Category Archives: malaria

Malaria Drugs Misused

The VOA reports:

Roughly 50 years ago, chloroquine and other quinine-derived drugs were extremely effective in treating malaria, a disease spread by the bite of mosquitos infected with the parasite, Plasmodium falciparum.

The illness causes extremely high fevers, bouts of chills, jaundice and severe anemia. Young children who contract malaria often die.

Chloroquine and mefloquine have since become ineffective against the parasite because of the misuse of chloroquine, but in the last decade or so, an effective, new drug [long used in China], called artemisinin, has come into use.

The World Health Organization (WHO) has urged countries to use artemisinin in combination with other anti-malarials so it, too, does not lose its effectiveness.

But the warning isn’t being heeded, and a study published this week in the journal the Lancet found the first evidence of resistance to artemisinin in two African countries where the drug is readily available, according to researcher Ramon Jambou of the Pasteur Institute.

“In Senegal and in French Guiana, artemisinin was not used by the ministry. It just used by everyone but on markets and so on,” he explained.

Dr. Jambou and colleagues took blood samples from 530 patients in French Guiana, Senegal and Cambodia treated with different artemisinin-derived drugs. The samples were tested to measure the parasite’s sensitivity to artemisinin.

The researchers found no resistance in samples taken from Cambodia, which carefully controls the use of the drug. The parasite was less sensitive to the drug in Senegal, where artemisinin is somewhat restricted. Resistance to the drug was greatest in French Guiana, where it is readily available.

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My Malaria Tales

In 1976, I got a chance to do linguistic fieldwork in Papua New Guinea. PNG is a malaria zone, so I tried to get antimalarials before I left, but hardly any doctors in Honolulu knew about either malaria or PNG, and they wouldn’t prescribe anything unless it was for treatment, not prevention. So my first day in Sydney, en route, I went to a public hospital and waited a long time to see a doctor. (Australia, like Canada, gives free but limited medical coverage to everybody.) When the doctor finally saw me, he asked me all sorts of questions about PNG because he was to spend part of his residency there, but he said state policy was to give only one week’s worth of medicine at a time free. So I got just two Chloroquine pills, one week’s prophylactic dose. I was due to arrive in PNG within the week.

In PNG I had no trouble buying Chloroquine at a local chemist (pharmacy) and took them faithfully every Sunday. For months, I was fine. The only problem I had was early on, when my intestinal flora were changing to accommodate the local diet. I got the runs one night really bad. The village was maybe 100 yards from end to end, with the women’s outhouse out over the water (flushed twice a day by the tide) near my end of the village and the men’s outhouse clear at the other end of the village, across a coconut log bridge over the stream that served as the village’s only supply of fresh, cold mountain water. The men’s bathing hole was upstream from the women’s bathing, laundry, and dishwashing area, and people were really careful not to shit near the river. That night, I must have walked through the dark village 6 or 8 times, setting off the dogs each time, but not always having much to feed the fish with by the time I climbed up into the four-hole outhouse and squatted over the ocean. So, before long, I’d start the long trek back, setting off the dogs again.

I slept under a mosquito net in the village, although not always when I took trips to the neighboring village where several kids from my host family went to school. (They boarded there.) One day during August (I think), I felt really feverish, with flu symptoms, but the next day I felt better, so I let the village boat, with its loud, 2-stroke, Japanese Yanmar diesel engine, leave for town without me. It was an 8-hour trip up the coast to Lae, where the boat would sell its catch of fish, fill up with ice for the next catch, take on supplies and passengers, and be back in a week. That evening after I went for my customary bath in the stream, I couldn’t stop shivering. My hosts built up the fire and I hunkered down next to it until the shivers turned to sweat. By that time, I figured I’d better take a treatment dose of Chloroquine: 2 pills every 4-6 hours, rather than 2 pills every week. In a day or two the flu symptoms abated and I broke out instead with intense itching under the skin of my hands and feet. It hurt to walk over the rough path to the bathing hole. So the next time the boat came back to load up and take more fish and passengers, I was on board.

