Dominic Lawson: A conspiracy of silence that kills millions

They question the logic of putting the health fears of food consumers above the lives of countless Africans
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The Independent Online

What is the biggest scandal to emerge this week? Was it the Daily Mirror's revelation that John Prescott had been conducting an affair with his diary secretary? Perhaps only Mrs Prescott would believe that. Most people would probably nominate the "losing" of well over a thousand foreign ex-jailbirds by the Immigration Directorate and the Prison Service. If we measured scandals as political earthquakes then that one is about 4.5 on the Richter Scale - plates are rattled, windows are broken, but with any luck there are no fatalities.

No, the biggest scandal to break this week appeared not in the tabloid press but in the sober pages of The Lancet. There can not have been many papers presented to that august medical journal with a title as explosive as this one: "The World Bank: false financial and statistical accounts and medical malpractice in malaria treatment". As this newspaper reported on Tuesday, Professor Amir Attaran and 12 other malaria specialists accused the World Bank of spending only half what it pledged in its Roll Back Malaria programme, of exaggerating the success of its projects and of funding "clinically obsolete treatments".

This last allegation is the most devastating. The authors claim that in India on five separate occasions in 2004 the Bank approved chloroquine for treating malaria, despite knowing it was ineffective against resistant forms of this agonising disease, and conclude: "Had a doctor or pharmacist behaved as the Bank did [they] would be condemned and possibly sued for medical malpractice." In a response published in the same issue of The Lancet, the Bank rejected all the allegations, although it ended with the New Labourish get-out: "We are committed to learning from our shortcomings and to sustaining our efforts."

What neither side seems willing to mention is the biggest scandal of all about malaria. That scandal is the refusal of the developed countries to sanction the use of DDT (Dichloro-diphenyl-trichloroethane) in the battle against the disease, which kills more children in Africa than any other infection - three times more than HIV/Aids. In 1948 the Swiss scientist Paul Müller was awarded the Nobel Prize for Medicine for discovering - nine years earlier - DDT's insecticidal properties. Seldom, if ever, has the award been better merited: Indoor Residual Spraying with DDT completely eradicated malaria in the US (where it was endemic) and also in Europe (Italy had been a particular sufferer). The use of DDT also led to dramatic declines in the lethal disease in Asia, South America, and Africa. It was the additional use of DDT -in vast quantities - to safeguard crops against a range of pests that aroused opposition from the fledgling environmental movement.

In 1962 Rachel Carson's immensely influential Silent Spring was published. The book warned passionately about the potential risks to wildlife - and humanity - from the excessive use of DDT. It led directly to the banning of DDT by the head of the newly-formed US Environmental Protection Agency, William Ruckelshaus. It was certainly a way of putting the EPA on the political map. Where America led, the rest of the developed world followed.

This country banned DDT in 1968. Yet as Richard Tren, the director of Africa Fighting Malaria, wrote six months ago: "Since the EPA banned DDT in agriculture, countless studies have been conducted into the potential impact of DDT on human health, yet none of them have been able to find concrete evidence of human harm. DDT is remarkably non-toxic to humans: people have tried to commit suicide by eating it and failed miserably. DDT is classified as a possible human carcinogen by the International Agency for Research on Cancer, but it is the same classification given to coffee and many other foodstuffs in our daily diet."

Two years ago, a group of malaria scientists and doctors organised by Africa Fighting Malaria sent a petition to the head of the World Health Organisation - which like all the other so-called humanitarian agencies will not support, fund or even permit the active use of pesticides in any anti-malarial campaigns - advocating the indoor spraying of DDT in Africa. Their petition states: "From the late 1970s onwards, malaria control strategy evolved primarily through political processes, not by consultation with malaria control experts: as a result malaria has re-emerged and is now a global health disaster."

Not surprisingly, African-Americans have begun to question the logic - and the humanity - of their country's leaders in putting the health fears of food consumers above the lives of countless millions of Africans.

The African-American Environmental Association produced a paper, quoting Paul Driessen, the author of Eco-Imperialism: Green Power, Black Death: "Where DDT is used, malaria deaths plummet. Where it is not used, they skyrocket. In South Africa the incidence of malaria had been kept very low (below 10,000 cases annually) by the careful use of DDT. But in 1996 environmentalist pressure convinced [the government] to cease using DDT. One of the worst epidemics in the country's history ensued with almost 62,000 cases in 2000. Shortly afterwards South Africa reintroduced DDT. In one year, malaria cases plummeted by 80 per cent. Next door, in Mozambique, which doesn't use DDT, malaria rates remain stratospheric."

The US should not take all the blame, however: last year the EU warned Uganda, which wants to introduce DDT in its battle with malaria: "We are concerned about the impact large scale DDT use would have on Uganda's food exports to the EU if such a decision was made." That, I think, is what's called a Sicilian warning.

As I say, the paper in this month's Lancet doesn't mention DDT at all. But The Lancet did publish a fascinating examination of this issue nine months ago, by Professors Rogan and Chen of the US National Institute of Environmental Health. They pointed out that there was indeed evidence that widespread use of crop spraying with DDT had an impact on the life-cycle of some breeds of birds, notably eagles, by causing a thinning of the shells of eggs.

While conceding that "in sub-Saharan Africa early pilot projects for malaria eradication show that the disease is highly responsive to control by DDT", Rogan and Chen claim that "well coordinated anti-malarial efforts in combination with efficient health infrastructures should have improved success in malaria control more than sole reliance on Indoor Residual Spraying of DDT." Should have? Well, it didn't. In any case, can we rely on sub-Saharan Africa to develop "efficient health infrastructures"?

The most pointed question of all, however, comes from the African-American Environmentalist Association: "Would you exchange the life of your child for all the eagles in your country?"

d.lawson@independent.co.uk

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