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Biting the bullet.

I want to thank you for turning your attention to malaria control ("Fatal Inaction," by Joshua Kurlantzick, July/August).

However I strongly disagree with Mr. Kurlantzick's assessment that, "the preoccupation with DDT is largely a distraction ... that has hampered efforts to provide better access to antimalarial drugs," specifically ACTs, which he argues are the real silver bullet.

First, environmental leaders most certainly do not all agree that the pesticide should be used to combat malaria, as Mr. Kurlantzick claims. Many oppose its use, and the European Union has taken the unconscionable public stance that if Uganda and other East African countries begin spraying with DDT, they can expect trade sanctions. If the EU is truly concerned about the chemical leaking into agriculture, it might instead offer to help control its application in those countries. If it is truly concerned about human life, it would support every effort to combat this terrible disease.

Second, few in the malaria control business argue that DDT is a silver bullet. It is one of many effective weapons against the disease, but it is not being employed because of wholly unscientific claims. DDT is unique in its ability to repel mosquitoes before they enter a home, and it lasts longer--so less has to be applied fewer times in a year to achieve the same effect as other insecticides. This is a significant competitive advantage for poor communities that have limited resources and are at the mercy of constant or seasonal malaria.

Unlike claims that DDT is harmful to humans, the facts I cite here have been published in peer-reviewed scientific journals.

Third, by arguing that ACTs are a silver bullet against malaria, Mr. Kurlantzick neglects the valuable role prevention plays in bringing malaria or any infectious disease under control. Fewer mosquitoes biting people means fewer infections, fewer parasites regenerating and circulating in a given community, fewer cases of malaria to treat, which means stronger, healthier communities, and improved ability to get scarce new drugs to victims. Simply put, effective prevention makes treatment dollars go farther. By any account, the most effective prevention methods available should be used and, by any scientific account, that means spraying with DDT, as well as passing out bed nets.

Mr. Kurlantzick and others might point to my emphasis on DDT and not bed nets as an unbalanced treatment of malaria prevention. The fact is bed nets, unlike DDT, are universally supported by donors and environmental leaders, in many cases to the exclusion of spraying with insecticides.

I appreciate both Mr. Kurlantzick and your publication's attention to malaria control. However there is no silver bullet, so we must use every available weapon to bring malaria under control.


Africa Fighting Malaria
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Author:Coticelli, Philip
Publication:Washington Monthly
Article Type:Letter to the editor
Date:Oct 1, 2006
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