The doctor I saw in town thought maybe I had reacted to the Chloroquine, so he put me on milder Camoquine and, sure enough, the next time I came down with malaria symptoms and took a treatment dose, at least I didn’t have that horrible itch. (By now many strains of malaria in PNG are resistent to both.) But the timing was bad. I had come into town about Thanksgiving time, and my host, an American with an MA in ESL from Hawai‘i, had fixed up a real American meal with turkey, deviled eggs, and pumpkin pies. My throat was swollen, it hurt to swallow, and I was too sick to join the crowd for dinner, so I went off to bed. That night my fever broke and I soaked the sheets. The next day I felt much better–and ravenous. Fortunately, there were leftovers of everything except the deviled eggs. I ate a lot, but swallowed carefully.

Back in Honolulu, I got another severe bout of malaria. By this time, I knew the whole cycle real well–24 hours of fever and chills followed by 24 hours of dull headache. It was sure to be Plasmodium vivax, according to Merck’s Manual, so I managed to get referred to a Dr. Berman, the only civilian doctor in town who knew much of anything about malaria. (He had seen plenty of it as an Army doctor in Vietnam.) So I drove to the emergency room of the hospital where he was supposed to start a shift at 7 pm. He took a long time getting to me and I spent the whole time shivering under the air-conditioning vent in the examination room, trying to cover myself with little hand towels.

When Berman finally saw me, I made the mistake of telling him I was suffering from P. vivax and asking for a treatment dose of Camoquine or its equivalent. He sent me for a blood test, but couldn’t find anything, so he sent me away for another 48 hours until I would be in worse shape again. When he couldn’t see anything in that sample, either, he told me to come back when I was really in the throes of fever and chills. So at the peak of the next 48-hour cycle, I was driving shakily through traffic to his downtown office. This time, he managed to find the little buggers under the microscope. He returned with a sarcastic “Congratulations, Dr. Outlier. Your diagnosis is correct. It’s Plasmodium vivax.” Whereupon, I let him have it, telling him each of those 3 lab tests cost me $24 that my grad student health insurance didn’t cover, and that I had been through a week’s worth of the symptoms a 3rd time now, thanks to him. I think he ended up waiving any of his own fees above what my health insurance covered. He also prescribed some very powerful drug that was supposed to clear the creatures out of my liver as well. I’ve never had a relapse since then.

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Anti-DDT Trumps Antimalaria in the West

An op-ed by Sebastian Mallaby in today’s Washington Post hits on a topic that was once close to my liver and is now closer to my heart, enforced disarmament in the battle against malaria.

Some 500 million people still get the disease annually, and at least 1 million die, but the World Health Organization refuses to recommend DDT spraying. The U.S. government’s development programs don’t purchase any of the chemical. In June President Bush made a great show of announcing a new five-year push against malaria; DDT appears to play no part in his plans.

But the worst culprit is the European Union. It not only refuses to fund DDT spraying: In the case of at least one country, it has also threatened to punish DDT use with import restrictions.

That country is Uganda, which suffered a crippling 12 million cases of malaria in a population of 27 million in 2003. The Ugandans know perfectly well that DDT can help them: As Roger Bate of the American Enterprise Institute recently testified to Congress, DDT spraying in one part of the country in 1959 and 1960 reduced the prevalence of malaria from 22 percent to less than 1 percent. Ugandans also know the record in South Africa, where the cessation of DDT spraying in 1996 allowed the number of malaria cases to multiply tenfold and where the resumption of spraying in 2000 helped to bring the caseload down by almost 80 percent.

So the Ugandans, not unreasonably, would like to use DDT. But in February the European Union waved an anti-scientific flag at them. The Europeans said Uganda might need to institute a new food monitoring program to assuage the health concerns of their consumers, even though hundreds of millions have been exposed to DDT without generating any solid evidence that the chemical harms people. The E.U. proposal might constitute an impossible administrative burden on a poor country. Anti-malaria campaigners say that other African governments are wary of even considering DDT, having seen what Uganda has gone through.

