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Malaria Scourge: The Facts, the Lies and the Politics By Dr. Felix S. Odaibo
In a series of articles, I shall discuss the issues of Malaria: The facts, that have been misconstrued or are not so well understood or known, the multiplicity of lies that have been churned out over the years and kept many people ignorant and misinformed as well as a discourse on the politics, both national and international, that has condemned the tropical and subtropical countries to penury and underdevelopment due to the scourging effect of malaria on their populace. Should we be questioning the lack of effective leadership role of World Health Organisation, WHO and its related organisations, either in relation to the issue of the premature banning of DDT or their slowness in appreciating the gravity of the changing landscape of chloroquine resistant malaria that had been sweeping right across the face of Africa since the 70's? How serious are they in truly tackling the problems that Malaria poses in these parts of the world today? When you come closer to home, how culpable are the elitist African governments and their agencies in not carrying out independent thinking and establishing effective programs that would have rapidly shrunken the extent of malaria since it affects, more frequently, the poorer and weaker members of their societies? What about the International Pharmaceutical companies? Why are they taking such an inordinately long time in switching to and manufacturing drugs that are effective in treating malaria in the face of the burgeoning drug resistant Malaria parasites and insecticide resistant mosquitoes? Is profit a motive in the tardiness of these companies in developing and manufacturing vaccines to Malaria parasites or are there other factors we do not know? Given the effectiveness of tackling other diseases such as polio and smallpox in the past, people may wonder if we are not simply witnessing the unfolding of a conspiracy between WHO along with other related world bodies on one hand, African governments and the International pharmaceutical industry in maintaining the status quo with regards to Malaria and Malaria control in Africa, on the other. Richard Worzel in his book "Who owns tomorrow" said 'Because travel is cheap and fast, it (Aids) became a global epidemic. Because it affects rich countries as well as poor ones, unlike malaria, it has become a cause celebre internationally, even though malaria kills many more people every year'. It is not an overstatement or exaggeration to say that rarely do you see the subject of Malaria hitting the headlines. Most of us that grew up in Nigeria have had at one time or the other been hit by it, and self managed it with impunity! That act in itself implifies a pitfall in the management and control of the disease. But the fact of the matter is, Malaria is one of Africa's great killers. It is claimed that whilst malaria is on the retreat in Asia and in South America, it is strongly on the offensive in Africa. Andy Seale of the World Health Organisation says "The disease itself holds Africans back, and stops development. Malaria keeps children away from school, it stops their parents from getting out into the fields, to harvest the crops and tend to the animals. In short, malaria keeps African nations poor. Without malaria there's no doubt that some of the poverty experienced in Africa would be relieved." From the foregoing, we know that WHO knows this, the Africans and their governments know this and the world at large know that without malaria, some of the poverty experienced in Africa would be relieved! So how long must this scourge go on before the bull is taken by the horns? Are all these talks about debt relief, eradicating poverty, glib talk or an attempt at just paying lip service to solving our poverty and underdevelopment issues when the true cause of our situation is so evident and so well documented? Barnaby Phillips in an article published on 25 April, 2000, looked at the impact of the disease in central Nigeria. He reported on Khadijat a 10-month-old whom he described as being lucky as her family had scraped together some money for a dose of chloroquine. The drug is subsidized, and has been sold for a pittance. Still, it said it is beyond the reach of many in Nigeria! In the village clinic, help is at hand for those who can afford it. He reported that Khadijat's mother, Chikina, says that all her three children have malaria. I am curious as to what he will discover if he were to follow up in year 2005 to find out what has become of these children. Would they still be alive or would they have succumbed to the other ravaging diseases that go concurrently with poverty?
In a country like Nigeria with the current foreign reserve hitting $27 billion dollars, the necessary resources are there. The logical question that follows is what is therefore holding back Nigeria and other relatively well off countries in Africa from eradicating Malaria, the greatest scourge the world has ever known, from this continent and from Nigeria in particular?
