Education And Debate Ethical debate

Doctoring malaria, badly: the global campaign to ban DDTDDT for malaria control should not be bannedCommentary: Reduction and elimination of DDT should proceed slowly

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7273.1403 (Published 02 December 2000) Cite this as: BMJ 2000;321:1403

Doctoring malaria, badly: the global campaign to ban DDT

The treaty on persistent organic pollutants—POPs—will be finalised at the United Nations Environment Programme meeting in Johannesburg, 4-9 December. One proposal is to ban DDT, still used by many countries for controlling the mosquitoes that spread malaria. It should not be banned, argue Amir Attaran and Rajendra Maharaj, specialists in malariology and also international development and law—there's no evidence that spraying with DDT harms anyone. The issue is not straightforward, says Richard Liroff, director of the World Wildlife Fund's alternatives to DDT project; the treaty raises a series of equity challenges.

DDT for malaria control should not be banned

  1. Amir Attaran (amir_attaran@harvard.edu), director, international health researcha,
  2. Rajendra Maharaj, deputy director, vector-borne diseasesb
  1. a Center for International Development, Harvard University, Cambridge, MA 02138, USA
  2. b South Africa Department of Health, Communicable Disease Control, Private Bag X828, Pretoria 0001, South Africa
  3. World Wildlife Fund-US, 1250 24th Street NW, Washington, DC 20037, USA
  1. Correspondence to: A Attaran

    Last year, deaths from malaria in Africa reached an all time high. Next year they will probably do so again, claiming around a million children. Yet in this deadly upward spiral, political pressure is building at the United Nations Environment Programme to pass a treaty by the end of 2000 to internationally ban or restrict one of the world's best anti-malarial tools.

    That tool is, of course, DDT—dichlorodiphenyltrichloroethane. The campaign to ban it, joined by 260 environmental groups, reads like a who's who of the environmental movement and includes names such as Greenpeace, Worldwide Fund for Nature (WWF), and (ironically) the Physicians for Social Responsibility. Together, they are “demanding action to eliminate” DDT and its sources.1

    This view is stunningly naive. DDT residual house spraying is an inexpensive, highly effective, practice against malaria, and it has been approved by the World Health Organization. In it, trained sprayers apply a small quantity of DDT on the interior walls and eaves of homes in endemic regions. The quantities involved are minimal (2 g/m2) and, unlike agricultural uses which inject tonnes of DDT into the outdoors, indoor house spraying results in little harmful release to the environment. For the amount of DDT used on a cotton field, all the high …

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