Refugees at Peace
Time
Mosquito Nets
and why Malaria is still an issue
By Nnamdi Okose
There is a malaria TV advertisement staring David Beckham.
The great footballer soliloquizes about how he never misses a free kick when he
is in the ‘zone’. Placing the ball outside the 18 yard, he fires a shot which
curves and hits a hapless stadium worker crossing the goal area. At the end of
the advert, the words, ‘we need nets appear boldly’. The ball obviously
signifies mosquito or malaria and the hapless stadium worker the victim. Or the
African.
The world Health report presented at Geneva in December 2011 did suggest a 33%
drop in mortality in the WHO African Region. This fall in mortality rate was
attributed to the use of bed nets. Of course, the report does issue a warning
that mortality will increase if funding drops. I did ask a medical doctor
whether he felt that there has been a drop in the incidence of malaria since
2000. In his opinion there wasn’t any significant drop in the incidence of
malaria since 2000. If the drop had been up to 33% it would have been
celebrated. Perhaps there has been a significant drop in mortality but not in
the incidence of malaria.
As malaria continues being a problem in Africa,
the recurring question is not whether we receive enough nets but whether we
need nets at all. This would mean challenging conventional wisdom that the best
way to prevent mosquito bites and therefore malaria is the use of mosquito nets.
Questioning whether the African deserves to be put under tents even at peace
time would mean challenging conventional wisdom that the best way to prevent
mosquito bites and therefore malaria is through the use of mosquito nets.
The use of mosquito nets probably dates back as early as
late 69-30 BC, these were the years that the legendary Cleopatra lived.
Cleopatra was said to have used a mosquito net. From 30 BC to 1882 AD the use
of mosquito nets completely faded into oblivion till an American medical doctor
made a spurious suggestion. Albert Freeman Africanus King one of the medical
doctors who attended to Abraham Lincoln at his assassination discovered the
link between mosquitoes and malaria. The great doctor who won a Nobel Prize
some years later after this discovery also suggested that a wire screen, the
size of the Washington Monument be erected around Washington for eradication of malaria.
Obviously, this would have been the biggest mosquito net ever made or conceived
and the idea was laughed away in those days. In 1998, when the Roll Back
Malaria programme was launched, more that 116 years after Dr. Africanus King’s
spurious suggestion, the use of insecticide treated nets became the pillar of
the program.
The preceding story about Dr. Aficanus King may serve not
only to juggle our minds on the historical facts about malaria but to show that
malaria was a big problem in America
as at 1882. In an academic article written by Robert Sallares et al, titled The
Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old
Problems, we are not only regaled with historical perspectives of the
existence of malaria in antiquity from the ancient Greeks to the ancient Romans
but we are reminded that despite the erroneous belief that “white men” (Europeans)
met mosquitoes in Africa for the first time, mosquitoes and malaria have always
been a problem in Europe. Sallares did opine that malaria was eradicated in
southern Europe between the 1930s to 1940s.
In 1948, another Nobel prize for medicine was awarded for
malarial reasons to Paul Herman Müller, a Swiss Chemist who discovered dichlorodiphenyltrichloroethane
commonly known as DDT. This was not surprising since DDT was widely used during
the Second World War and after that for the eradication of Malaria in Europe
and America.
Of course DDT did not work like magic; it had to be carefully and strategically
applied. History is replete with how DDT was even dusted on human beings to get
rid of typhus and lice.
In 1962, an American biologist Rachel Carson published a
book that was to change the environmental climate of the world forever. In the
book titled Silent Springs, Carson
published her findings showing how the use of pesticides damaged wild life,
caused animals to become impotent, killed fishes, confused the biological
clocks of birds and caused cancer in humans. Among the guilty chemicals, the
major receptor of her passionate attack was DDT. Her findings were startling
and were rejected for about 6 more years. In 1969, the Global Malaria
Eradication Programme which used DDT as its major tool was discontinued. But by
that same year, malaria was no longer a problem either in America or Europe.
It had been eradicated by DDT.
After 1969, DDT was demonized. Every known cancerous ailment
was attributed to it including breast cancer. Rachel Carson had opened the eyes
of the world to its silent springs but had not proffered any solution to the
teeming number of dying people in Africa. It
is interesting that many years after Carson
published her book, her findings were not seriously challenged. An anonymous
essay titled Rachel Carson’s Silent Springs and the Beginning of the
Environmental Movement in the United
States, recounts the “howl of indignation”
that the book was greeted with by the members of the chemical industry. There
were accusations that Carson
was not qualified to make such statements, that her findings were “passioned
up” but without any scientific proof, Rachel Carson was still right.
In a commentary in the Lancet medical journal of 2000, A.G
Smith brought forward the scientific antithesis to Carson’s Silent Springs. He states
that, “The early toxicological information on DDT was very reassuring; it
seemed that acute risks to health were small. If the huge amounts of DDT used
are taken into account, the safety record for human beings is extremely good.
In the 1940s many people were deliberately exposed to high concentrations of
DDT through dusting programmes or impregnation of clothes, without any apparent
ill effect. There are probably few other chemicals that have been studied in as
much depth as has DDT, experimentally or in human beings”. In the same edition
of the Lancet, D. R Roberts et al agree that, “When a malaria-endemic country
stops using DDT, there is a cessation or great reduction in numbers of houses
sprayed with insecticides, and this is accompanied by rapid growth of malaria
burden within the country.”
This essay does not suggest in anyway that DDT is not
harmful. But it is important to contend that other insecticides which normally
contain synthethic phyrethroid, allethrin, cyfluthrin, permethrin, tetramethrin
etcetera, are also harmful to humans. In essence, a commonsensical way of
seeing it is that any thing that would poison an insect would also poison a
human. But is the minimal risk to humans enough to give a dog a bad name? Take
for example the case of Kraisana Kraisantu one of Thailand’s most foremost
pharmacists and the woman who made generic HIV drugs cheap in Thailand. Zidovudine
was the substance in the HIV drug , a nucleoside analog
reverse-transcriptase inhibitor which was known to be quite dangerous to
handle. But Kraisantu knew that with the right precautions, many lives would be
saved in the long run. Her colleagues did not share this feeling and she had to
work by herself developing this medicine for 6 months. The drop in the death
toll of HIV is attributable to her.
The fight against malaria can be perhaps viewed as a battle.
In this battle the enemy happens to be the mosquito and its bullets malaria.
The mosquito nets are trenches, bunkers, and refugee tents where the wounded
soldiers or the civilians or perhaps the war shy soldiers hide out. But the
irony of this war is that everybody catches the bullet no matter how we dodge
the bullets. Just like David Beckham, the mosquitoes never miss when they are
in the ‘zone’ and they always happen to be in the ‘zone’. In this battle, instead
of hiding out in nets, the best strategy would have been the strategic
elimination of mosquitoes. And using DDT may be the only starting point.
Carlos Catão Prates Loiola in his research titled The Use
of DDT in Malaria Control Programs in Brazil did infer that 99.4% of
malaria cases in Brazil was
now limited to the Amazon regions of Brazil. This meant that 1/7
Brazilians were still exposed. Knowing the population of Brazil, this is
quite a large number. But the fact that malaria has been contained to only the Amazon
regions is testament to the efficacy of
fighting the malaria battle with DDT.
So why would the United Nations and other world donors not
endorse and fund the strategic use of DDT in the battle against malaria? Europe
for example has been against the use of DDT in Africa despite the willingness
of some African governments like Kenya to use the substance. Since
the global position against DDT is not backed by empirical evidence one wonders
why Africans are still kept as refugees at peace time.
Written By Nnamdi Okose