Several factors have been postulated as accounting for limited successes in eradicating malaria:
a) Lack of political will and commitment of successive Nigerian government in tackling it. b) Poor awareness and appreciation of the magnitude of the malaria burden right across the board. c) Poor health facilities and practices by individuals and in communities. d) Resistance to drugs and insecticides by malaria parasites.
The reality of living with Malaria in Nigeria is captured in an article published in Vanguard 26 July 2005 where a 28-year-old Donatus Ega, a resident of Central District of Abuja, visits a chemist or retail drug outlet whenever he is down with malaria. "I prefer going to the chemist than to go to the hospital to see a doctor because apart from the chemist being more affordable, it is also more accessible," He further revealed that apart from the convenience he gets from patronizing chemists, he often falls back on a local herbal remedy for malaria whenever the treatment offered by the chemist fails. "I take dogonyaro which I was told by a particular retailer contains 37 substances of which only three are safe for human consumption."
THE FACTS.
I shall spend quite some time talking
about the mundane facts of malaria as it is germane to understanding
and appreciating the lies, politics and the solutions that I shall
proffer eventually. So bear with me for the next few
pages whilst we go through the following text.
a) Historical perspectives. Malaria
is such a very old disease that prehistoric man is thought to have
suffered from it. The name is derived
from the Italian, (mal-aria) or "bad air" and it was also known as
Roman fever. Descriptions of the disease date back to 1600 B.C.
The Greek physician, Hippocrates, known as the Father of Medicine,
described it during the fourth and fifth centuries B.C. There were
numerous, sometimes bizarre, theories on how malaria was transmitted
until 1898 when Dr. Ronald Ross, a physician in the British Army
based in India, discovered that that female Anopheles mosquito was
actually responsible for transmitting the malaria parasite. This
discovery opened up an avenue for public health officials to target
their attack for disease control on the Anopheles mosquito. This
discovery revolutionized malaria control, which had hitherto often
been haphazard or based purely on treating the patient by killing
the malaria parasites.
b) Geographical
spread.- Malaria probably originated in Africa and
accompanied human migration to the Mediterranean shores, India and
South East Asia. In the past it used to be common in the marshy
areas around Rome. As Malaria is a
disease mostly of tropical and subtropical areas, it is
particularly prevalent in sub-Saharan Africa, but also common
throughout other tropical regions of China, India, Southeast Asia,
and South and Central America. Fishermen and traders, long
before British colonization, probably introduced the disease into
northern Australia and in the past malaria was not uncommon in the
northern parts of that country. WHO however declared Australia
free of malaria in 1981. Since that time however, many patients
have contracted locally acquired malaria. Malaria was also common
in the United States during the 19th and early part of the 20th
century. It was a leading cause of casualties among U.S. soldiers
during the Vietnam War and in the Pacific region during World War
II.
It is just about 30 years since
endemic malaria was finally eradicated in western Europe - Thanks
to Drainage, drugs and insecticide which contributed to malaria’s
disappearance along with improved sanitation, nutrition and living
conditions. The last major outbreak in the Netherlands was in
1946 when nearly 2,400 people were infected in the town of Zaandam.
There were seasonal epidemics in Southern Europe until the 1950s.
It was not until 1975 that the last pocket of indigenous malaria
in Greek Macedonia was considered eliminated and the World Health
Organization declared the European continent free of the disease. What is Malaria? Malaria is a parasitic infection transmitted to humans through the bites of infected female Anopheles mosquitoes. About sixty species of the Anopheles mosquito are major transmitters of the disease. There are 4 different types of Malaria parasites, Plasmodium falciparum, P. malariae, P. ovale, P. vivax. Within each species there are many variant strains. Worldwide, P. falciparum and vivax cause the vast majority of clinical cases and nearly all of the deaths and serious morbidity.
