POLICY IMPLICATIONS OF DDT AND MALARIA IN AFRICA

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POLICY IMPLICATIONS OF DDT AND MALARIA IN AFRICA
By Paul Saoke, Executive Director PSR-Kenya Vice
President, ISDE, Africa Region
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The Stockholm Convention on DDT

• The Stockholm Convention does not ban DDT
  production and use, though strict conditions have
  been set on its use and Parties are asked to
  request exemption to produce, procure and use the
  chemical.
• Use of DDT may only be allowed when locally safe,
  effective and affordable alternatives are not
  available to the Party.
• Parties must set-up special public DDT registers
  and must still comply with reporting and other
  obligations.

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SC on DDT cont.

• All Parties must promote research and development
  for alternatives to DDT. Its use will be allowed
  until technically and economically viable
  feasible alternative products, practices or
  processes are available.
• DDT may be used only in site-limited processes
  where they are chemically transformed in the
  manufacture of other chemicals that do not
  exhibit POPs properties.

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SC on DDT Cont.

• The Parties using DDT are further asked to
  develop and implement a plan of action, as part
  of the implementation plan and that shall
  include
• Development of regulatory and other mechanisms to
  ensure that DDT use is restricted to disease
  vector control
• Implementation of suitable alternative products,
  methods and strategies, including resistance
  management strategies to ensure the continuing
  effectiveness of these alternatives.
• Measures to strengthen healthcare and to reduce
  the incidence of the disease.
• The parties within their capabilities to promote
  research development and safe alternative
  chemical and non-chemical products, methods and
  strategies for Parties using DDT, relevant to the
  conditions of those countries and with the goal
  of decreasing the human and economic burden of
  disease (Annex B Part II of the Stockholm
  Convention).

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African countries seeking Exemptions to use DDT
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African countries seeking Exemptions to use DDT
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African countries seeking exemptions to use DDT
Cont.
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Malaria belt in Africa
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Approaches to combating Malaria

• WHO Roll Back Strategy
• 1. To provide early diagnosis and prompt
  treatment of malaria
• 2. To plan and implement selective and
  sustainable preventive measures, including vector
  control
• 3. To detect early, contain or prevent
  epidemics
• 4. To strengthen local capacities in basic and
  applied research to permit and promote the
  regular assessment of a country's malaria
  situation, in particular the ecological, social
  and economic determinants of the disease.

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Malaria chemotherapy

• Drug combination therapy aimed at multi-stage
  attack on the parasite
• Shift to artemisinin and derivatives fast
  acting
• Need to shift to ACTs
• Possible drug combinations.

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Harmful effects of DDT

• DDT remained in the shelves for 60 years until it
  was discovered by Paul Herman Muller
• Swiss scientists established association between
  unborn and functionally impaired calves whose
  mothers had been grazed on DDT sprayed pastures
  in the 1950s
• Rachel Carsons Silent Springs of 1962 painted
  the ecological consequences of DDT.
• - Disappearance of bird species like bald eagle

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Health effects

• Endocrine disruption
• Reproductive health effects

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Endocrine disruption

• DDT attach to proteins in cells known as "hormone
  receptors
• They may mimic the normal hormone, increasing
  female or male functions
• May block the normal function, resulting in
  decreased female or male functions.
• Feminization of males may occur but not the
  reverse.

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Testicular dysgenesis

• Skakkebæk et al (2001) discovered that testicular
  dysgenesis syndrome (TDS), which comprises of
  hypospadias, poor sperm quality, testicular
  cancer and cryptochirdism syndrome have a common
  etiology linked to environmental factors.

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Hypospadias
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Cryptochirdism
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Alternatives to DDT

• Pyrethrins/pyrethroids
• Insecticide-Treated Nets (ITN)
• In door residual spraying (IRS)
• Larviciding
• Integrated Vector Control (IVM)
• Biological Control
• Chemical traps

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The Mexican experience

• Program of Simultaneous Intensive Actions (PAIS)
  in 1990
• Improvement of personal and domestic hygiene
• Prompt diagnosis and treatment of malaria
• Environmental control elimination of mosquitoes

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Vector Control and Resistance to DDT

• Indications that the kdr gene acquired in the
  1980s may have been conferred to current
  mosquito species (anophelenes)
• Chapin et al A kilo of DDT adds another 105 new
  malaria cases (El Salvador)
• Liroff malaria rates in Brazil went up even as
  spraying of houses with DDT increased, but
  dropped after Brazil shifted strategies in 80s
  and 90s

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Monitoring vector resistance

• WHO has only developed guidelines for DDT use but
  not holistic approach to implementation of the
  requirements of the SC regarding DDT
• WHO to handle technical issues exemptions, DDT
  register and development of standards for DDT
  alternatives
• ICIPE to take on the practical issues like
  developing policy guidelines, ecologically suited
  IVM strategies and monitoring of vector
  resistance and capacity development of countries
  to implement alternatives.
• Develop standardized protocols for trials and
  operations

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Mosquito resistance to DDT in Africa(Source WHO
Afro)
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Resistance5. Lessons from India

• Exo-phyllic transmission of malaria due to time
  spent outdoor
• Weakened surveillance due to high staff turn over
• False belief in DDT as a silver bullet
• Mud adsorption cancels efficacy of DDT
• Coverage must be gt90
• (Sharma 2003)

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Vikuge and Ethiopiacase studies

• African governments are vulnerable to crude donor
  policies disposal of obsolete pesticides
• Dependence on donor money for redress
• Ethiopia is manufacturing DDT unclear of WHO
  certification (quality ?)
• Has historical problem of obsolete pesticides.
• Difficulties in avoiding stockpiles of Ops.
• Implications for technical and material
  assistance
• The existence of legislation does not guarantee
  enforcement.

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Ethiopias Obsolete Pesticides
(Source FAO 1998)
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HIV/AIDS malaria

• Immuno-supressed individuals become easily
  susceptible to malaria infection
• antimalarial treatment failure may be more common
  in HIV-infected adults with low-CD4 counts.
• HIV compromises malaria treatment in pregnant
  women.
• Drug interactions may occur between
  anti-malarials and drugs for opportunistic
  infections.

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Precaution and costs

• Persistent bio-accumulative compounds should be
  eliminated from use even without demonstrating
  toxicological risks
• The cost element involved in researching health
  effects of chemicals at all levels then resources
  in excess of 50 billion would be required
• to study only two possible chemical combinations
  among the 500 commonest would amount to 20.7
  million experiments.
• To study all three chemical combinations of all
  the 500 chemicals would result in running 166
  million experiments (Rachels Environmental
  Health Weekly 447.

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Right to know

• Article 10 Public information, awareness and
  education
• Article 9 (b) paragraph 5 Provision to the
  public of all available information on POPs
  readsFor the purposes of this Convention,
  information on health and safety of humans and
  the environment shall not be regarded as
  confidential
• Involvement of the vulnerable especially of
  women and children in interventions

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Malaria funding

• Governments and their agencies should take fiscal
  advantages provided by the SC
• GEF should waive co-financing of research on DDT
  alternatives
• Bilateral and multi-lateral debts should be
  waived in order to free the much needed resources
  for malaria control

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To protect human life and the environment

• Every man sitting in this room today is half
  the man his grandfather was, and the question is,
  are our children going to be half the men we
  are? Lou Guillette to US Congress1993, Referring
  to the perceived decrease in human sperm counts.
• THE END