Malaria is a dangerous disease that kills children and is very debilitating for adults, and often deadly. There is the scientific knowledge to combat this disease successfully, but there have not been the resources for places where malaria is the worst. Now there is more money ... but mostly not used in the most cost effective ways. Using integrated malaria management concepts can improve outcomes ... and helping communities so that this is done is our primary challenge.

There are several multi-million fund flows to combat malaria with substantial resources being allocated to increasing access to: (1) treatment with more effective but more costly drugs with focus on children and pregnant women; (2) insecticide treated bednets mainly for children and pregnant women; and (3) research on the science, and especially as it relates to vaccines. The evidence that these expenditures are resulting in a sustainable and cost effective reduction in the prevalence of malaria is weak. 

There is an increasing allocation of resources to interior residual spraying (IRS), including the use of DDT, but, again, the evidence for its cost effectiveness and sustainability is limited. 

The main sources of funds are: (1) the President's Malaria Initiative (PMI) from the United States; (2) the malaria component of the Global Fund for AIDS, Tuberculosis and Malaria; (3) the major philanthropic foundations including the Bill and Melinda Gates Foundation; and (4) a growing community of individual supporters (mainly funding bednets).

The Integrated Malaria Management Consortium (IMMC) is working to get comprehensive integrated mosquito and vector control programs implemented so that there are much better outcomes and more sustainable results and in the most cost effective manner possible. Some of the analytical work done by the IMMC suggests that it will be possible to get results that are 10 times, maybe even 100 times more cost effective than the single intervention approaches that have been used up to now.

In the United States that was affected with malaria until the 1950s, there are until now mosquito and vector control districts almost everywhere ... and these organizations conduct surveillance for possible disease all the time, and when problems are identified they carry out the appropriate interventions including larviciding to reduce recruitment into the vector population, and adulticiding to kill the flying parasites.

Modern pesticide spraying using ultra-low-volume (ULV) technology is very safe for the human population and the environment, though lethal for mosquitoes. It is very cost effective when managed properly. Larviciding that kills mosquitoes before they become mobile is even better, but requires timely data about the state of the breeding habitat. 

The use of DDT in support of malaria control is very cost effective AND environmentally safe. DDT is opposed by many based on much information that is not supported by any scientific data, while ignoring the reality of DDT's effectiveness as a tool for the reduction in malaria prevalence. DDT is the preferred chemical for use in interion residual spraying.

• 09/17/2007 16:50
  • 09/17/2007 16:24