In Africa, P. falciparum, the most dangerous of the parasites, causes over 90% of all malaria infections. So far, entomologists have identified over 2000 species of mosquito, but only the Anopheles mosquito actually transmits malaria. In Africa the major vector of malaria is An. gambiae, and there are many members of this group of mosquito. The parasite after spreading rapidly through the bloodstream to the liver, emerges again into the blood stream, finally to settle in the red blood cells, where it multiplies and emerges in bursts of new organisms. These parasites, because of their large numbers, can cause particular damage to the nervous system, liver, and kidney. The resulting disease in humans can be devastating especially in young children and adults including westerners, pregnant mothers and their unborn babies as well as Nigerians in Diaspora who have been away from Nigeria or other malarious zones for more than 2 years and have either not developed natural immunity or have lost it. This group are also very vulnerable to cerebral malaria which can result in death within hours. Others die later from the infection either from overwhelming anaemia, liver or kidney failure. Generally speaking with untreated malaria, up to 20% of persons infected with falciparum malaria will die.
How do mosquitoes find their targets? With the process of breathing in people and animals, they exhale a mixture of moisture and carbon dioxide(CO2) and Octenol, a type of alcohol. Mosquitoes and other biting insects have ultra sensitive receptors which can detect the presence of these chemicals (kaironomes), from almost 100 feet away. Because the attraction is so powerful, the mosquitoes immediately fly toward the source of the chemicals. Additionally, circulating blood is warm so that human targets radiate body heat. Mosquitoes have sophisticated heat sensors to help them locate blood, their food supply, making mosquitoes, in effect heat-seeking missiles, following both exhaled gases and body heat directly to their target. Now you know some people tend to attract more mosquitoes than others! It is believed that mosquitoes can actually see their victims within 30 feet away. When they fly around the victim, they are actually looking for landing sites where the blood is closest to the surface.
Burden of Malaria in Nigeria. Nigeria's health care system as provided through the public sector, is organized in a three-tiered system. Whilst the federal government develops policies and guidelines, providing funding and technical support, as well as monitoring and evaluating implementation, the 36 states provide the second tier of the system. The third tier is at the level of the local government areas (LGAs). Although decentralization is a stated goal of the current health ministry, the States and LGAs primarily implement policies developed at the federal level. Local council health departments are required to establish educational malaria programmes. Malaria control is supposed to be a prime focus of these programmes. Despite all these years of independence, Nigeria has only 18.5 physicians per 100,000 population, compared to 210/100,000 in Canada. Nigeria boasts of 1.7 hospital beds per 1000 population. However, the bulk of these health resources are located in the south-western corner of the country (Source: WHO/UNICEF Joint Programme on Mapping for Public Health). One consequence of this distribution of health resources can be seen in maternal mortality data: maternal mortality is 339 per 100,000 live births in the southwest, where the health infrastructure is strongest, and 1,716/100,000 in the northeast of the country. The stark reality of this scourge in Nigeria is as follows: a) In Nigeria, there is an estimated 25% -30% of mortality in children under five, or an estimated 300,000 deaths each year due to Malaria. b) In a research article, "Malaria in Nigeria: a revisit", Salako LA, et al of Clinical Pharmacology Unit, University College Hospital, Ibadan, found a high frequency of asymptomatic malaria parasitaemia in rural and urban school-children aged six to 12 years in south-western Nigeria between January 1987 and October 1988. Asymptomatic malaria parasitaemia was detected in the rural school-children all year round with the lowest parasite rate in January and the highest in July, corresponding to the mid-dry and wet seasons respectively. This was also noted to be common amongst urban school-children, but the frequency was lower than in the rural children. Of 7713 patients clinically diagnosed as having malaria 4425 were found to have parasitologically-proven malaria.
c) In April 2004 Nigeria's Minister of Health reported that Nigeria spent over $1 billion annually in treating malaria, and that malaria was the cause behind one out of three deaths in children, and one out of ten deaths of pregnant women. He cited chloroquine resistance as a growing problem, owing in part to counterfeit drugs.
d) On the same vein, Dr. Bamgboye Afolabi, a Director at the World Health Organization (WHO), while delivering a lecture on Current Trends in Malaria Management organized by the Lagos State Ministry of Health, disclosed that residents of Lagos State spend about N1 trillion annually on Malaria treatment. According to him, if each family spent an average of three million families would spend about N3.8 billion annually on prevention of malaria, excluding the cost of purchase of mosquito coils, nets, transportation, days of consultation at various hospitals, drugs, wrong diagnosid, cost of care for child left at home during consultation with health officials and low productivity, etc.
