One should as a rule respect public opinion in so far as is necessary to avoid starvation and to keep out of prison. – Bertrand Russell Times on malaria: the solution is to deliver expensive drugs
The Times has an editorial today (Sun Oct 16) supporting greater efforts to combat malaria, which kills as many as three million people a year, almost all of them poor African children under five.
How many of cases of malaria are also counted among the roughly three million deaths worldwide ascribed to HIV?AIDS is not known, but since according to some reports deaths from almost any disease are counted as “AIDS” in Africa if it seems likely to promote US and other foreign aid, and death totals in sub-Saharan Africa reportedly do not observably reflect any new AIDS “pandemic”, it seems likely that many are moved under the “AIDS” umbrella.
In other words, much of “AIDS” in sub-Saharan Africa is likely malaria, a disease that has made a comeback with the banning of DDT and the migration of Africans to urban areas too close to water. According to the scientific literature, malaria prompts AIDS test cross reactions, so malaria survivors are liable to test positive for HIV antibodies ever afterwards,
The Times editorial is concerned with the failure of the Roll Back Malaria campaign to roll back malaria. More people are suffering from the disease than before, it seems.
The solution is clear to the Times editors.
After failed attempts to eradicate malaria, the emphasis today is on control, by spraying insecticides on interior walls and covering sleeping children with insecticide-treated mosquito nets, as well as using drugs to cure the disease.
Whether this means DDT is not stated, One assumes the Times writer means other insecticides, but then why does he or she not state this explicitly? How effective are other insecticides are, compared with DDT? Why have they failed to eradicate malaria overseas, when they are credited with keeping it out of the US since DDT?
The editorial doesn’t answer these questions, preferring to move on rapidly to considering the problem of treatment. In other words, it shows a strong bias towards dealing with malaria with drugs for the patients rather than insecticides for the mosquitoes that infect them,
The treatment of malaria is held back by the cost of new and better drugs, since the old ones grow ineffective.
The best treatments are drug combinations whose core ingredient, artemisinin, a plant extract long used in Chinese herbal medicine, is buttressed by an additional medication. Such combination treatments work in the vast majority of cases and have yet to encounter resistance. But because they cost 10 to 20 times as much as the standard drugs, international agencies have been slow to change.
The greatest killer of human beings in history, malaria before the 1940′s and DDT used to kill three million a year. 6 or 7 million cases occurred in the United States, mostly in the South and in California. With the help of DDT malaria was eradicated from the US in 1951. Malaria is now bigger than ever, however, one of the two huge disease scourges of the world, along with tuberculosis. The Times quotes 300 million, but possibly 500 million cases occur each year; the figure is uncertain because many do not or cannot seek care. Africa has most (85%) of the world’s malaria, which may be one reason why malaria research has been notoriously underfunded.
Critics reviewing the record complain vociferously that nearly all this suffering could have been prevented if DDT hadn’t been banned by the US in 1972, and that this banning was done on a political rather than a scientific basis, with “Silent Spring” by Rachel Carson the main scientific reference relied on rather than the extensive hearings conducted by the EPA in 1971, when 125 witnesses testified and 9,362 pages of testimony were recorded.
The hearing examiner Judge Edmund Sweener concluded in his report in 1972 that DDT was not a cancer or birth defect hazard to man, and when used according to the proper guidelines was not detrimental to wildlife and was urgently needed to combat malaria. His scientific advisors wrote an 80 page report unanimously rejecting the claims of environmentalists as unsubstantiated and that there was no reason to ban DDT. The World Health Organization stated during the hearings that “no economic alternative to DDT is available..the consequences of the withdrawl of DDT would be very grave and …the safety record of DDT is truly remarkable.”
We are drawing above on a recent book which contains a readable summary of this questionable episode, science fiction writer James Hogan’s remarkable “Kicking the Sacred Cow: Questioning the Unquestionable and Thinking the Impermissible” (Baen, 2004). Hogan says his account, which he calls “Save The Mosquitoes: The War on DDT”, draws heavily on “Ecological Sanity”, by George Claus and Karen Bolander, which devoted 600 pages to the debate. Hogan’s book is a fresh but extremely thorough look at a number of scientific heresies ranging across a number of fields. His treatment of the AIDS controversy is accurate.
Given the poor record of the New York Times in covering the scientific literature reviewing and rejecting HIV as the cause of AIDS, to which it has devoted a mere handful of reports (about five or six as we recall) in line with a superficial dismissal of the controversy within the field over twenty one years, we worry that it has made a similar error in dismissing DDT.
