Cover Story

Kill or be killed

Malaria takes one child every 30 seconds and costs billions to combat; but unless the mosquitoes die . . . they will find a way in

Issue: "Malaria: Kill or be killed," Oct. 29, 2005

In Africa, mosquitoes go blood hunting after dusk. They often drift in through open windows or doors, but any crack or crevice will do. Inside, they sniff out their prey: a mother scrubbing pots after dinner, a child's ankles as she finishes her homework.

Bedtime is the best time for feeding. Through the quiet darkness comes a mosquito's reedy whine when it zips past your ear. But in Africa mosquitoes mean more than itchy bites; just one can bring death through malaria. And trillions breed anywhere there is fresh standing water, even puddles.

Sleepers sometimes use insecticide-treated bed nets as a defense-the nets often hang over floor mats, not beds-but the mesh turns stifling in the heat. Badly hung nets have gaps, and any tear renders them useless. Trying to stop every mosquito is a dead man's game: They will find a way in.

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The only winning way to fight Africa's malarial mosquitoes is the law of the jungle: Kill them before they kill you. This is a story of how those who would save human lives lost their most effective weapon, and how some policy wonks are moving beyond their academic journals and seclusion in order to say, loud and often, give us back the weapon.

The story has to begin with big numbers, a little climatology, and a bit of entomology. The numbers: Some 500 million cases of malaria occur worldwide every year, and 1 million people die, nine-tenths of them in Africa. The disease is the leading murderer of Africans under 5-it kills a young child every 30 seconds-and survivors often suffer brain damage.

The climate fact is simple: Africa is a hot continent. That's relevant here because the process of transmitting malaria begins when a mosquito bites someone already infected and ingests the malarial parasite. Over a two-week period-but one that goes faster when it's hot-the parasite goes through a transformation called sporogony; once it occurs, the mosquito can infect others. The curious part is that the life span of the mosquito is also two weeks, so in cool areas mosquitoes typically die just before they become infectious-but in Africa they bite first, die later.

The entomology, or study of insects, explains why Africa is hit harder by malaria than, say, India. It takes two human bites in a row-one for the mosquito to ingest the parasite, the other two weeks later to infect another person-for malaria to be transmitted. In India, the predominant mosquito type prefers to bite cattle, but in Africa, mosquitoes almost always bite humans. The result is that malaria can be transmitted in Africa nine times more readily than in India.

Trying to stop every human-stinging mosquito is a dead man's game: They will find a way in.

The United States has been contributing about $200 million per year to Africa's war on malaria. Four months ago President Bush promised an additional $1.2 billion over five years in U.S. anti-malaria funding. But last week a coalition of 100 doctors, scientists, and activists said that anti-malaria funds up to now have been misspent.

The "Kill Malarial Mosquitoes Now" coalition-including eminent malaria experts and public health specialists, the former U.S. Navy Surgeon General, the national chairman of the Congress of Racial Equality, a co-founder of Greenpeace, the president of the National Black Chamber of Commerce, and the president of the Association of American Physicians and Surgeons-says most of the annual $200 million currently spent goes to advising African governments on how to combat malaria, not on actual combat.

The KMMN coalition says that only a small fraction of that amount goes to supplying bed nets and medicines. And zero goes to the most effective weapon: the insecticide DDT, which eradicated malaria in Europe and the United States more than half a century ago, but was later banned in the West for its supposed environmental effects.

The coalition's aim is to persuade Congress to devote two-thirds of annual U.S. anti-malaria funds to indoor insecticide spraying with DDT. Bed nets and life-saving drugs are important, explained Paul Driessen of the Center for the Defense of Free Enterprise, "but they just don't do the trick."

What used to do the trick was DDT, dichloro-diphenyl-trichloroethane, a chemical accidentally synthesized in 1874. In 1939, Swiss scientist Paul Muller discovered it killed many insects, including flies and mosquitoes. Allied forces used it in World War II, and scientists soon learned that small amounts sprayed on the inner walls and surfaces of homes repelled and killed malarial mosquitoes for up to a year-a revolutionary length of time compared to older pesticides that lasted only weeks.

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