(Nature asked me to write this article after the editor saw my feature in Nature Medicine on DDT’s return. The feature came two months ahead of the announcement that the WHO would back DDT. This article appeared the week after the announcement, in the 21 September 2006 issue.)
The World Health Organization (WHO) announced on 15 September that it will support the indoor spraying of pesticides generally, and DDT specifically, to control mosquitoes in countries with high rates of malaria. The US Agency for International Development signalled a similar shift in policy back in May.
Although these agencies never formally opposed DDT, they did not fund countries to purchase it, and instead actively promoted the use of insecticide-treated bednets. Malaria rates have continued to rise in the meantime, claiming more than a million lives a year, mostly in sub-Saharan Africa. The agencies now advocate combining the two approaches.
“I have to pinch myself a little to believe that they’ve done this, but I’m really, really happy they have,” says Amir Attaran, professor of law and medicine at the University of Ottawa, Canada, who has long criticized the agencies for their malaria policies.
In sharp contrast to its previous stance, the WHO also admitted for the first time that it stopped supporting DDT despite evidence of its effectiveness. “There are lots of data there, but people are so emotional about the issues,” says Arata Kochi, director of the WHO’s Global Malaria Programme. “Science comes first and we must take a position based on the science and the data.”
DDT, or dichlorodiphenyl-trichloroethane, is an organochlorine that is more effective, cheaper and longer-lasting than the alternatives. Fears about its use date back to the 1960s when Rachel Carson’s book, Silent Spring, famously chronicled its devastating effects on the environment. In the years that followed, the United States and many European countries banned DDT.
These countries once used thousands of tonnes of the pesticide for agricultural purposes. But the use of DDT for malaria control is very different: small quantities are sprayed once or twice a year on the inside walls and ceilings of houses.
Following widely publicized success with DDT in some countries such as India and South Africa, others began clamouring for the pesticide. “A lot of countries, especially in southern Africa, have become bullish about the use of DDT,” says Richard Tren of the non-profit group Africa Fighting Malaria.