GUYANA continues to encounter malaria as a major public health problem. While significant progress has been made in the last five (5) years in the prevention and control of malaria in Guyana, we have had significant problems in sustaining reduced level of malaria incidences in Guyana in the last 12 months.

The use of long-lasting insecticide impregnated bed nets, more training for health workers, and use of better medicines have contributed to an almost 80% reduction of malaria between 2004 and 2008. Yet the efforts have stagnated and this year there has been a significant increase in malaria incidences in Guyana.

Clearly, without an effective, long-lasting residual and affordable insecticide to reduce the mosquito population (effective vector control) to break transmission of malaria, the fight against malaria in any country will continue to be a difficult and daunting challenge and success cannot be guaranteed.
For many countries, this realization is a case of déjà vu. In Guyana’s case, we can recall the use of DDT as the insecticide used for indoor residual spray (IRS) in the 1950s which led to the elimination of malaria from Guyana’s coast.

QUOTE: As Minister of Health, particularly as the impacts of climate change take effect, it is my position that vector-borne diseases like malaria will not be rolled back, but rather will surge. We will fail against these diseases, such as malaria and dengue, because of global policies that limit our use of effective tools such as DDT. I am, therefore, calling on the global authorities to re-examine their position on DDT.

My position is that DDT is the most effective and affordable chemical we have to control malaria. My position further is that the global response to the burgeoning malaria rates in the world should allow for DDT residual spraying. My position is that the benefits in the use of DDT for public health purposes far outweighs the risk for low-level usage of this chemical.

Regulations and policies of industrialized countries and international agencies that block financial assistance to countries for the use of DDT for malaria control should be eliminated. It is my view that we should establish a global mechanism for the production and distribution of DDT for prevention and control of malaria, dengue and other mosquito-borne diseases. The low-level usage for public health purposes will not have any environmental impact.

With the virtual banning of DDT, the pyrethroids have now largely replaced other insecticides including DDT, as the main IRS insecticide. Mainly because of their short residual life-cycle and biodegradable property, the pyrethroids have been the preferred insecticide for IRS control of mosquito (vector) population, in preference to DDT.

But the use of the pyrethroids has been limited because of their extremely high cost and the need for greater frequency of application when compared to DDT in the hot, humid conditions of the endemic malarious areas which are also far, isolated and difficult to access. These areas are the rich, biodiversity areas of the Amazon of Regions One, Seven, Eight, Nine and parts of Two and Ten. Also, they are the areas of Guyana’s forest, mineral deposits and vast water resources and the home of the poor, vulnerable indigenous Amerindians.

While the Stockholm Convention includes special provisions for the phase out of DDT, it also provides for DDT continued use for malaria control in countries with specific exemption. Thirty-one of the 91 countries that signed the Stockholm Convention requested exemptions for DDT use to control Malaria. Guyana is listed by WHO as a “recent user” when Guyana was the first country in the Americas to use DDT in 1942 for malaria control.

However, since the Stockholm Convention, the manufacturing of DDT has been severely curtailed with only a few countries including India and China in production. Also, while WHO still endorsed and support DDT for Vector Control, transportation of the insecticide is prohibited.

There are many other examples of poor international policies relating to DDT that have contributed to morbidity and mortality of mosquito-borne diseases. Belize, for example in 2000, was threatened by USAID with withdrawal of support if it were to use DDT.

Guyana, like many other poor countries need increase donor funding for not only malaria prevention and control but also for research and with the present non-availability of DDT – either allowing its availability or the international community providing sustained support for alternative control methods.

Sustained international donor support for vector control activities is not available at this time. Without such support, the availability of expensive recommended IRS commodities will remain unreliable and, therefore the battle against the malaria vector will remain weak.

As Minister of Health, I believe that the almost one million deaths of persons because of malaria and the countless other deaths caused by other vector-borne diseases around the world make it an imperative for Global authorities to re-think policies relating to DDT. DDT has been an effective tool to control mosquito population in countries around the world before the virtual ban of DDT.

The case against DDT as a harmful environmental chemical is weak compared to the fact that millions are dying and hundreds of millions are sick and disabled and becoming impoverished because of mosquito-borne diseases.
The virtual banning of DDT is a policy that cannot be justified, and as climate change causes a new surge in mosquito population, we need to use all effective vector control chemicals at our disposal.

Between 1955 and 1969, there was a WHO-led campaign to stop malaria and other mosquito-borne diseases. These efforts failed badly. The new assault against malaria, called the Roll-Back Malaria Programme, started in 1998. We must not allow this campaign to suffer the same faith as the previous campaign. But we will fail unless we are willing to use all tools at our disposal. The removal of DDT from the arsenal of tools we can use against mosquito is not only a foolish policy, but a deadly and impoverishing one.

Take for example, the fact that more than 800,000 persons, including a large number of women and children, die in Africa alone each year and Africa loses more than US$100B annually because of malaria alone. DDT can prevent these deaths and reduce the haemorraging of financial resources that could be used to lift Africa out of poverty. Similar stories abound in other regions of the world.

And bear in mind that most of the rich countries used DDT to once control vector like mosquitoes. Today, these are the countries in the forefront of the policies to ban the use of DDT in developing countries.

I do not think we need to re-examine the decision to ban DDT for agricultural use.
Make no mistake, the battle against malaria will not be won because of DDT alone. The battle against malaria has to be fought on many fronts: education and awareness, eradication of the vector (mosquito), as well as medically treating the parasite itself.