Please read the rest.

I’ve only experienced the mildest form of malaria, Plasmodium vivax. It was unpleasant enough, but P. falciparum is the true killer. And it’s spreading.

UPDATE: Two discussion threads in diametrically opposed blogs question Mallaby’s take and tease out some of the finer points of the DDT vs. malaria issue. Enviro-hawk Tim Lambert argues that the E.U. is only concerned to prohibit the use of DDT on agricultural products that it imports. Everyone seems to agree that’s a dangerous and counterproductive use of DDT, in that it fosters DDT-resistant strains of malaria more quickly than localized use does and can endanger other species. So agricultural use should be banned. There seems to be much less agreement about how much and how widespread DDT resistance already is. The most effective use of DDT seems to be spraying it on the inside walls of houses or on mosquito nets. Libertarian Ron Bailey‘s piece sparks a debate about how effective DDT is relative to other chemicals, what the relative costs are, and how important human life is relative to that of other living creatures.

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Nick Kristof on Environmentalists Gone Wild

I enjoy Nick Kristof’s political unreliability. In the New York Times of 12 March, he takes on environmental car-alarmists.

When I first began to worry about climate change, global cooling and nuclear winter seemed the main risks. As Newsweek said in 1975: “Meteorologists disagree about the cause and extent of the cooling trend … but they are almost unanimous in the view that the trend will reduce agricultural productivity for the rest of the century.”

This record should teach environmentalists some humility. The problems are real, but so is the uncertainty. Environmentalists were right about DDT’s threat to bald eagles, for example, but blocking all spraying in the third world has led to hundreds of thousands of malaria deaths.

Likewise, environmentalists were right to warn about population pressures, but they overestimated wildly. Paul Ehrlich warned in “The Population Bomb” that “the battle to feed humanity is over. … Hundreds of millions of people are going to starve to death.” On my bookshelf is an even earlier book, “Too Many Asians,” with a photo of a mass of Indians on the cover. The book warns that the threat from relentlessly multiplying Asians is “even more grave than that of nuclear warfare.”

Too many Asian men, and not enough Asian women. Now that’s the real problem in Asia. Meanwhile bald eagles multiply and malaria just gets worse and worse.

UPDATE: The Belmont Club has much more about efforts both to ban DDT and to resist banning it, with follow-ups here and here.

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Missiles Protected Food in Soviet Afghanistan

After daybreak the bombs came. The earth vibrated from the thousand-pounders dropped by the fighter jets overhead. Clouds of dust from exploding earth filled the air. The nearest bomb hit several hundred yards away from us and, as it turned out, nobody was hurt. It had been a useless exercise: the jets had taken off from the military air field at Jalalabad, dropped their bombs from about ten thousand feet, and flew home. The jets were flying so high that from the ground they appeared no larger than specks. Even with television-guided missiles–which these planes were not equipped with–hitting a target as small as a pup tent from that altitude is exceedingly difficult. It was another potent illustration of how the Stingers had changed the face of the war. Weighing only thirty pounds, the heat-seeking antiaircraft missiles were mobile and cost only $75,000 apiece, and in two out of three times that they were fired in Afghanistan, a Stinger destroyed a Soviet jet or helicopter that cost about $4 million each. So the Soviet and Afghan government pilots weren’t taking any chances….

The Kot Valley unrolled like a plush green carpet at the foot of Spinghar, a jungly world in sight of the snows. We alighted under a large plane tree on a raised table of earth about a hundred feet over the valley, providing a prospect from which to espy the terrain we were about to enter. A local farmer laid out a rush mat and Turkoman rug for us. His son, wearing a gold Sindhi cap, brought ceramic cups for tea. I took off my shoes and smelly socks and let the hot sun dry my feet while I drank tea under a blue sky on a rug I would have been proud to have in my living room back in Greece. It was the kind of moment that a traveler files away in his mind in order to impress people later on. But what I also remember about that moment was what the farmer told Wakhil about all the irrigation ditches that had been blown up by fighter jets, and the flooding in the valley and malaria outbreak that followed. Malaria, which on the eve of Taraki’s Communist coup in April 1978 was at the point of being eradicated in Afghanistan, had returned with a vengeance, thanks to the stagnant, mosquito-breeding pools caused by the widespread destruction of irrigation systems. Nangarhar was rife with the disease. This was another relatively minor, tedious side effect of the Soviet invasion that lacked drama and would only have numbed newspaper readers if written about or even mentioned in passing–which it never was.