Malaria Control. Political Aspects.
The Roll Back Malaria Initiative
being the pre-eminent program in Nigeria predicated the
holding of the African Summit on Roll Back Malaria, being
initiated and hosted by Nigeria’s President Olusegun Obasanjo
in Abuja on 25 April 2000.
The Abuja Summit produced the Abuja Declaration, endorsed by all African Heads of States and Governments in attendance.
The Declaration
promises to: Milestones set for the RBM scheme included:
2001
- Revision and distribution of National drug policy on malaria
treatment and prophylaxis
2003
- Ensure availability of pre–packaged drugs in all
(100%) health facilities
2005 -
Network of laboratories to be strengthened and operated
at optimal capacity Certain facts are important for malaria control. It is important to appreciate the three major tools that are currently used to combat malaria: controlling mosquitoes, reducing human–vector contact, and preventing and treating disease with drugs. I shall not go into the details though interesting life cycle of the malaria parasite, suffice to say that soon after the emergence, the mosquito adults mate and the female goes in search of its first blood meal. If this contains gametocytes of malaria parasites, the parasite undergo fertilization in the mosquito's stomach, the complete process lasting over a period of about 12 days, before the parasites populate the mosquito's salivary glands. During subsequent feeds the injection of saliva into the host carries parasites (sporozoites), which may establish a new malaria infection in the host. During the approximately 12 days required for sporozoite development, a member of most female tropical anopheline mosquito species would be expected, if it survives, to re-visit houses 3 or 4 times to take bloodmeals and thus initiate new cycles of egg development.
Approaches at malaria control.
Mosquito Larval control also contributes to some malaria vector
control programs, especially where larval sites are limited in
extent and are definable - e.g. wells and water tanks in urban
areas. In rural areas and in the wet tropics such as in Nigeria,
it is important to appreciate that the Anopheles
mosquito may breed in every water filled can, pot, broken
bottle, gutter which abounds in Nigeria making larval control
an almost hopeless undertaking. Vector control has saved millions of lives worldwide, through indoor residual spraying, environmental management to eliminate breeding sites, and use of mosquito larvicides. There are various methods of vector control and they are not necessarily mutually exclusive. Because the Anopheles mosquito normally bites in the early evening and through the night, not during the day, many of these methods focus on protecting dwellings and their inhabitants.
IRS - One of the most effective methods of vector control is Indoor Residual Spraying (IRS). If the mosquito can be killed at any one of those 3 or 4 house visits it can never develop sporozoites and become a disease vector. It is this fact which is the key to most successful malaria vector control programs which aim to increase the dangers of house visits for adult mosquitoes. Most Anopheles mosquitoes do not feed during the day but rather do so at dusk or during the night. An. funestus for example feeds most actively between 2am and 4am. In this method, a sprayman sprays the inside walls of houses with residual insecticides. When mosquitoes rest on the walls, they absorb the insecticide through their feet. The pesticide either kills them immediately or soon afterwards. Spraying continues to play a major role in malaria control in much of Latin America and in parts of Asia. But its cost, logistical complexity and moderate efficacy make it poorly suited for controlling malaria in rural areas of sub-Saharan Africa. In Manitoba, Canada, attempts have been made to reduce the mosquito load by releasing Dragon flies. As a group of insects, they are increasingly being viewed as beneficial for their role in insect pest control. There is presently an ongoing survey on these insects. Bats, as well as dragon flies, are also heavy consumers of mosquitoes. It is probably not possible to increase the bat population in a given place by introducing new ones since they have a strong homing instinct and are likely to go back where they came from. ITN - In another method of control, a person sleeps under insecticide treated nets (ITNs). The ITN works not only by creating a barrier between the mosquito and its intended meal, but also by killing the mosquito if it lands on the net. Reduction of human–vector contact through insecticide-treated bednets is better suited for malaria control in Africa, enjoys greater community acceptance and is as efficacious as indoor residual spraying. But although they are inexpensive and effective, fewer than 2% of Africans sleep under them. Massive campaigns to increase their use are required as a matter of urgency especially in rural Nigeria,
Countries around the world use other methods of vector control with varying degrees of success. These methods include larviciding (killing with insecticides the mosquito larvae before they hatch), the removal of breeding grounds by drying up wetlands or ensuring that pools of standing water are drained or by using biological controls such as fish that eat mosquito larvae. The success of these controls depends highly on the type of vector and its breeding habits, the geography of the area and the socio-economic status of the population at risk.
