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It's not hard to understand why anyone who's seen the ravages of epidemic malaria -- especially in sub-Saharan Africa -- would seriously consider any measure that might slow it down. The mosquito-borne disease kills a million kids a year, 90 percent of them Africans. That's just appalling, and it explains the talk in recent years of resuming widespread use of DDT, the villain of Rachel Carson's Silent Spring.
Where the worst malaria epidemics rage, DDT is still brought to bear -- with restrictions specified by international law -- as heavy artillery. But as Kim Larsen reported in "Bad Blood," the centerpiece of OnEarth's Winter 2008 issue, reliance on DDT carries problems that go beyond any well documented effects to human health and the environment. Mosquitoes, like so many other small, short-lived organisms, undergo mutation and natural selection in extreme fast forward; widespread use of DDT simply means that malaria's "vector" will evolve to become DDT-resistant in short order. Larsen makes it clear that hopes for a silver bullet that would eradicate malaria are likely misplaced:
No one really believes any longer that a single, monolithic solution will one day vanquish the disease, with the exception perhaps of vaccine researchers. But even if a malaria vaccine is one day formulated -- by no means a sure thing -- the challenge of inoculating millions in remote locations all over Africa may be insurmountable. Quinine, DDT, chloroquine, past vaccine quests, bed nets -- each, to one degree or another, has held out passing hope that it might singlehandedly save the day. But today most experts embrace the concept of integrated malaria management, along with its subset, integrated vector management.
Resistance, even to our most cleverly designed weapons, is malaria's ace in the hole. This is why policy makers in Geneva and field-workers in Nyabondo tend to agree: the best strategy for outmaneuvering the wily disease is to hit it and the mosquito it rode in on with as wide a range of ammo as possible.
This past week, the case for integrated malaria management was bolstered by some very good news indeed: according to a new WHO study, the distribution of large numbers of insecticide-treated bed nets and a new medicine have in several African countries resulted in dramatic reductions in both childhood malaria cases and malaria deaths. Ethiopia saw child malaria deaths drop more than 50 percent. In Rwanda, they plummeted more than 60 percent in only two months. The WHO's malaria chief, Dr. Arata Kochi, is quoted in the New York Times article as saying "If this is done everywhere, we can reduce the disease burden 80 to 85 percent in most African countries within five years."
It's a very human impulse, it seems to me, to want to nuke malaria with huge quantities of DDT. We want science and technology to surgically remove such threats from our lives. A relatively low-tech solution like deploying bed nets doesn't provide that sort of gratification; instead, it is a way of living with malaria. And isn't that the way of it -- doesn't the lasting solution to most problems lie in changing how we live, and not in the quick fix?
Postscript: There are a number of web campaigns that convert donations into bed nets for African families; my favorite is Nothing But Nets, from the UN Foundation.
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