We crossed rice, grain, and maize fields, walking along rebuilt irrigation embankments and down dusty trails partially shaded by apple and apricot trees. It was hot and, for the first time since I left Peshawar, a bit humid too. Almost every mud brick dwelling we saw had been hit by a bomb. Yet more civilians lived here than elsewhere in the Spinghar region, and women in colorful chadors were ubiquitous in the fields, separating the strands of grain and carrying bundles of it on their heads. Only since the end of 1986 had refugees started to come back to the Kot Valley from Pakistan. The upsurge in cultivation was the result of one thing: Stingers. High-altitude Soviet bombing notwithstanding, the missiles were providing enough air cover to frighten away low-flying gunships, allowing some peasant farmers to return and start growing crops. Relief workers in other parts of Afghanistan where the mujahidin had Stingers had also noticed this phenomenon. The antiaircraft missiles were actually putting food in people’s mouths.

We rested again in an apple orchard, and a farmer brought us the best meal I had eaten so far in Afghanistan: curds, lentils, greasy fried eggs, apples, and green tea. The heat, the greenery, the water slowly trickling in the stagnant canals, and the timelessness of the setting evoked a town in the Nile Delta in Egypt.

SOURCE: Soldiers of God: With Islamic Warriors in Afghanistan and Pakistan by Robert D. Kaplan (Vintage, 1990, 2000, 2001), pp. 126-129

Soldiers of God is a thoughtful, insightful, highly readable book. Battlefield smart, rock solid.” –Dan Rather

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The Peripatetic Remains of a French Explorer

On 5 June 1866, a party of French explorers began heading up the Mekong under the leadership of a distinguished naval veteran of the Crimean campaign, Commander Ernest Doudart de Lagrée (no relation to the fictional Simon Legree). Unfortunately, Lagrée’s health got worse and worse the farther they traveled upriver.

By the time the explorers left Kunming, on 9 January 1868, Lagrée’s condition had worsened markedly, and after five days travel he was no longer able to remain seated on the horses they had with them and had to be carried on an improvised litter. When on 18 January, the party reached Dongchuan, a minor settlement close to Huize, the district capital of this sparsely settled region, it was apparent that Lagrée was gravely ill. He was suffering from severe dysentery, a fever that was probably malaria, and was again troubled by the chronic problem of his infected throat.

So he stayed behind with a naval doctor, Joubert, while his second in command, Garnier, set out to find the Mekong again.

The end came on 12 March. Believing that Lagrée’s body would lie forever in China, Joubert removed his heart and fashioned a lead casket in which to carry it back to France. Conscious of his medical responsibilities, he performed a post-mortem examination and found the second abscess on Lagree’s liver that had escaped his surgical intervention. Then, with Lagrée’s body placed in a heavy Chinese coffin, Joubert supervised its burial in the grounds of a pagoda outside Dongchuan’s walls…. There was now nothing more to do but to wait in the cold, isolated settlement whose only active commerce seemed to be in wooden coffins….

This was both the practical and symbolic end of the expedition‚Ķ. Determined that Lagrée’s body should be laid to rest in French soil in Saigon, [Garnier] ordered the coffin to be exhumed and carried with the party as they continued northwards. Another thirteen days of slow and exhausting travel were necessary before the party reached the Yangtze and the opportunity to continue their travel down to the coast by boat.

They sailed downriver to Shanghai, then down the coast to Saigon, arriving on 29 June 1868.

