THE LITTLE LADY WITH THE BLOOD ON HER HANDS (via Jeff Guinn):

What the World Needs Now Is DDT (TINA ROSENBERG, 4/11/04, NY Times Magazine)

As malaria surges once again in Africa, victories are few. But South Africa is beating the disease with a simple remedy: spraying the inside walls of houses in affected regions once a year. Several insecticides can be used, but South Africa has chosen the most effective one. It lasts twice as long as the alternatives. It repels mosquitoes in addition to killing them, which delays the onset of pesticide-resistance. It costs a quarter as much as the next cheapest insecticide. It is DDT.

KwaZulu-Natal, the province of South Africa where Ndumo and Mosvold are located, sprayed with DDT until 1996, then stopped, in part under pressure from other nations, and switched to another insecticide. But mosquitoes proved to be resistant to the new insecticide, and malaria cases soared. Since DDT was brought back in 2000, malaria is once again under control. To South Africans, DDT is their best defense against a killer disease.

To Americans, DDT is simply a killer. Ask Americans over 40 to name the most dangerous chemical they know, and chances are that they will say DDT. Dichloro-diphenyl-trichloroethane was banned in the United States in 1972. The chemical was once sprayed in huge quantities over cities and fields of cotton and other crops. Its persistence in the ecosystem, where it builds up to kill birds and fish, has become a symbol of the dangers of playing God with nature, an icon of human arrogance. Countries throughout the world have signed a treaty promising to phase out its use. [...]

Probably the worst thing that ever happened to malaria in poor nations was its eradication in rich ones. That has made one of Africa's leading killers shockingly invisible. ''Silent Spring had a clear message about things at home Americans could see and touch and feel,'' said Brooks B. Yeager, vice president of the Global Threats Program for the World Wildlife Fund. ''Americans who live on the Carolina coast know the brown pelicans have come back'' since DDT spraying was halted. ''Malaria is a long way away. You have to read about it or see in person its devastation, and not many Americans have the opportunity to do it.'' [...]

Bed nets are an exciting and important form of mosquito control. But they have major drawbacks. Even a few dollars is still too much money. People surveyed in rural Africa about what they would like to buy listed a bed net as only the sixth product on their wish list. The first three were a bicycle, a radio and, most heartbreakingly, a plastic bucket. The price is also kept artificially high because most countries, shamefully, still tax bed nets. And until nets with long-lasting insecticide can be widely distributed, bed nets need regular retreatment. It is insecticide that protects, not the net, and the insecticide wears off without people knowing it.

Both bed nets and house spraying can be effective, and studies comparing costs differ on which is cheaper. For the world malaria establishment, however, one huge difference is that with house spraying, the central government -- and therefore donors -- bear the cost. Financing repeated rounds of spraying, donors argue, is not sustainable. ''But 'sustainable' is what you choose to sustain,'' Amir Attaran fumed. ''Nobody demands my garbage collection in Cambridge, Mass., be sustainable. The garbageman comes once a week, and it is accepted that society pays for that.''

Mozambique is now doing house spraying successfully and cheaply without a national army of sprayers and a fleet of S.U.V.'s. Mozambique hires a few people in each community and gives them two weeks of training and the materials they need. Those sprayers then walk from house to house, spraying each one twice a year. ''It helps save on transport costs, and the fact that sprayers come from the community makes it a lot more credible in terms of people accepting what is done in their households,'' said Jotham Mthembu, KwaZulu-Natal's malaria control program manager, who also advises the program in neighboring Mozambique. Mozambique, because it depends on Western donors, uses a more expensive insecticide. But if it used DDT, it could protect people for $1.70 per person per year.

There are other ways to control mosquitoes. Parts of India, for example, are having success stocking mosquito-breeding ponds with guppies, who eat mosquito larvae. But India's ingenious strategy would not work in Africa, where mosquitoes breed in cattle hoofprints during the rainy season.

Malaria must be more than simply a line item in the health budget. Malaria kills tourism and foreign investment. It greatly reduces human intelligence and productivity and lessens agricultural yields. Against these costs, a nation's business sectors and economic ministries should willingly join the fight -- and donors must begin to think of malaria control as an unusually cost-effective antipoverty program.

South Africa's success is inspiring another look at DDT around the continent. Uganda, Kenya and other places are now examining whether it could work in their nations. If it could, donors should encourage it. DDT is a victim of its success, having so thoroughly eliminated malaria in wealthy nations that we forget why we once needed it. But malaria kills Africans today. Those worried about the arrogance of playing God should realize that we have forged an instrument of salvation, and we choose to hide it under our robes.

Some lies are just too precious for even somewhat sensible folks to ever let go. Brown pelicans, raptors and other birds came back because we stopped letting people kill them, not because DDT was banned.

Posted by Orrin Judd at April 15, 2004 1:42 PM