Thursday, November 27, 2008
By Jasson Urbach
The annual South African Development Community (SADC) malaria day was held on 14 November. Health ministers attending the commemorations descended on the small town of Jozini in northern KwaZulu-Natal to raise awareness of the risks of the disease before the start of the rainy season that typically runs from November through to March. During this period, the scourge of malaria is at its worst in the region.
Ministers of Health also visited the local community to observe spray operations, where small amounts of insecticide are sprayed on the inside walls of houses in a process known as indoor residual spraying (IRS), IRS protects the occupants of a sprayed house from the deadly mosquito for up to one year.
However, well-meaning but ill-conceived decisions by parliamentarians in far off places could prevent SADC ministers from being able to obtain these valuable insecticides to control the disease. Recently the European Union (EU) proposed new regulations over the use of agricultural insecticides. These regulations are widely decried as unscientific and capricious in nature. The British government suggests that in the worst case scenario up to 85 per cent of chemicals currently used in EU agriculture will be outlawed and would “make conventional commercial agriculture in the UK unachievable as it is currently practised”. If this legislation is passed, it threatens all farmers and consumers. As the global reaction has been to export EU rules elsewhere, in time it may well affect all corners of the globe.
Unbeknown to most, these regulations will harm malaria control programmes around the world since almost all chemicals currently used for malaria control have been developed for the agricultural sector and simply adapted for public health. If, as predicted, the regulation outlaws pesticides, which are widely used for IRS and in the treatment of long lasting insecticide treated nets (LLINs), it is unlikely that production would continue for the tiny public health market. Even if production is to continue, it is probable that it will be on a much smaller scale, which will cause the price of the insecticides to rise – something that poor African governments simply cannot afford. Restricting access to insecticides will further exacerbate the scourge of this disease and the result will be many more lives lost unnecessarily. By almost every measure, the risks from a malarial mosquito are dramatically graver than any potential risk from insecticides.
Malaria kills a child every thirty seconds in Africa. The majority of deaths world-wide, over a million each year, occur in children under the age of five and in pregnant women. Effective malaria control saves lives, prevents the trauma of unnecessary deaths in families, and has beneficial economic consequences for those who are spared from this debilitating disease. Malaria sufferers have great difficulty in carrying out sustained work, which intensifies human misery and poverty in areas where the disease is prevalent. Combining drug therapy for humans, along with effective insecticides for IRS, provides the one-two punch necessary to break the transmission cycle and to knock out the disease.
In malarial countries it is estimated that the disease reduces per capita economic growth by 1.3 per cent per year. This equates to approximately $12 billion in forgone income. Controlling malaria will consequently not only reduce human suffering but will also allow people to work and sustain themselves and their families. The SADC ministers therefore have an economic as well as a humanitarian reason for doing all they can to fight the tiny but deadly killer: the malaria-carrying anopheles mosquito.
Malaria is generally limited to the far North Eastern corners of South Africa where the Limpopo, Mpumalanga and KwaZulu-Natal provinces border with neighbouring countries. The South African ministry of health along with other independent organisations have established cross border initiatives with neighbouring countries to control the disease in these countries. Arguably the most successful cross border malaria control programme has been the Lubombo Spatial Development Initiative (LSDI). The LSDI is a tri-lateral agreement between the governments of Mozambique, South Africa and Swaziland and has substantial input from South Africa’s Medical Research Council (MRC).
Since its inception in 1998 the programme has reduced the incidence of malaria on the border between South Africa and Swaziland from over 25 per cent to less than 2 per cent. In Maputo province the parasite prevalence was over 60 per cent in 1999, but it is presently well below 5 per cent.
South Africa is now hoping to emulate the successes of the LSDI programme by collaborating with Angola, Botswana, Namibia, Zambia and Zimbabwe in a regional initiative known as the Trans Zambezi Cross Border Initiative. Once again it is envisioned that the cornerstones of the programme will be the use of effective insecticides and anti malarial treatments. Without the use of insecticides it will be impossible to break the transmission cycle. SADC ministers should therefore join together and put pressure on the EU to consider the consequences on public health of the proposed legislation, not only for the African continent but for all the malarial areas around the world.
Jasson Urbach is an economist with the Free Market Foundation and a director of the health advocacy group Africa Fighting Malaria.