Lagrée’s body was laid to rest with funerary pomp in Saigon, with his friend from the time of his posting in Cambodia, Bishop Miche, officiating at the burial service. But this was not the end of travels for his mortal remains. When, in 1983, the local authorities in Saigon, by this stage officially known as Ho Chi Minh City, declared their intention of building over the French colonial-period cemetery in which Lagrée’s remains lay; the French government arranged for the coffin to be transported to France and taken, eventually; to Saint-Vincent-de-Mercuze, to be placed in the family mausoleum.

SOURCE: The Mekong: Turbulent Past, Uncertain Future, by Milton Osborne (Grove Press, 2000), pp. 103-108

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New Hopes for a Malaria Vaccine

Virginia Postrel notes a possible breakthrough in developing a malaria vaccine, thanks in part to funding from the Bill & Melinda Gates Foundation. She quotes the Washington Post:

An experimental vaccine can slash the risk that children will get malaria, apparently offering the first effective way to inoculate youngsters against one of the world’s biggest, most intractable killers, researchers reported yesterday.

An eagerly awaited study involving 2,022 children in Mozambique, in east Africa, found the vaccine cut by one-third the likelihood of getting malaria and reduced by more than half the risk of developing serious, life-threatening cases of the disease….

The malaria parasite infects about 300 million people each year and kills between 1 million and 3 million, mostly children — making it the most common infectious disease and among the top three killers. Although malaria has been largely eliminated from the United States and Europe, it remains a major public health scourge in the developing world. In Africa, malaria is the No. 1 killer of children younger than 5, claiming the life of one child every 30 seconds by some estimates….

“Malaria has had a sense of hopelessness and intractability about it,” said Melinda Moree, director of the Malaria Vaccine Initiative, which is promoting development of malaria vaccines with funding from the Bill & Melinda Gates Foundation. “These results bring hope to us all that a malaria vaccine might at last be within our grasp.”

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Pacific War U.S. Soldier’s Photo Album

The Library of Congress collection Experiencing War: Stories from the Veterans History Project includes a photo album by Denton W. Crocker, a “bug-chaser” medic in a malaria survey unit who trained at Camp Pickett, Virginia, and New Orleans, Louisiana, and was then deployed in 1944-45 to Milne Bay in Papua, Hollandia in Dutch New Guinea, Morotai off Halmahera, Mindoro Island outside Manila Bay, Cape Zampa in Okinawa, and finally Takarazuka near Osaka, Japan. It contains 81 photos.

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A Growing Malaria Problem

In honor of Earth Day, last night’s NewsHour with Jim Lehrer on PBS showed a segment about the possible danger of global temperatures rising enough to permit bird malaria to wipe out unique endangered species at higher elevations in Hawai‘i. As one who has experienced repeated bouts of human malaria (P. vivax, not the dreaded P. falciparum variety), I thought I might mark the occasion by reminding readers yet again that the human malaria problem is already here and growing fast, and that we do not lack the means to fight it, if we are persistent and careful and rethink old shibboleths about DDT.

Most of what Ellen Ruppel Shell wrote about the Resurgence of a Deadly Disease in The Atlantic back in 1997 still applies.

All but obliterated in the developed world half a century ago, and suppressed in the Third World in the 1950s and 1960s [thanks to DDT!], malaria has since returned in full force to North Africa, India, Southeast Asia, China, South America, and the Caribbean. Worldwide incidence of the disease has quadrupled in the past five years, and resistance to available drugs for prevention and treatment is growing rapidly. Nearly 40 percent of the world’s population lives in regions where malaria is endemic, and millions more live in areas that are encountering the disease for the first time in decades….

Nonetheless, the United States has shown little interest in the problem. Malaria is transferable in blood, yet it is not screened for in the American blood supply. The country’s Anopheles mosquito population has gone unmonitored for more than fifty years. “We just don’t know the potential for transmission,” says John Beier, a professor of tropical medicine at Tulane University. Temperature and humidity may well be among the most important factors in the rate of spread of the disease, yet we have only a vague notion of what effect, if any, climate change will have on malaria transmission — if, for example, global warming can be expected to bring malaria and other mosquito-borne diseases north from Mexico. Most Americans seem to think the disease has been eradicated or, at worst, is confined to the tropics. In fact there are few places on earth that cannot sustain a malaria epidemic.

