DDT and Deaths From Malaria –BECKER

The world health community justifiably pays enormous attention to the number of deaths from Aids, which amounts to about 3 million persons a year worldwide. Malaria receives far less attention, even though it too is very deadly, causing about 11/2 million deaths per year. The world Trade Organization (WTO) declared in 1998 a "war on malaria" that aimed to cut malaria deaths in half by 2010. Instead, deaths from malaria have been increasing, not falling. The reason for the failure of this malaria war is mainly that in the name of environmentalism, the WTO and other international organizations rejected the use of an effective technique, namely spraying DDT on the walls of homes in malaria-infected areas. What is especially disheartening about the huge number of deaths from malaria, and a fact that sharply distinguishes malaria from Aids, is that malaria deaths could be greatly reduced in a cheap way without requiring any fundamental changes in behavior, A small amount of DDT sprayed on the walls of homes in vulnerable malaria regions is highly effective in deterring malaria-bearing mosquitoes from entering these homes. Finally recognizing this, a couple of weeks ago the WTO relaxed its support of the ban on DDT, and instead supported spraying of DDT on house walls in malaria-ridden areas. This decision is likely to influence the position on DDT spraying of the World Bank, UDAID, and other relevant organizations. Some African countries, like Zambia and South Africa, which are not dependent on international support for their efforts at fighting disease, had already started to use DDT as a fundamental malaria-fighting weapon prior to the new WTO guidelines. South Africa decided to use DDT in the face of EU opposition after suffering a deadly malaria outbreak. DDT apparently helped that country greatly reduce its incidence of malaria. DDT was developed as the first modern insecticide during World War II, and was remarkably successful in reducing deaths from malaria, typhus, and other insect-borne human diseases. DDT was extensively used worldwide in the subsequent two decades with continued success as protection against these diseases, and was employed even more extensively to rid cotton and other crops of destructive insects. In 1959, the United States alone used 80 million pounds of DDT, with the overwhelming share being devoted to spraying crops. This widespread spraying of crops with DDT generated strong opposition to its use because of evidence that DDT was destroying some wildlife. This opposition was sparked by Rachel Carson’s 1962 best selling book Silent Spring, which alleged that DDT caused cancer and harmed bird reproduction. Harm to birds and other species is pretty well documented, but after over 50 years of trying, no real evidence has been found linking DDT to cancer or other serious human diseases. In any case, by the end of 1972, DDT's use in the United States was effectively banned. That ban soon became common in all rich countries, and in most poor countries too, as they responded to pressure from international organizations and Western governments. One unintended consequence of the DDT ban was a devastating comeback by malaria and some other diseases after they had been in retreat. Other pesticides that replaced DDT have been much less effective at reducing malaria and other diseases transmitted by insects. The USAID has been a strong advocate of mosquito bed nets as an alternative to DDT. Mosquitoes operate mainly from dusk until dawn, so netting over beds can be effective if used persistently and correctly. Unfortunately, in many African countries bed nets are not readily available, and they are often not used to protect children since poor families may only have one or two nets. Moreover, families frequently do not bother to use these nets during some of the hours when mosquitoes are still active. So while bed nets could be a useful part of an overall strategy against malaria, they are not a good substitute for DDT. Drugs that had been effective for a while in curing malaria or preventing its occurrence have become obsolete over time as the pathogens they target mutate into resistant strains. This means that drugs used to fight malaria need to be continually updated, but unfortunately international organizations are notoriously slow at responding with newer more effective drugs. I am an "environmentalist", but I do not believe that all reasonable cost-benefit analysis should be suspended when discussing environmental issues. The ban on using DDT in houses to fight malaria is an example of environmentalism that lost all sense of proportion. As has happened with nuclear power and in other environmental situations, exaggerated claims about negative environmental effects of DDT on humans were publicized, and these claims were further exaggerated after being picked up by the media and politicians. As a result of the hysteria against the use of DDT for any purpose, millions of lives were lost unnecessarily during the past several decades to malaria and some other insect-borne diseases. These deaths occurred only, I repeat only, because of international pressure on African and other poor countries not to use DDT and certain other pesticides in fighting malaria and other diseases caused by insect bites. The fact is that the quantities of DDT needed to be quite effective against malaria in tropical and other countries, where it is often at epidemic levels, is a tiny fraction of the amounts that had been used to rid crops of pesticides. Opponents of DDT use in disease control should wake up and realize that there has been a health "crisis" for decades, a crisis that could have been controlled if more common sense had guided international policy. The WTO's reversal of its position to allow small amounts of DDT to be used on the walls of houses to prevent mosquitoes from entering them is a belated but welcome recognition of this continuing health crisis.