Other strategies include: intermittent preventive treatment in infants (IPTi) uses existing drugs to protect infants from the worst effects of the disease. Infants receive an antimalarial three times during the first year of life at the time of routine immunization, whether or not they have malaria. Two studies in Tanzania have shown that IPTi reduces malaria and anaemia in the first year of life by up to 60% . IPTi has the potential to become a major tool for malaria control in Africa because it can be delivered through the Expanded Programme on Immunization (EPI), one of the best-functioning systems of regular health contact with young children in Africa. Presently, the cornerstone of malaria control worldwide remains effective and inexpensive drugs.
Drugs. Quinine has been used for more than three centuries and until the 1930's it was the only effective agent for the treatment of malaria. It is one of the four main alkaloids found in the bark of the Cinchona tree and is the only drug which over a long period of time has remained largely effective for treating the disease. Partly because of undesirable side effects, it is now only used for treating severe falciparum malaria .
Mepacrine developed in the early 1930's is now considered to have too many undesirable side effects and is no longer used. It was used as a prophylactic on a large scale during the second world war (1939-45) when it was then considered a safe drug. It had a major influence in reducing the incidence of malaria in troops serving in South East Asia. Chloroquine first used in the 1940s shortly after the Second World War is a low cost drug but very effective for treatment and prophylaxis. It was used in curing all forms of malaria, with few side effects when taken in the dose prescribed for malaria. Unfortunately most strains of falciparum malaria are now resistant to chloroquine. Chloroquine resistant vivax malaria has also been reported.
Fansidar is a combination drug, popular in Nigeria in the 70 to 80's. Each tablet containing sulphadoxine 500mg. and pyrimethamine 25mg. It is no longer recommended because resistance to Fansidar is now widespread and serious side effects have been reported.
Maloprim is a combination of dapsone and pyrimethamine. Resistance to this drug is now so widespread that its use is no longer recommended.
Mefloquine
(Lariam) was first introduced in 1971, and
it is related structurally to quinine. The compound was
effective against malaria. Its long half life meant it
served as a good prophylactic. Increasing resistance and
together with undesirable side effects including acute brain
syndrome has resulted in a decline in its use.
Halofantrin (Halfan) belongs to a class of compound called the phenanthrene-methanols and is not related to quinine. It is an effective antimalarial introduced in the 1980s, but due to its short half life of 1 to 2 days, is therefore not suitable for use as a prophylactic. Unfortunately resistant forms are increasingly being reported (initially in Cameroon and Senegal in West Africa) and there is some concern about side effects such as neuropsychiatric disturbances. Other side effects include abdominal pain, diarrhoea, itchiness and skin rash. It is not recommended for use in pregnancy nor is it advised in women who are breastfeeding.
Artemisinins is derived from a Chinese herbal remedy and covers a group of products. The two most widely used are artesunate and artemether. While they are widely used in Southeast Asia they are not licensed in much of the so called "Western World" . A high rate of treatment failures has been reported and it is now being combined with mefloquine for the treatment of falciparum malaria.