A much more iconoclastic take on Earth Day appeared in the San Francisico Chronicle, coauthored by Patrick Moore, apostate cofounder of Greenpeace who left to become chairman and chief scientist of Greenspirit, and Nick Schulz, editor of

Ironically, the very movement that made its presence felt in rallies across this country in 1970 and that thrives in the developed world today must shoulder much of the blame for the developing world’s sorry state. It is impeding both economic and environmental progress due to an agenda that is anti-development, anti-technology and, in the final analysis, anti-human.

For example, today’s eco-activists boast that they have blocked more than 200 hydroelectric projects in the developing world over the past two decades. It is true that hydro power has a large ecological footprint, creating lakes and filling valleys. But it is a renewable energy that makes it possible to read after the sun goes down, boosting literacy in poor areas. It provides controlled irrigation for better crop yields and mitigates flooding and the loss of life and property damage….

Or consider that the pesticide DDT has been proven to radically reduce malaria in South Africa, while activist groups such as the World Wildlife Fund push for a total ban on its use. It only needs to be sprayed inside houses, where it poses no threat to the external environment, to make it effective. Despite the ability to stop malaria in its tracks with DDT — as the United States had already done before its use was prohibited here — 300 million people will become infected every year and at least 1 million will die, according to the World Health Organization.

UPDATE: Abiola Lapite’s Foreign Dispatches and Virginia Postrel’s Dynamist blog jumped on this story before I did: Abiola on 11 April (where I found the NYT article); Postrel on 19, 20, 21, and again on 21 April (where I found the Atlantic article).

UPDATE 2: Now the Washington Post has weighed in.

A large portion of the blame for the increased incidence of malaria can be laid at the feet of WHO itself, as well as other aid agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the U.S. Agency for International Development (USAID).

These agencies’ mosquito-prevention and drug-treatment policies in Africa are in tatters. A group of prominent malaria experts has even charged the agencies with malpractice for their reluctance to supply new, more expensive and better drugs for treatment [like artemisinin combination therapies (ACTs)], and for sticking instead with essentially ineffective medicines [like chloroquine and sulphadoxine-pyrimethamine]. But if WHO and its partners are serious about reducing the malaria threat, they need to reconsider their approach and start using all the weapons available to combat malaria — and soon.

While AIDS gets all the attention for destroying the young adults of Africa, few Westerners are aware that malaria kills more children than any other disease….

Preventing malaria means creating a barrier between the mosquito, which is the carrier of the malarial parasite, and the parasite’s primary host — humans. Since malarial mosquitoes bite only between dusk and dawn, WHO’s campaign has promoted bed nets, which can protect those who sleep beneath them. But this policy has had limited success. Nets for a whole family are expensive, and mosquitoes can take many blood meals between dusk and bedtime. Also, nets work best if treated with insecticide. But a recent survey in Kenya found that 21 percent of households had one single bed net, and only 5.6 percent of these were insecticide-treated. Moreover, mosquitoes are growing resistant to the type of insecticide with which the nets are coated.

By contrast, South Africa — which is rich enough to fund its own public health programs and doesn’t need to rely on WHO’s largess — has reduced malaria transmission by 90 percent in recent years, by a combination of returning to an old insecticide and investing in a new drug. It chose to spray insecticides, especially DDT, on the inside walls of dwellings to prevent mosquitoes from entering the buildings. This protects everyone inside all the time, not just when people might be sleeping.

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DDT Good! Chloroquine Bad!