Comments

[Lee]

That's a neat argument, and I agree, but every libertarian blogger covers this once a year as a poke in the eye to those darn old leftists.

I'm a big fan of both of you guys, but too often you choose well-worn topics. You ought to write with the assumption that your smart readers know all the standard libertarian stories and are looking for something unique and original.

[James]

When I was in India, I tried using a mosquito net, but it wasn't too effective (it also prevented me from using the ceiling fan, because the fan was the only thing to hang the net from). My hosts got me a product called Good Knight, which works like a Glade air freshener except that it releases some sort of insecticide. I have no idea if it is legal in the US, and it requires an outlet (or some source of heat to release the chemical), but it was very effective. Mosquitoes rarely ventured into my room, and when they did they seemed to go crazy. I still got a few mosquito bites when I wasn't in my room, but overall it was great.

Not sure this has any bearing on the discussion, but if Good Knight doesn't use DDT, maybe it's a feasible alternative in places with electricity.

Actually, now that I think about it, I had a persistent cough while I was in India, but I attributed it to the filthy New Delhi air. You'd want to test this thing pretty thoroughly before adopting its use.

[James]

A little research reveals that Good Knight products (which are apparently manufactured by a joint venture company partly owned by Sara Lee) contain allethrin, which has low toxicity for humans and birds (according to wikipedia). Good Knight worked well for me, but obviously I can't vouch for its overall effectiveness.

[Wes]

...malaria deaths could be greatly reduced in a cheap way...Suppose there are 100 million people who are at high risk for malaria and it would cost $1/person/month to supply enough DDT. That would be over 1 billion dollars per year. Compared to the hundreds of billions cost of the Iraq war that's pretty cheap but compared to Bill Gates' fortune that's quite a bit. Furthermore, even at $200,000 per scientist (salary and supplies) that's enough to hire 5,000 scientists working for a year on a malaria vaccine that would completely eliminate malaria if discovered....without requiring any fundamental changes in behavior,...That depends. If the village was located in a mosquito free area but people were getting infected when they went down to the river to get water then providing the village with a water supply might be more effective. Also, if people in the village congregated outside in the evening to socialize, then spraying inside the houses might have minimal effect.I'm not personally opposed to spraying DDT in homes but I'm very skeptical that it's some sort of magical solution.

[Haris]

1.2 billion dollars per year to save 100 million lives works out to $12 a life. Unbelievably cheap. Even over 70 years [probably too high given low life expectancies], that's $840 per life. Still crazy cheap. Adding the fact that maybe only 1% of people at risk would otherwise die, that works out to 1 million lives saved for $84 billion, or roughly $84,000 per life. [Someone check my math.] Given that statistical lives in the US are valued in the millions, I think it's pretty certain that even African lives are worth more than $84,000. I'll grant that African lives are worth less than Americans in a pure accounting sense - Africans produce less in their lifetimes than Americans because Americans are more productive. But there is more value to a life than its contribution to GDP, and I'm not even referring to the metaphysical value of a human life. But a living person creates utility to friends and family, adding to their happiness in a way that is not accounted for. In addition, deaths produce negative utility. I know people are reluctant to apply economic valuation to lives, but I'm using it to promote saving lives, so cut me some slack.

Anyway, I know Wes's point was basically to question whether DDT is the most efficient use of limited resources for Malaria prevention. The answer is that we don't really know. It's pretty impossible to know if and when a malaria vaccine can be created. And we do know that DDT spraying helps now. And despite being an econ major, I have to ask the following question: is it fair to spend money on vaccine research to save future generations when we could spend money on DDT to save present generations? Given that we don't know the cost of one of the alternatives [vaccine], I find it hard to justify not spraying.

