Sunday, April 11, 2004

What the World Needs Now Is DDT

I never thought I'd see the day, but the New York Times appears to have ditched its automatic genuflection before the idols of the environmental movement to make room for this excellent article on the tremendous harm that has been, and still is being, done by environmental activists to efforts to control malaria in the Third World. The success of environmental pressure groups in extending the ban on DDT usage from the Western world, where malaria has long been banished, to the entire globe, is the single best illustration of why I am so distrustful of such groups, and so scornful of their agenda.

The year 2000 was a time of plague for the South African town of Ndumo, on the border of Mozambique. That March, while the world was focused on AIDS, more than 7,000 people came to the local health clinic with malaria. The South African Defense Force was called in, and soldiers set up tents outside the clinic to treat the sick. At the district hospital 30 miles away in Mosvold, the wards filled with patients suffering with the headache, weakness and fever of malaria -- 2,303 patients that month. ''I thought we were going to get buried in malaria,'' said Hervey Vaughan Williams, the hospital's medical manager.

Today, malaria has all but vanished in Ndumo. In March 2003, the clinic treated nine malaria cases; Mosvold Hospital, only three.

As malaria surges once again in Africa, victories are few. But South Africa is beating the disease with a simple remedy: spraying the inside walls of houses in affected regions once a year. Several insecticides can be used, but South Africa has chosen the most effective one. It lasts twice as long as the alternatives. It repels mosquitoes in addition to killing them, which delays the onset of pesticide-resistance. It costs a quarter as much as the next cheapest insecticide. It is DDT.

KwaZulu-Natal, the province of South Africa where Ndumo and Mosvold are located, sprayed with DDT until 1996, then stopped, in part under pressure from other nations, and switched to another insecticide. But mosquitoes proved to be resistant to the new insecticide, and malaria cases soared. Since DDT was brought back in 2000, malaria is once again under control. To South Africans, DDT is their best defense against a killer disease.

To Americans, DDT is simply a killer. Ask Americans over 40 to name the most dangerous chemical they know, and chances are that they will say DDT. Dichloro-diphenyl-trichloroethane was banned in the United States in 1972. The chemical was once sprayed in huge quantities over cities and fields of cotton and other crops. Its persistence in the ecosystem, where it builds up to kill birds and fish, has become a symbol of the dangers of playing God with nature, an icon of human arrogance. Countries throughout the world have signed a treaty promising to phase out its use.

Yet what really merits outrage about DDT today is not that South Africa still uses it, as do about five other countries for routine malaria control and about 10 more for emergencies. It is that dozens more do not. Malaria is a disease Westerners no longer have to think about. Independent malariologists believe it kills two million people a year, mainly children under 5 and 90 percent of them in Africa. Until it was overtaken by AIDS in 1999, it was Africa's leading killer. One in 20 African children dies of malaria, and many of those who survive are brain-damaged. Each year, 300 to 500 million people worldwide get malaria. During the rainy season in some parts of Africa, entire villages of people lie in bed, shivering with fever, too weak to stand or eat. Many spend a good part of the year incapacitated, which cripples African economies. A commission of the World Health Organization found that malaria alone shrinks the economy in countries where it is most endemic by 20 percent over 15 years. There is currently no vaccine. While travelers to malarial regions can take prophylactic medicines, these drugs are too toxic for long-term use for residents.

Yet DDT, the very insecticide that eradicated malaria in developed nations, has been essentially deactivated as a malaria-control tool today. The paradox is that sprayed in tiny quantities inside houses -- the only way anyone proposes to use it today -- DDT is most likely not harmful to people or the environment. Certainly, the possible harm from DDT is vastly outweighed by its ability to save children's lives.

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Even when spraying is possible, though, developed nations don't want to pay for it. Instead, the malaria establishment in developed nations promotes the use of insecticide-treated nets that people can buy to hang over their beds. Treated bed nets are indeed a useful tool for controlling malaria. But they have significant limitations, and one reason malaria has surged is that they have essentially become the only tool promoted by Western donors. ''I cannot envision the possibility of rolling back malaria without the power of DDT,'' said Renato Gusm-o, who headed antimalaria programs at the Pan American Health Organization, or P.A.H.O., the branch of W.H.O. that covers the Americas. ''Impregnated bed nets are an auxiliary. In tropical Africa, if you don't use DDT, forget it.''

The other reason DDT has fallen into disuse is wealthy countries' fear of a double standard. ''For us to be buying and using in another country something we don't allow in our own country raises the specter of preferential treatment,'' said E. Anne Peterson, the assistant administrator for global health at Usaid. ''We certainly have to think about 'What would the American people think and want?' and 'What would Africans think if we're going to do to them what we wouldn't do to our own people?'''

Given the malignant history of American companies employing dangerous drugs and pesticides overseas that they would not or could not use at home, it is understandable why Washington officials say it would be hypocritical to finance DDT in poor nations. But children sick with malaria might perceive a more deadly hypocrisy in our failure to do so: America and Europe used DDT irresponsibly to wipe out malaria. Once we discovered it was harming the ecosystem, we made even its safe use impossible for far poorer and sicker nations.


Today, westerners with no memory of malaria often assume it has always been only a tropical disease. But malaria was once found as far north as Boston and Montreal. Oliver Cromwell died of malaria, and Shakespeare alludes to it (as ''ague'') in eight plays. Malaria no longer afflicts the United States, Canada and Northern Europe in part because of changes in living habits -- the shift to cities, better sanitation, window screens. But another major reason was DDT, sprayed from airplanes over American cities and towns while children played outside.