Traditional Medicine. An initial symposium held at Oxford University in September 1995 on plant-based antimalarials held at Oxford University. This symposium was part of an international conference on traditional medicine and public policy organised by the Global Initiative For Traditional Systems (GIFTS) of Health. RITAM was established during 1999 as a network of researchers and others active or interested in the study and use of traditional, plant-based anti-malarials.
Utilization of traditional medicine is widespread in non-industrialised countries. The efficacy of many traditional treatments have been well documented, including malaria and other parasitic disorders. Currently, modern pharmaceuticals are not available in constant supply in those areas most affected by malaria - particularly in sub-Saharan Africa and in South and SE Asia. The increasing adulteration and faking of drugs in Nigeria has rapidly convinced the people of the futility in buying and relying on those drugs. Furthermore, the cost of drugs, if available and effective, is so high that institutions and patients are increasingly unable to afford them unless subsidized. Reports from clinics and NGO’s in Africa, where 80% of the world’s malaria burden exists, indicate that the poorer members of society such as Mr Donatus Ega are now using traditional medicine at least for economic reasons. The two most effective drugs for malaria originate from plants: quinine from bark of the Peruvian cinchona tree, and artemisinin from the Chinese antipyretic Artemisia annua. It is probable that other plants such as dogonyaro contain as yet undiscovered antimalarial substances. Much research has focused on trying to isolate and purify these from plants. However, there has been almost no research into the clinical effectiveness of herbal remedies as they are used in real life. However recently, a study that involved the extraction of component compounds of both pawpaw and mango leaves, the evaluation of their active constituent and their employment in the treatment of trypanosomiasis in laboratory infected mice inoculated with the Trypanosoma brucei species, was carried out by researchers at the College of Medicine University of Lagos (CMUL), Idi-Araba, led by Dr. Veronica Okochi.
National malaria control programmes have largely ignored the potential of traditional healers, even though they are more numerous and culturally accepted than conventional health care workers. The same Veronica Okochi is involved with Nigerian Natural Medicine Development Agency (NNMDA) Victoria Island, Lagos in developing a herbal preparation made up of garlic, ginger, lemon grass, grapefruit, basil and neem tree for the treatment of malaria. Though the anti-malarial activity of the herbal preparation needs a high dose of 32000mg/kg body weight to achieve a 100 per cent clearance of the malaria parasite in three days, almost the same result recorded with 10mg/kg body weight of Artesunate.
Vaccine Production. I used to wonder why all sorts of vaccines have been formulated but not to Malaria, considering that vaccine to flu, a virus known for its rapid replicating propensity, are now commonly available. The truth of the matter is that many factors make malaria vaccine development difficult and quite challenging. First, the size and genetic complexity of the parasite mean that each infection presents thousands of antigens to the human immune system. Understanding which of these can be a useful target for vaccine development has been complicated and time consuming, and to date many promising ones have been identified.
Secondly, the parasite changes through several life stages even while in the human host, presenting a different subset of molecules for the immune system to combat at each stage. Thirdly, the parasite like Schistosomiasis has evolved a series of strategies that allow it to confuse, hide, and misdirect the human immune system. The continued success of the parasite is due in part to its ability to alter its surface proteins to deceive the host immune system, and to suppress immune responses to its quiescent liver stage. To develop vaccines and drugs that exploit these vulnerabilities in the parasite's biology necessitates a complete understanding of the parasite and its complex relationships with its human and mosquito hosts. This is where cracking P. falciparum's genetic code published in 2002 presents a ray of hope, as this has energized the malaria scientific community and has also served to attract a much broader range of scientists to join the effort in discovering an effective vaccine. These scientific establishments, both private and governmental, have brought technologies such as gene chips, proteomics and comparative genomics to research, though for now, no extraordinary breakthroughs are forthcoming. Gene-chip technologies are useful in studying how the parasite is forced to alter, to avoid the immune system, how it responds to drugs and to identify mutants that confer resistance. Malaria vaccine has not been forthcoming for quite sometime, but the rising funding levels, promising scientific advances, and heightened global awareness of malaria have increased commitment to develop an effective malaria vaccine as soon as possible. An article published in the Lancet about Malaria Vaccine trial, are the most promising yet. The vaccine was used to protect 2,022 children in Mozambique and cut the risk of developing severe malaria by 58%. The vaccine is directed against the form of the malaria parasite, sporozoite. The team is led by a Spanish expert from the University of Barcelona, working with drug company GlaxoSmithKline, created through a grant from the Bill & Melinda Gates Foundation, to overcome barriers to malaria vaccine development - the PATH Malaria Vaccine Initiative. It is very encouraging that among the under two year olds in the study, the vaccine was 77% effective against severe malaria.
