It is unusual for an insect to take hostages. Yet, this is the reality of Lango sub-region, Northern Uganda, which registers some of the highest malaria incidence rates in the world; and includes Apac district, whose residents suffer an astonishing 1,568 bites per person per year from mosquitoes carrying the malaria parasite. 

When a programme of household spraying using the chemical DDT [dichlorodiphenyltrichloroethane] was launched to beat the scourge, gleams of hope -and suspicion- appeared. However, an injunction from the Kampala High Court halted the process after only Apac, and neighbouring Oyam, had been sprayed. It appears that DDT’s notorious public image, and evidence of its improper usage in Lango, is offering controversy, but little else, to a population paying a ransom in malarial blood. 

Genesis of a controversy

“DDT is toxic to human health”, says Ellady Muyambi, General-Secretary of Uganda Network for Toxic Free Malaria Control (UNETMAC), a conglomerate of anti-DDT lobbies responsible for the court injunction. “We have scientific studies which have demonstrated toxicity of DDT in regard to human health and [know] it will affect the environment. It accumulates in the food chain and can be transported from an area where it was used, to an area where it was not. In all other African countries which have been using DDT, they have failed to eliminate malaria. Seventeen countries have tried it and have failed; now they opted to use other options. So we are saying our country should not rely on it.”

Uganda’s National Malaria Control Programme, under the Ministry of Health, actively supports the use of DDT in indoor residual spraying (IRS). Dr John Bosco Rwakimari, Director of the National Malaria Control Programme argues that “DDT is the most researched chemical on earth. More than a million research papers have come out.  Of all these, none has come up with substantial scientific evidence that DDT is harmful to human beings or the environment. The only documented evidence of DDT being harmful to the environment is because it affects mosquitoes, small insects, like earthworms. As far as side effects on human beings, animals, environment in general, there isn’t any proven evidence.”

The writer and scientist Rachel Carson first drew attention to the effects of DDT in her seminal 1962 book “Silent Spring”, which sparked the US environmental movement. She argued that DDT’s presence in the food chain killed birds and fish, prompting, in her words, a “spring without voices” and hinted at the inherent dangers it posed to humans as well. Dr Rwakimari remarks “it’s been 60 years since Carson. So many studies have [since] been done.” Indeed, America successfully used DDT for malaria control and as an agricultural pesticide until banning it in the 1970s.

DDT in Uganda

The official turnaround on DDT was prompted by the World Health Organisation (WHO) approving its use for IRS in September 2006. It argues that by spraying the inside walls of houses, the chances of DDT flowing into the ground or into water sources are minimised. It was subsequently approved by the US Agency for International Development (USAID) as a key weapon to fight malaria under the President’s Malaria Initiative, which has allotted US$21.8 million towards malaria control in Uganda.

Yet, DDT is one of twelve chemicals marked for elimination by the Stockholm Convention on Persistent Organic Pollutants, to which Uganda became a party in May 2004. “DDT was never banned for public health, only for agricultural use,” Dr Rwakimari is quick to point out. “The Stockholm Convention left a window open for DDT use as vector [parasite carrying organism] control, for IRS. It’s unfortunate that during the ban of DDT for agricultural use. WHO also relegated IRS strategy to the bottom. It’s one of the best strategies for banning malaria; instead they pushed for nets and medicines. As far as public health is concerned, prevention is best and you target the transmitter or vector first if you want to get rid of the problem.” As part of a tripartite strategy, USAID advocates DDT as the most cost-effective solution, but also provides insecticide-treated nets and anti-malarial drugs through its Uganda programme.

“They are saying ‘DDT is cheap’, compared to other options,” Muyambi responds. “When you look at the requirements for implementing it, it’s not cheap. When we’re looking at cost effectiveness, we’re looking at the whole effect of the programme including health and environmental effects afterwards.”

Poor teamwork hurts the poor

The arguments seem rarefied in marginalised Apac, where malaria has had a damaging effect on the population’s health and economic productivity. The Hon. David Ebong MP (Independent, Maruzi) reflects the need to do something tangible about the situation when he says “I see no immediate option apart from the use of DDT. Having the highest malaria prevalence in the world, what options apart from what we have?”

At the same time leaders are worried that their constituents, many of whom are certified organic producers, will lose their markets as their products may contain traces of DDT, making these unacceptable to overseas buyers. Hon. Ebong feels the district must prepare for this by “diversifying our economic benefits by giving alternative resources” to producers. He is piloting bio-fuel production in Apac, confident that “there’s nothing related to DDT that would affect it. In fact it is surely the only way of running away from the market we’re losing from the use of DDT.”

However, the political establishment recognises that irregularities have occurred. Apac Resident District Commissioner Alex Jurua says “as a government representative, it was my duty to support the programme in the district and I’m happy with the result. [But] there were a few problems of course, relating to the involvement of different stakeholders. We had to struggle to be involved in terms of monitoring, in terms of what was happening in the field but also there was a problem of payments, sometimes, for the field staff.”

Hon. Ebong echoes the sentiments when he says, “we think we could have played a more stronger role in mobilising people to take it [the campaign] in a more positive way. That also determines the extent we were successful in running this programme. We could have done better if all the institutions and stakeholders were working together as a team; I think there was a big gap there.”

By Devapriyo Das, Freelance Journalist and Public Affairs Consultant