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Better living through chemistry: DDT could save millions of Africans from dying of malaria—if only environmentalists would let it

Washington Monthly, March, 2003 by Alexander Gourevitch

BY MOST MEASURES, UGANDA IS ONE of the success stories of African development. Under President Yoweri Museveni, a former guerrilla and darling of the international donor community, Uganda has achieved GDP growth of 6 percent per year, gradually expanding political freedoms, and a measure of peace. In a continent beset by poverty and political disorder, Uganda has slowly become a model for how to get things right. Even the AIDS epidemic, which infected an estimated 20 percent of Uganda's population a decade ago, seems to be under control.

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But a more old-fashioned plague has come back to haunt Uganda: malaria. The mosquito-borne illness costs Uganda more than $3.47 million a year. Today, up to 40 percent of the country's outpatient care goes to people thus infected. Total infections are so numerous that the government doesn't even try to track them, but last year, 80,000 people died of the disease, half of them children under the age of five.

So last December, at a convention of regional health ministers held in Kampala, Jim Muhwezi, an army officer and member of parliament who today serves as Uganda's minister of health, announced the launch of a new campaign against the epidemic, using Dichloro-diphenyl-trichloroethane, or DDT. To Muhwezi, DDT--a pesticide widely proscribed in Europe and banned in the United States since 1972--was a cheap, effective weapon against malaria for a poor country with minimal public health resources. And in South Africa, the recent reintroduction of DDT spraying had reduced malaria rates by 75 percent over two years. "Instead of sitting back and watching our people die of malaria and lose in economic terms," he proclaimed, "an all-out war against the disease must be waged."

But Muhwezi encountered opposition almost immediately. After his announcement, Andrew Sisson, a USAID official attending the Kampala convention, told one session that in the United States DDT had been found to "cause environmental problems," according to Muhwezi. A member of Uganda's parliament warned Muhwezi that Europe and the United States might ban imports of Uganda's fish and agricultural exports, a fear shared by local environmentalists, according to the Nairobi East African, Kenya's leading daily. Since USAID prefers to fund bednets as a solution to Uganda's mosquito problem, Muhwezi is unsure if he'll be able to obtain international assistance to fund a DDT-based malarial eradication project. "We hope they'll come along. But if they don't, we'll do it alone."

Until recently, one might have considered Uganda's to be a tragic but unavoidable tradeoff--deprive many of an uncontaminated natural environment, or save few from malaria. In much of the world, after all, the popular conception of DDT is of a dangerous and toxic chemical that pollutes water and poisons the food chain; in the United States, DDT is remembered as the pesticide that helped put bald eagles on the endangered species list. But a growing body of scientific evidence suggests that the popular conception is wrong. Older studies on the effects of DDT have been called into question, and newer ones militate against the notion that DDT is inherently dangerous. For the kind of use Muhwezi has i mind, in tact, DDT may not be dangerous at all.

The stakes are high. Uganda is but one of many African countries suffering from malaria epidemics. Africa already accounts for 90 percent of the 2 million deaths and 300 million infections around the world each year, and it costs the continent 1.3 percent in annual growth per year, according to the economist Jeffrey Sachs. Mosquitoes are increasingly resistant to the main insecticide put into use to replace DDT; and the parasite that causes the disease has, in recent years, become increasingly resistant to the cheapest and most common medical treatment, a drug called chloroquine. Yet most international aid agencies, development agencies, and lending institutions have moved away from funding spraying projects in general, and DDT use specifically. Without assistance, African governments cannot afford spraying programs, leaving them bereft of a safe, effective, and cheap defense. Which means that aid agencies and governments opposed to DDT use may end up costing Africa millions of needless deaths.

Bad Medicine?

DDT first came to the United States after the late 1930s, when Dr. Paul Muller, a chemist with the Swiss firm J.R. Geigy, found that minuscule amounts of DDT killed just about every insect he could find. Slow to break down, a single application of DDT remained toxic for up to a year, which made spraying programs much easier to administer, especially in remote locations. It was cheap to produce, easy to ship, and did not require the extensive safety gear of other insecticides. And remarkably, even when mosquitoes developed resistance to the toxicity of DDT, it still acted as a repellent and irritant, driving nocturnal mosquitoes out of homes before they had a chance to bite. (This mechanism was discovered later--originally, it was just toxicity and safety that attracted people to DDT.)

Better living through chemistry: DDT could save millions of Africans from dying of malaria—if only environmentalists would let it

Washington Monthly, March, 2003 by Alexander Gourevitch

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