Malaria remains a devastating global problem, with 300 - 500 million cases and 3 million deaths occurring annually, mostly in children. In the United States, the 1,167 cases reported in 1995 were a 15% increase compared with 1994 (MMWR 2/26/99). Worldwide, only AIDS and tuberculosis cause more deaths.
A wider range for the insect vector is one of the predicted consequences of catastrophic global climate change, a favorite threat of Physicians for Social Responsibility and their allies, who strive to make ``advocacy and activism regarding the link between the environment and patient health become the responsibility of health professionals'' (AM News 11/6/00).
This link has always been a stretch. Mosquitoes that carry malaria have always been present domestically. At the turn of the century, Washington, DC., was considered a hardship post by foreign diplomats because of the high prevalence of malaria. An estimated 600,000 cases occurred in the continental U.S. in 1914.
Even global warmers now concede that there would be remarkably few changes in mosquito distribution, even under the most extreme scenarios, in an article entitled to suggest the opposite (Rogers DJ, Randolph SE, The Global Spread of Malaria in a Future, Warmer World, Science 2000;289;1763-1766; 2283-2284).
While malaria ``has been included in most predictions about the impact of climate change on the future distribution of vector-borne diseases, [t]hese studies ... generally use only one or at most two climatic variables to make their predictions.'' Models do not accurately describe the current distribution of malaria and ``cannot be used to give reliable predictions about the future.''
Obviously, a global energy rationing regime is not going to stop malaria- especially since poverty is ``a particularly recalcitrant contributor to and consequence of infectious diseases'' (Binder S et al, Emerging Infectious Diseases: Public Health Issues for the 21st Century, Science 1999;284:1311-1312).
Money is pouring into malaria research. NIH funding has increased five-fold and should reach $50 million in 2001. The Bill & Melinda Gates Foundation plans to disburse $115 million, $50 million through its Malaria Vaccine Initiative . The hope is to find a vaccine that will be 95% effective for 6 months: long enough to protect troops deployed to an endemic region (Science 2000;290:434-437).
The situation with drugs is desperate as the malaria parasite is becoming resistant to every cheap drug that works-chloroquine is ineffective nearly everywhere-and even to newer drugs like mefloquine. Drugs designed with the aid of genome sequencers are probably a decade away. Fortunately, artemisinins, used as herbal remedies in China for 2,000 years, look promising. Clinical trials were delayed because of WHO concerns about neurotoxicity in animals. Some think that the biggest roadblock was lack of the right regulatory ``credentials which people seem to regard almost as religious edicts'' (Science 2000;290:437-438).
Efforts are underway to engineer a mosquito that is refractory to the malaria parasite, and get it to replace the native population (Science 2000;290:440-441).
For all of the ingenious effort, malaria fighters are in some ways ``worse off than we were in the 1950s'' stated Louis Miller, a leader of the anti-malaria effort at the National Institute of Allergic and Infectious Diseases (NIAID), because effective pesticides like DDT are less available. The use of pesticide-soaked bed nets, for example, has produced ``a substantial reduction in child mortality'' in western Kenya, where children may experience 300 infective mosquito bites per year. ``Few other interventions have produced such credible evidence of effectiveness,'' stated Richard Skeketee, chief of CDC's malaria branch (Science 2000;290:428-430). The ``U.N.-backed push to phase out DDT'' makes the reinvention of the mosquito more urgent.
Once focused on the nuclear disarmament of the American military, Physicians for Social Responsibility (now billed as ``a group concerned with environmental health'') is now working for the disarmament of the malaria fighters, through a comprehensive ban on their most effective weapon, DDT. Their ally, the World Wildlife Fund, is pressing for a total global ban by 2007.
At least one expert, Dr. Donald R. Roberts of the Uniformed Services University of the Health Sciences states that ``DDT is the best insecticide we have for controlling malaria.... We have got to stop pressuring countries to ban DDT. It is immoral'' (NY Times 8/29/99). With only three countries still manufacturing DDT-Mexico, China, and India-lack of a reliable supply has forced some African nations to resort to more expensive pyrethroids.
U.S. District Judge Manuel L. Real has entered the fray against DDT, ruling that DDT pollution on the ocean floor is responsible for decades of injury to bald eagles and peregrine falcons. The U.S. Department of Justice was seeking $150 million for damage to natural resources plus about $10 million for past cleanup costs. In Los Angeles County, 150 municipalities and three companies agreed to pay $67 million in damages for their role in the pollution. It is alleged that 100 tons of DDT lies on the Palos Verdes Shelf and is continuing to contaminate the ocean.
``Most experts say it breaks down slowly, remaining in ocean sediments for decades if not centuries'' (LA Times 10/3/00).
Montrose Chemical Company, once the world's largest manufacturer of DDT, the most widely used pesticide in history, is now defunct except for the lawsuit. It has agreed to settle the case for an undisclosed amount. The consent decree is to be published in the Federal Register after Dec. 15; public comment will be open for at least 30 days before Judge Real decides to approve it (LA Times 10/28/00).
Dr. J. Gordon Edwards of San Jose State University, who never received any money from Montrose, writes: ``I got involved in assembling my data on DDT in the Los Angeles sewers, thinking it would be vital during the suit against Montrose.... I have now heard that they may be reaching a settlement, rather than seeking a victory, because it costs too much to compete with the government attackers, who have unlimited funds.''
A key piece of incriminating evidence is the amount of DDT in the Montrose sewer line. ``Dr. Risebrough took his remarkable sample by opening a manhole cover near the coast and dipping some water out. He analyzed it in a lab at Berkeley, using unreliable methods. Dr. Alice Ottoboni visited his lab and told me he couldn't possibly have made an accurate analysis because it was such a mess. AND the lighting consisted of fluorescent light tubes (the ballast of which throw off PCBs, which, at that time, gave GLC readings identical to DDT).''
Additionally, Dr. Edwards writes: ``My naive view was that the EPA conclusion that DDT in sea water was short-lived (with 92% of it gone in 38 days, along with its breakdown products) would make it obvious that the ridiculous claim of tons of DDT still in the bay after over 25 years of breaking down in sea water would at least force the attackers to provide samples of the sediment for scientific analysis by the defense. It is obvious that DDT cannot still be in the sediment!''
There will probably be continued suits against DDT, Dr. Edwards believes.
The pogrom against DDT amounts to war against African children and others. Getting out the scientific information is a critical public health effort. DDP plans to examine and comment on the proposed consent decree and invites your help.
In addition to the usual star-studded lecture program, Dr. Kenneth Lucas is arranging some very special tours of Nellis Air Force Base, which will be having spectacular air shows, and the Nevada Test Site. The former will probably occur on Friday, July 13, and the latter on Monday July 16. The meeting site is the Sahara Hotel at the very special weekend rate of $79 (Friday and Saturday) and weekday rate of $32. Space is limited. Reserve a place NOW by calling (520) 325-2680.
DDP, 1601 N. Tucson Blvd. Suite 9, Tucson, AZ 85716, (520)325-2680