The New York Times
October 16, 2005
Editorial
How Not to Roll Back Malaria
Seven years ago, with much fanfare, international health and development agencies unveiled the Roll Back Malaria campaign, which was supposed to cut malaria deaths in half by 2010. Yet progress has been worse than sluggish: there are actually indications that more people are suffering from malaria now than when the campaign started. This is simply unacceptable. We know what needs to be done to control malaria. What is lacking is the drive and resourcefulness to do it.
Malaria, a mosquito-borne disease, kills more than one million people a year, mostly children. It sickens hundreds of millions more, and imposes $12 billion a year in economic costs on sub-Saharan Africa, the hardest-hit region. After failed attempts to eradicate malaria, the emphasis today is on control, by spraying insecticides on interior walls and covering sleeping children with insecticide-treated mosquito nets, as well as using drugs to cure the disease.
These simple tactics work well, but incredibly, they are not being used at anything near the rate that has been promised. Five years ago African leaders resolved that by the end of 2005, at least 60 percent of the vulnerable populations would have insecticide-treated mosquito nets and appropriate medicines. The targets for nets have been reached only in a few selected areas. Otherwise, distribution is lagging and many of those who get the nets have not been taught to use them regularly.
Most shocking has been a reluctance to use the right drugs. For decades malaria fighters relied on chloroquine, a pill so cheap it is often popped like aspirin at the first sign of high fever. Unfortunately chloroquine and another standard drug have become ineffective in many parts of Africa. The best treatments are drug combinations whose core ingredient, artemisinin, a plant extract long used in Chinese herbal medicine, is buttressed by an additional medication. Such combination treatments work in the vast majority of cases and have yet to encounter resistance. But because they cost 10 to 20 times as much as the standard drugs, international agencies have been slow to change. Last year, an article in The Lancet, a British medical journal, accused the World Health Organization and Roll Back Malaria of medical malpractice for providing ineffective drugs to malaria victims. Only then did the effort to provide the new, effective drugs quicken.
Some 33 African countries have now officially adopted combination therapy, but only 11 have begun to roll out the drugs and only a few have done so nationally. While start-up financing is available, many African leaders are reluctant to commit to higher-cost drugs with no assurance that there will be money to continue purchasing them indefinitely.
This is not the fault of selfish pharmaceutical companies. Novartis, which makes the best of the combination drugs, is selling it at cost and has ramped up production greatly despite limited demand. The company will produce 30 million treatments this year but has received orders for only 13 million. Nevertheless, it plans to produce 100 million treatments next year even without orders. Novartis should not be expected to take a huge loss for its corporate citizenship. The best and fairest way to get these drugs used would be to guarantee long-term purchases so that timid African leaders will consummate the switch, either to the Novartis product or other combination therapies.
International donors, though increasingly generous, still need to give more. Even with a big increase in financing through the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the United States is a hefty contributor, only about $600 million a year is currently available to meet needs estimated at $3 billion a year. Pledges of additional money from the United States, the Group of 8 industrial nations, the World Bank and programs financed by the Gates Foundation should swell the kitty. President Bush is to be commended for proposing to spend $1.2 billion over five years to fight malaria in 15 African countries, much of it for treated nets, indoor spraying and combination drugs.
But two worrisome problems remain. One is that international donors have a history of being more generous with pledges than with money. And even if the money comes, it has to be administered much more effectively than has been the case so far.
The Roll Back Malaria campaign, which was started by the World Health Organization and other United Nations agencies, has grown into an unwieldy partnership that includes nonprofit organizations, corporations, malaria-stricken countries and donor nations, including the United States. The campaign has been lambasted in medical journals for failing to move more aggressively, but no one seems accountable. Meanwhile, many African governments have not met their own promises for increasing health expenditures, and the United States Agency for International Development has come under scathing criticism from analysts who complain that it spends most of its money on consultants and technical help rather than needed materials.
After years of relative neglect, the war on malaria is finally getting the attention it deserves. But it desperately needs more effective leadership. With so many different players involved in a host of countries, perfect coordination will never be possible. But the core United Nations agencies that started Roll Back Malaria can be pushed for faster results. Kofi Annan should name a malaria czar, to apportion tasks and take the heat if goals are not met.
* Copyright 2005 The New York Times Company