On one occasion in 1976 when I left my New Guinea village to make a trip into town, my host family asked me to get medicine to kill the head lice their son had picked up while away at school. I did so, and he rubbed it into his hair and then tried to refrain from scratching his scalp as the lice ran around in their death throes. I think he may have had to “lather, rinse, repeat” to get the remaining nits after they hatched, too. It seemed to be effective, but I was horrified at the time to read on the label that the active ingredient was DDT. Nowadays, though, the reputation of DDT seems to have entered rehab.

On 11 April, the New York Times carried a story by Tina Rosenberg headlined, What the World Needs Now Is DDT:

[The book] ”Silent Spring” changed the relationship many Americans had with their government and introduced the concept of ecology and the interconnectedness of systems into the national debate. Rachel Carson started the environmental movement. Few books have done more to change the world.

But this time around, I was also struck by something that did not occur to me when I first read the book in the early 1980’s. In her 297 pages, Rachel Carson never mentioned the fact that by the time she was writing, DDT was responsible for saving tens of millions of lives, perhaps hundreds of millions.

DDT killed bald eagles because of its persistence in the environment. ”Silent Spring” is now killing African children because of its persistence in the public mind. Public opinion is so firm on DDT that even officials who know it can be employed safely dare not recommend its use. ”The significant issue is whether or not it can be used even in ways that are probably not causing environmental, animal or human damage when there is a general feeling by the public and environmental community that this is a nasty product,” said David Brandling-Bennett, the former deputy director of P.A.H.O. Anne Peterson, the Usaid official, explained that part of the reason her agency doesn’t finance DDT is that doing so would require a battle for public opinion. ”You’d have to explain to everybody why this is really O.K. and safe every time you do it,” she said — so you go with the alternative that everyone is comfortable with.

”Why it can’t be dealt with rationally, as you’d deal with any other insecticide, I don’t know,” said Janet Hemingway, director of the Liverpool School of Tropical Medicine. ”People get upset about DDT and merrily go and recommend an insecticide that is much more toxic.”

So DDT is now making a comeback, but Chloroquine, the antimalarial I took in New Guinea, is now anathema. (And it wasn’t all that effective for me. I got a bad case of Plasmodium vivax while there, and another within a year of returning from fieldwork.)

On 8 April, the Independent carried an alarming story by its health editor, Jeremy Laurance, headlined WHO failures led to hundreds of thousands dying from malaria, say medical experts.

Two of the world’s most powerful medical organisations have been accused of medical malpractice for knowingly promoting useless drugs that have led to the deaths of hundreds of thousands of children.

The World Health Organisation and the UN Global Fund, which was set up to buy drugs for poor countries, have allocated millions of dollars to malaria medicines that are no longer effective against the disease, a group of specialists said. They claim negligence by the two organisations contributed to a rising death rate from malaria, which has doubled in a decade in some parts of Africa because of growing resistance to older drugs.

The WHO launched its Roll Back Malaria programme in 1998 with a target to halve the number of deaths by 2010, but six years into the 12-year programme deaths have risen from between 600,000 and 800,000 to over one million annually, of which 90 per cent are in children under five.

Amir Attaran, of the Royal Institute of International Affairs in London, who made the accusation of malpractice in The Lancet with 12 malaria specialists from Britain, the US, Africa and the Far East, said yesterday: “I am angry because I know hundreds of thousands of kids have died for nothing; possibly millions. It is really negligent for these organisations to have made no progress towards the target in six years. Why should anyone connected with the programme still have their job?”

In 2003 the Global Fund, acting on advice from the WHO, spent $41.4m (£22.5m) on the outdated anti-malarials, chloroquine and sulfadoxine-pyrimethamine, which have been rendered useless by growing drug resistance, but only $18.3m on artemesinin-based therapies, which are effective.

Countries worst affected by malaria in sub-Saharan Africa have proved reluctant to buy the new artemesinin drugs because they are more expensive at $1 to $2 a dose, 10 times more than chloroquine. Although they get help from the Global Fund, they fear they may be left to foot the bill themselves. As a result, patients treated with the outdated drugs in Africa outnumber those given the effective artemesinin drugs by more than 10 to one.

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