[Hannah]

I do hope that Professor Becker has been misled by someone and that these comments don't reflect his own lack of research into the topic. Tim Lambert's response outlines the major mistakes in his posting so I won't repeat them here.

Those of us who actually work in malaria control know that there is no one solution to this problem. DDT and IRS can be an effective part of a comprehensive strategy that includes effective treatment (artemisinin combination therapy is currently the best drug we have) and use of long-lasting insecticide treated nets (LLINs). The WHO, the Bank, and USAID have understood this for a while, and the recent WHO announcement does not reflect a change in policy, just politics.

Malaria is transmitted differently in different regions; even within the same city transmission patterns can vary widely. IRS is great in some situations (for epidemics and in areas where malaria does not occur all year-round) but not in others (very rainy environments; year-round malarious areas).

For those interested in cost-effectiveness, there are a variety of good studies that have been (Morel et al, 2005; Hanson et al 2004 among others). ACTs are the most effective at reducing fatalities, and nets and spraying both reduce incidence by about 50%. The best bang for the buck though comes when you combine all these approaches.

Instead of pitting interventions against each other, we need to call on donors to fully fund malaria prevention and control programs, so that we can use all the tools at our disposal to prevent unnecessary deaths from this disease.

[Agrian Redobog]

It is sorely disappointing to see a serious thinker give vent to what is no more than a second-rate conspiracy theory.

[happyjuggler0]

Please don't be mislead by Lambert. He seems to have made a serious hobby of bashing people who want to use DDT. This is a link to t post, where in the thread Lambert convincingly (to me anyway) loses the debate despite a valiant attempt. gcochran seems more on the ball and without an agenda beyond saving poor people from needless deaths and suffering.

[Niels Olson]

AIDS should be in all caps: it stands for Auto-Immune Deficiency Syndrome.

[Peter Pearson]

@Lee:

"You ought to write with the assumption that your smart readers know all the standard libertarian stories and are looking for something unique and original."

Becker and Posner bring an immense amount of respectability to a position. For that reason, I'm especially happy to see them tackle an issue that has been popular with libertarian bloggers.

[Wes]

Anyway, I know Wes's point was basically to question whether DDT is the most efficient use of limited resources for Malaria prevention.It's not just resources for malaria prevention that are limited. It's all resources. Money that gets spent on spraying DDT in homes is not available for anything else and money that is spent on anything else is not available to be spent on spraying DDT in homes. If you want DDT sprayed in homes then you either have to advocate that private individuals spend less on other things (to afford private donations or increased taxes) or you have to advocate that governments spend less on other things (like the Iraq war).To put it simply, you can't just say "We should spend billions on spraying DDT in homes", you have to say "We should stop spending billions on wars/jewelry/science so we can spend billions on spraying DDT". The challenge, in my view, is less to figure out where to start spending the money and more to figure out where to stop spending the money.If Becker said "The US government should raise taxes and stop spending money on expensive discretionary items like the Iraq war and, after it has payed off the national debt, it should then fund malaria prevention.", I would be like "Yeah, that makes a lot of sense." As it is, I'm like "Yeah, OK, but the US government already spent it's money on things like tax cuts and the Iraq war. Thanks to the Republicans, there just ain't nothin' left." (Actually less than nothing when you consider the national debt.

[happyjuggler0]

Wes,

I disagree with the notion that one needs to figure out which tradeoffs to make in order to recognize that one ought to be making a different tradeoff than is currently the case.

Becker and Posner are making the case that indoor DDT spraying in malarial areas has a hugh added value, in contrast with those who simply assume that all DDT use is negative.

Ideally everyone who reads this blog already assumes there are tradeoffs for every action chosen or not chosen.

[HEDGG]

I think the international organization concerned with malaria erradication is the WHO (World Health Organization) rather than the WTO. WTO has enough work trying to save the Doha Round from completely collapsing to be working on health issues as well. By the way, are health issues trade related? As far as I see, they are only pretenses for protectionism against cheap food stuffs from developing countries.

[ZZTop]

I think Ms. Carson should be tried in the International Criminal Court.

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