Mosquito modification.
Insecticides. DDT controversy- DDT (dichlorodiphenyltrichloroethane), an organochlorine pesticide, became widely used in pest control after scientist Paul Herman Muller discovered its insecticidal properties in 1939. Hailed as a major public health achievement, this discovery earned Muller a Nobel Prize in 1948 because it provided an affordable way to manage major public health risks carried by mosquitoes, lice, and other vectors. DDT helped cleanse Nazi war victims of disease-ridden lice, protected allied troops against vermin and typhus, and became a key tool in fighting malaria around the world-saving millions of lives.In the United States.Rachel Carson’s Silent Spring, published in 1962, highlighted the environmental problems and notably its impact on birds of prey. Three years after the publication of Silent Spring, Paul Müller died in 1965. After seven months of testimony despite the fact that EPA Administrative Law Judge Edmund Sweeney stated that “DDT is not a carcinogenic hazard to man. ... The uses of DDT under the regulations involved here do not have a deleterious effect on freshwater fish, estuarine organisms, wild birds, or other wildlife. ... The evidence in this proceeding supports the conclusion that there is a present need for the essential uses of DDT!
EPA head [and
Environmental Defense Fund member/fundraiser]
William Ruckelshaus - who had never attended a single day’s
session in the seven months of EPA hearings, and who admittedly
had not even read the transcript of the hearings - overturned
Judge Sweeney’s decision. Ruckelshaus declared that DDT was a
“potential human carcinogen” and banned it for virtually all
uses. The US banned DDT in 1972. Many other
countries followed suit. The Swiss authorities were reluctant to
act but when Canadian and US authorities started to restrict
importation of Swiss cheese because of DDT residues, they had to
react so they banned DDT within a few months However, some nations still effectively use DDT for malaria control. For example, Ecuador has increased its use of DDT since 1993 and has experienced the largest reduction of malaria rates in the world. When South Africa removed DDT from its malaria control programme in 1996, one of the worst malaria epidemics in the country's history followed. When DDT spraying stopped as happened in South Africa and several South American countries in the 1990s, the number of malaria cases exploded. Only when South Africa reintroduced DDT in 2000 did it manage to bring the epidemic under control. Read about it in http://news.bbc.co.uk/1/hi/world/africa/4264374.stm
Arguments about DDT applied to field crops
accumulating in food chains are considered inapplicable to DDT
sprayed inside houses. However, unfortunately in low income
countries it is almost impossible to prevent illicit diversion
of insecticides intended for anti-malaria use to farmers.
In
2001, more than 120 countries signed up to a global treaty – the
Stockholm Convention - banning the use of 12 chemicals known as
Persistent Organic Pollutants. The treaty made provision
for about 25 countries to continue using DDT to combat malaria
in accordance with WHO guidelines until they could develop
cost-effective alternatives.
