one strategy disease, you need prevention and treatment running side by side,” said Lyimo.
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