Cover Story

Kill or be killed

"Kill or be killed" Continued...

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

By 1952, DDT had helped eradicate malaria in the United States, and a worldwide anti-mosquito campaign greatly reduced infections in Asia and Latin America. Only three countries in Africa got in early, though, and in 1962 biologist Rachel Carson's book, Silent Spring, attacked pesticides for causing environmental damage and singled out DDT as the worst offender.

Ms. Carson said the chemical was behind the thinning eggshells of some birds and was contributing to fewer hatchlings and the decline of species such as the bald eagle. Silent Spring helped the modern environmental movement get its wings, and the movement in 1972 succeeded in having use of the chemical banned in the United States. (In one of history's curious footnotes, the big political push for a DDT ban came from President Richard Nixon, looking to build bridges to the left.)

Soon the World Health Organization (WHO) and the U.S. Agency for International Development (USAID) cut out DDT from its programs, and instead started talking up bed nets. Author and physician Michael Crichton described the results of the de facto ban on DDT this way: "It has killed more people than Hitler." That's because trying to stop every human-stinging mosquito is a dead man's game: They will find a way in.

We've learned two things in the three decades since DDT disappeared from the disease-fighting weapon rack. First, Ms. Carson's concerns turned out to be overwrought. Lab experiments in which captive birds ingested hundreds of times more DDT than their counterparts would encounter in the wild did not thin their eggshells dangerously; bird populations actually increased while DDT was in use. Nor is DDT carcinogenic to humans; that was another Carson claim. Infants nursing where there's been heavy DDT spraying may gain weight more slowly than others, but that's a lot better than dying from malaria.

We've also learned not to trust the foreign aid establishment. Many health workers are dedicated, but Monique Maddy's Learning to Love Africa (HarperCollins, 2004) is one of many recent works to criticize the "endless parade of well-paid experts [who have] little or no incentive to bring a project to fruition. On the contrary, any project that ended, successful or not, would reduce the number of consulting contracts available to the large cadre of international experts dependent on the UN system for their livelihoods."

Ms. Maddy, who was born in Liberia and worked for the UN in Indonesia, Angola, and the Central African Republic, writes of UN-sponsored events she attended in compounds and convention centers where Dom Perignon and vintage French wines flowed not far from shantytowns where rice and beans would be a feast. She describes the pleasure of being "an academic, a self-appointed guru of global poverty, reeling in millions of publicly funded dollars to collect and disseminate data and writing alarming reports that I know will never be read, let alone acted upon."

USAID has not been so bad, according to Senate testimony in May by Roger Bate, a resident scholar at the American Enterprise Institute, who stated that "the Agency would rather allocate its monies to U.S. organizations likely to waste a good portion of it but steal none, rather than local institutions that are in a better position to effectively use resources but are more vulnerable to instances of fraud and embezzlement."

Mr. Bate noted that USAID "uses earmarked malaria funds for peripheral actions. (Read Mr. Bate's full Senate testimony in pdf format). These consist mainly of paying Washington-based contractors to consult with local health ministers on policy matters, give advice on management issues, train selected administrators and health care workers, and help run basic health education programs." Millions in USAID anti-malaria funds never leave the Washington area.

Mr. Bate described a typical USAID-funded project in Kenya that "made no effort to measure whether the project made any progress towards its goal (reduction of deaths and severe illness due to malaria) . . . instead measured several objectives (five in this case) loosely related to its goal . . . revised downward its targets for some of those objectives after the mid-term report revealed unsatisfactory progress . . . failed to meet many of these objectives (even downwardly revised ones) . . . despite unimpressive results, the final evaluation gave the program a positive assessment."

But Lester Munson, chief of staff for USAID's global health bureau, told WORLD last week that the agency was not wasting money, and instead was building "infrastructure" so that new allocations will be well spent. "A lot of stuff USAID has done for the last 10 years has paved the way for these large amounts of commodities to be used correctly," he said. He expects that some future USAID funds will be used for insecticide spraying.

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