Get Out Your Bed Nets

Published on 20th September 2005

Gulf Coast residents are slowly recovering from Katrina’s winds, floods, anarchy, and tardy local, state and federal disaster responses. Now they face yet another peril. Millions of acres of brackish, polluted water could become fertile breeding grounds for billions of mosquitoes. Some fear the hordes could infect survivors with West Nile virus and encephalitis – or even malaria and yellow fever. They point out that the United States had 2,500 serious cases and 100 deaths from WNV in 2004; that yellow fever killed 9,000 people in New Orleans and Memphis in the summer of 1878; and that malaria killed thousands of Americans every year until the 1940s.


However, a comparable disaster in Katrina’s wake is unlikely, say experts. US health officials have already launched C-130 aircraft capable of spraying 60,000 acres per day with Dibrom, which is safe for humans and the environment but extremely effective for mosquito control.


In 1999 three C-130 Hercules sprayed for 22 days in the wake of Hurricane Floyd. They killed 99% of all mosquitoes across 1.7 million acres in Virginia and North Carolina. This year’s program will be even more extensive.


Inexplicably, this rapid response to health threats here in the United States stands in marked contrast to the approaches US-funded aid programs take in developing countries wracked by diseases of truly epidemic proportions. Indeed, hurricane survivors can be thankful that US health officials are not controlled by the U.S. Agency for International Development (AID), World Health Organization (WHO) or World Bank (WB). Those agencies would likely tell survivors,” Get out your bed nets.”


All three organizations decry the horrendous disease and death toll that malaria inflicts on African and other developing countries. In fact, nearly 450 MILLION Africans get malaria every year, and up to 2 million die. Half the victims are children.


In Kenya, malaria claims 34,000 children a year; in Uganda, up to 50,000; Ethiopia: 75,000. In the Democratic Republic of Congo, it kills 225,000 children annually! The USAID, WHO and WB all give lip service to insecticides. But they almost never support, promote or fund the use of DDT or other insecticides. Instead, they emphasize Insecticide-Treated Nets (ITNs) and new anti-malaria drugs. This supposedly underscores their “renewed assault on malaria” and a strategy that “has moved from words to action.”

Sadly, it’s more rhetoric than reality.


For years, USAID spent millions on malaria consultants and conferences. This year, its expanded budget also emphasizes producing 55 million pediatric doses of new Artemisia-based (ACT) drugs by 2006. But with 500 million people getting malaria every year worldwide, this is woefully inadequate, especially with the disastrously poor transportation and medical infrastructure across much of Africa.


AID is also fostering net distribution, via partnerships with the private sector, and the Bank recently gave Congo $30 million to get “at least two” ITNs in each household. This, it says, “could slash child deaths by as much as one-fifth.”


Two nets per household is hardly enough, especially when the entire family could be protected by programs that spray walls with tiny amounts of DDT just once or twice a year, to keep 90% of mosquitoes from even entering the home, killing any that land, and irritating the rest so they don’t bite. And a 20% reduction is unconscionably low, when DDT programs get four times that.


South Africa used household DDT spraying, followed by ACT drugs, to slash malaria rates by 93% in three years. Its success inspired Mozambique, Zambia and other countries to institute similar programs. But the EU has threatened Uganda with sanctions on its agricultural goods, if it follows suit.


WHO Director Lee Jong-Wook calls nets and drugs “proven strategies.” But seven years after the vaunted Roll Back Malaria campaign was launched, even his own organization admits it’s still “too soon to tell” if malaria rates have gone down at all. Moreover, with ACT drugs in short supply, many of its anti-malaria kits still contain drugs that are no longer effective against this killer disease.


USAID claims spraying won’t work because there aren’t enough trained sprayers, inadequate infrastructures prevent them from getting to villages, and “a high percentage of homes” must be treated if spraying is to be effective. This is simply false.


Spraying isn’t rocket science. Training people and getting the job done once or twice a year is easier than getting bed nets and drugs to every parent and child. And spraying protects every person in every house that’s treated.


Bed nets protect only those who use them, work only if they’re not torn, and are of little use when people are still working or doing homework. Further, many people simply don’t use them. Sleeping under a bed net is nearly impossible during torrid African nights, says Omololu Falobi, a journalist in Nigeria. Use the net anyway, and you get heat rashes all over your face and body. Most villages have no electricity to power fans or air conditioners, and many of the same environmentalists who oppose pesticides also oppose electricity generation on any scale that would power these cooling systems.


Even in cities like Lagos power outages are frequent, rendering fans and AC useless. “Even if you have a generator,” says Falobi, “you don’t want to put it on throughout the night, for fear of carbon monoxide poisoning.”


Kenyan Pauline Mwinzi’s father nevertheless insisted that his family use bed nets. But she still came down with cerebral malaria and nearly died, and her father succumbed to the disease when she was six. Today, she says, “as mother of several kids myself, I refuse to use bed nets. There’s got to be a better way of dealing with mosquitoes.”


There is. But anti-pesticide activists and bureaucrats – safe in their malaria-free offices – refuse to consider them. Instead, they worry about trivial risks from pesticides – and ignore the devastation and death caused by diseases that pesticides could prevent.


These are life-or-death decisions for malaria-endemic countries. Their health ministers must have the right to make decisions based on science and effective use of scarce human, medical and financial resources – without fear of reprisals if their decisions include DDT and other pesticides, along with nets, drugs and other measures.


America would never tell hurricane survivors they must rely on bed nets and anti-malaria drugs that are in critically short supply, or simply don’t work. Telling Africans to do so violates their most basic human rights – to health, prosperity and life itself.


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