In Southern Europe, Latin America and Asia, DDT played an even more prominent role in controlling malaria. A malaria-eradication campaign with DDT began nearly worldwide in the 1950's. When it started, India was losing 800,000 people every year to malaria. By the late 1960's, deaths in India were approaching zero. In Sri Lanka, then called Ceylon, 2.8 million cases of malaria per year fell to 17. In 1970, the National Academy of Sciences wrote in a report that ''to only a few chemicals does man owe as great a debt as to DDT'' and credited the insecticide, perhaps with some exaggeration, with saving half a billion lives.

From the 1940's to the late 1960's, indoor house spraying with DDT was tested all over Africa. It was least effective in the lowland savannas of West Africa, but even partly successful programs provided considerable health improvements. And in other parts of Africa, DDT reduced the infant mortality rate by half and in some places wiped out malaria completely.

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The move away from DDT in the 60's and 70's led to a resurgence of malaria in various countries -- Sri Lanka, Madagascar, Swaziland, South Africa and Belize, to cite a few; those countries that then returned to DDT saw their epidemics controlled. In Mexico in the 1980's, malaria cases rose and fell with the quantity of DDT sprayed. Donald Roberts, a professor at the Uniformed Services University of the Health Sciences in Bethesda, Md., has argued that when Latin America stopped using DDT in the 1980's, malaria immediately rose, leading to more than a million extra cases a year. The one country that continued to beat malaria was Ecuador, the one country that kept using DDT.

In the few countries where it is used today, DDT is no longer sprayed from airplanes, and no country admits to using it as an insecticide for crops -- although there are probably cases where it is diverted for agricultural use. Its only legitimate use is inside houses. Roberts said that the quantities used for house spraying are so small that Guyana, to take one example, could protect every single citizen of its malarious zones with the same amount of DDT once used to spray 1,000 acres of cotton. ''The negative environmental effects of DDT use that led to its banning were due to massive, widespread agricultural use,'' says a fact sheet published by Usaid (no fan of the chemical). ''Spraying limited amounts of DDT inside houses is considered unlikely to have major negative environmental impact.''

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Rereading ''Silent Spring,'' I was again impressed by the book's many virtues. It was serialized in The New Yorker in June 1962 and published in book form that September -- a time when Americans were living in the golden glow of postwar progress and science was revered. ''Silent Spring'' for the first time caused Americans to question the scientists and officials who had been assuring them that no harm would result from the rain of pesticides falling on their farms, parks and backyards. Carson detailed how DDT travels up the food chain in greater and greater concentrations, how robins died when they ate earthworms exposed to DDT, how DDT doomed eagle young to an early death, how salmon died because DDT had killed the stream insects they ate, how fiddler crabs collapsed in convulsions in tidal marshes sprayed with DDT.

''Silent Spring'' changed the relationship many Americans had with their government and introduced the concept of ecology and the interconnectedness of systems into the national debate. Rachel Carson started the environmental movement. Few books have done more to change the world.

But this time around, I was also struck by something that did not occur to me when I first read the book in the early 1980's. In her 297 pages, Rachel Carson never mentioned the fact that by the time she was writing, DDT was responsible for saving tens of millions of lives, perhaps hundreds of millions.

DDT killed bald eagles because of its persistence in the environment. ''Silent Spring'' is now killing African children because of its persistence in the public mind. Public opinion is so firm on DDT that even officials who know it can be employed safely dare not recommend its use. ''The significant issue is whether or not it can be used even in ways that are probably not causing environmental, animal or human damage when there is a general feeling by the public and environmental community that this is a nasty product,'' said David Brandling-Bennett, the former deputy director of P.A.H.O. Anne Peterson, the Usaid official, explained that part of the reason her agency doesn't finance DDT is that doing so would require a battle for public opinion. ''You'd have to explain to everybody why this is really O.K. and safe every time you do it,'' she said -- so you go with the alternative that everyone is comfortable with.

''Why it can't be dealt with rationally, as you'd deal with any other insecticide, I don't know,'' said Janet Hemingway, director of the Liverpool School of Tropical Medicine. ''People get upset about DDT and merrily go and recommend an insecticide that is much more toxic.'' (emphases added)

Even if it could be established that DDT were harmful to birds in the minute quantities required for malaria prevention, I would still be for its widespread use - I know what it's like to suffer from malaria, and putting myself in the shoes of those children whose lives are unnecessarily at risk because of the blanket ban on DDT use, I know that I'd be cursing those who put the needs of the spotted eagle ahead of my survival.

What is most enraging is that, despite denials to the contrary when challenged in the media, I know from personal experience that more than a few environmental opponents of DDT use actually don't think the malaria pandemic is necessarily a bad thing, as they see it as a natural means of keeping human numbers on the continent down, and thereby safeguarding the continent's wildlife; similar sentiments have also been expressed about the "beneficial" effects of the tse-tse fly, again to my hearing.

I have news for those who'd put the welfare of wild animals ahead of that of their fellow human beings - Africa isn't just a gigantic game reserve, to be pristinely maintained for the benefit of filming documentaries to keep you suitably entertained. If "nature" means so much to you, concentrate your efforts on your own backyards, rather than trying to further your crusade on the shoulders of those who are too poor to have their voices heard on CNN and in international fora. Millions shouldn't have to die for the sake of an environmentalism that has become an ersatz religion for many comfortable westerners.