Mosquito/Malaria Control (48)
I am delighted that someone has found an example of malaria con-
trol that did not use insecticides. Richard Willis at Princeton
has pointed us in the direction of the efforts in the Zambian
copper belt in the 1930s, and continuing into the 1940s. The re-
port documenting this prepared by Jürg Utzinger, Yesim Tozan and
Burton H. Singer at the Princeton University Office of Popula-
tion Research is very interesting and very encouraging.
So that there is no confusion, I am interested in helping Bill
Nesler and a growing group of his colleagues put together a com-
prehensive plan that will reduce the incidence of malaria cost
effectively and sustainably in severely affected areas. One pos-
sible location for this is in Monrovia, Liberia.
The Willis feedback is interesting... because what it shows is
that there has been success in first: getting control; and, sec-
ond: staying in control. The cost to get control was substan-
tial. The cost to maintain control was substantially less.
The work of WHO and UNICEF in the 1950s and early 1960s did not
have quite the same impact, and certainly not as quickly. The
difference, I would surmise, is that the Zambian situation was
one where the scope was really quite limited and the intensity
of the initial effort did get the whole malaria cycle under con-
trol in the first annual cycle, something that has not often
been accomplished. WHO and UNICEF essentially ran out of money
and other priorities took over.
I am an accountant. I am therefore always somewhat sceptical of
the "costings". In a project that one tries to mount today,
there is no colonial corporate organization that are committed
to serious improvement of the local environment... and therefore
costings for a modern project have to include the complete man-
agement structure needed to ensure success. This is not cheap.
In the Zambian situation I would think that the costs of "manag-
ing" the project were absorbed by the mining company, and are
not reflected in the figures reported. I also note that it seems
that there were quite important "clearing" of the rivers and
marshlands... something that modern environmentalists might con-
sider quite anti-social as these areas, while being great for
mosquitoes are also critical in the life-cycle of all sorts of
other species. As a former CFO of an international fishing com-
pany, I have a huge respect for the importance of wetlands and
the mangroves in the profit performance of a fishing company...
and the maintenance of a healthy eco-system!
I was interested to see the response from Isaac Kigozi. As Bill
Nesler has pointed out aerial spraying to kill mosquitoes is NOT
agricultural spraying... the amounts of insecticide involved are
very different. The purpose is to kill mosquitoes at least cost
and with the minimum of collateral damage of any sort. The ref-
erence to the Bush initiatives is interesting... and I am sure
people on this list have already seen reference to the aerial
spraying that has been done in the United States by the Air Na-
tional Guard in the last few weeks in the aftermath of the
Katrina and Rita hurricanes to ensure that there is no major re-
establishment of a dangerous mosquito population. It has been
done several times after hurricanes in various parts of the USA.
In the comprehensive program that I hope will become "standard"
there should be the best possible use of ALL available interven-
tions. In Monrovia, Liberia there is a marsh/wetland area right
in the middle of the city... the ONLY practical way to address
mosquitoes in this terrain is aerial spraying. In parts of the
city ground fogging will be practical. In addition interior re-
sidual spraying (IRS) might be a good intervention, and insecti-
cide treated bednets (ITN) might be a worthwhile intervention.
The most cost effective program is going to be one where the in-
cidence of both mosquitoes carrying malaria and humans carrying
malaria is rapidly reduced. Timely local analysis of progress
using science based facts will give the feedback needed to opti-
mise the operations. Success will be when malaria causes sub-
stantially less death and illness.
There is a secondary debate going on concerning DDT. In terms of
cost and effectiveness DDT is an attractive insecticide for
anti-mosquito interventions. It was originally banned by the EPA
(Environmental Protection Agency) in the USA in the 1970s based
on a growing concern about its environmental impact. In retro-
spect it would have been better to limit its use rather than to
ban its use. Prior to the ban, it was almost certainly overused
and therefore was becoming an issue in the environment... but
the nature of the issue is still not entirely clear. Other
chemicals were also in the environment and might easily have
been the causal factors in the some of the experiments that were
conducted. Recent results from using DDT on a rather limited
scale in Southern Africa look very good... and with reasonable
care, the outcome in terms of malaria reduction, and related re-
duction in mortality and morbidity is way more beneficial than
the possible limited collateral risks.
Lastly... I have not had any feedback offline about NOT working
at addressing the malaria crisis in Africa... all I have had is
encouragement. The question is how to do it the best possible
way... at the best possible cost... with durable results... and
how to get something like this funded.
I am not coming at this from an academic and theoretical per-
spective. Though I now live in New York... I have spent a lot of
time over the past 30 years in malaria affected areas... many of
the staff I have been responsible for have had malaria, and
their children have died. Many of these people have talked to me
over the years about why was malaria being addressed in the old
colonial days, and not in the post colonial times. Why is it not
being done by the independent government authorities and by the
new international official relief and development assistance
(ORDA) community. Maybe the answer is that if you visit Africa
and stay in air conditioned housing and air conditioned offices
and air conditioned cars... and have the latest in prophylactic
medication... malaria may not bother you very much. But for most
Africans... I am bold to say... malaria is at the very top of
the things to be solved.
Sorry about the length of this... but malaria death should have
ended long ago... we have just put money in the wrong places.
If I have this wrong... please let me know.
Tr-Ac-Net in New York
The Transparency and Accountability Network
With Kris Dev in Chennai India
and others in South Asia, Africa and Latin America