Private Sector Initiatives. PATH http://www.path.org/ is an international, non-profit organization that creates sustainable, culturally relevant solutions enabling communities worldwide to break longstanding cycles of poor health. The PATH Malaria Vaccine Initiative (MVI) is a global program established through an initial grant of $50 million from the Bill & Melinda Gates Foundation, which later awarded it an additional $100 million. MVI’s mission is to accelerate the development of promising malaria vaccines and ensure their availability and accessibility for the developing world, including supporting a clinical trial that proved to be one of the most significant advances in malaria vaccines in decades. The Harvard Malaria Initiative (HMI), founded by the Harvard School of Public Health in 1997, focuses on basic scientific research on disease mechanisms in malaria, using findings to discover and develop new drug and vaccines therapies for the disease. http://www.malariavaccine.org/down-links.htm "Because drug resistance is a major problem with malaria, we must do the research to find antimalarial drugs. Genomics is one path to development of drugs and vaccines to treat and prevent malaria," said Dr. Wirth. The sequencing of the malarial parasite’s genome will be instrumental in helping identify new drugs and vaccines. Exxon Mobil donates to this fund.
The Global Fund http://www.theglobalfund.org/search/portfolio.aspx?countryID=NGA&lang=en was created to finance a dramatic turn-around in the fight against AIDS, tuberculosis and malaria by helping to finance 108 million bed nets to protect families from transmission of malaria, thus becoming the largest financier of insecticide-treated bed nets in the world. It is also helping the delivery of 145 million artemisinin-based combination drug treatment for resistant malaria. Within Nigeria, http://www.theglobalfund.org/search/portfolio.aspx?countryID=NGA&lang=en Yakubu Gowon Center for National Unity and International Cooperation is the Principal recipient of the fund. With the Malaria roll back program, the grant was signed 22 October 2004. Of the total $44+ million requested, almost $21million was approved with $8.7 million disbursed so far. The objective of the proposal is to reduce malaria mortality and morbidity in children under 5 and pregnant women by 30% by the year 2007. Another sum of $20.4 million has been approved for Improving Malaria Case Management Through Promotion and Distribution of Pre-packaged Artemisinin-based Combination Therapy (ACT) and Training of Health Service Providers in Nigeria.CHEVRON - The aim of CNL’s malaria control programme is to reduce the impact of malaria on employees, their families and the communities in which they live. CNL’s malaria prevention efforts focus on raising awareness, provision of subsidized ITNs, rapid responses to increases in incidence and prophylaxis. It has implemented around the clock availability of one day ‘rapid diagnosis’ tools to encourage early definitive diagnosis. Employees, dependants and contractors have access to free treatment through CNL medical facilities.
EXXON MOBIL - In 2004, ExxonMobil gave more than $2 million in research and partnership grants to global health organizations to combat malaria in African communities. The grants are to improve treatment, educate citizens, and help prevent the spread of malaria. While community education, bed nets, and medications can be effective in treating the disease, ExxonMobil is working to combat this global health threat through a concert of public/private partnerships to tackle the disease from multiple angles. Nigerian Breweries and other national and world groups have, through their private programs worth mentioning but for lack of space, been making contributions to Malaria eradication programs.
In summary, malaria, believed to have originated from Africa, has been around for centuries. This scourge has exerted major and untold economic and social burden on Africans, Nigeria and Nigerians in particular. Whereas with improved socioeconomic conditions and the extensive use of DDT in the past, the rest of the world have virtually eradicated Malaria in their respective areas .
The world bodies responsible for monitoring the Malaria situation in Africa have dragged their feet in many ways and the ineffectual and ineffective public policies of most of the African governments and their agencies who have been extremely tardy in getting on top of the problem has helped to propagate this undesirable situation. When you add the lack of funding, until recently, in tackling the issue of vaccine production, then it is easy to appreciate why we are where we are with the Malaria issue in Africa! These and other aspects of the lies, politics and profferred solution to Malaria scourge will be discussed in the next article . Dr Felix Odaibo is a Consultant Physician in Alberta Canada. He is an elected member of the Council of the College of Physicians and Surgeons of Alberta. He was previously Asst. Professor of Paediatrics in University of Manitoba, Winnipeg and former Councillor of the College of Physicians and Surgeons of Manitoba
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