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DDT and malaria control

In a clear departure from its earlier stand on dichlorodiphenyl-trichloro ethane (DDT) not being a high priority component of the anti-malaria programme, the United States Agency for International Development (USAID) recently endorsed indoor spraying of DDT in countries where efforts to control malaria had failed. The World Health Organisation, a staunch supporter of DDT for indoor spraying, is soon expected to come out with its revised guidelines. After being hailed as a miracle chemical in controlling malaria for nearly three decades, DDT became one of the most discredited insecticides since the early 1970s; the U.S. banned it in 1972 on environmental grounds and many European countries soon followed suit. The USAID's policy reversal will mean that in the battle against malaria, which annually kills one million people around the world — nearly 90 per cent of whom are from Africa — DDT will once again play an important role. USAID, one of the largest funding agencies for malaria control, had not banned the use of DDT, but it did not provide funds for using it either. With many African countries dependent on external funding for fighting the disease, denial of funds meant denial of one of the cheapest and effective options available. This, despite the 2001 Stockholm Convention on Persistent Organic Pollutants permitting countries to use it in their public health programmes.

The reversal of USAID's policy amounts to an admission that the priorities and concerns of developed countries cannot be imposed on many African countries. The lessons learnt from indiscriminate and non-specific target use of DDT should be borne in mind though. WHO maintains that the use of DDT is acceptable but it "should only be used in well defined, high or special risk situations." Considering that its use in agriculture was widely prevalent before being banned in the 1970s, the task of ensuring that the insecticide does not get diverted for agricultural use should get priority. Instances of such diversion that have come to light in India, where its use for indoor spraying is permitted, are a clear pointer. Though it will be one of the most challenging tasks, the price paid for not accomplishing it will be high. Chances of mosquitoes developing resistance to DDT are real; cases of such resistance have been reported in rural India where it is routinely used for vector control. For indoor spraying to be effective, strict adherence to WHO norms is imperative. If indoor spraying will result in a sharp reduction in malaria incidence, greater benefits will accrue from making bed-nets impregnated with insecticides easily affordable by the poorest of the poor. According to the Global Fund, only about two per cent of the children in Africa use such bed-nets. The long-term strategy should be to find non-chemical ways of fighting the vector. Global funding agencies that have been reluctant to fund DDT programmes should not shy away from this task.

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