What if we killed all the mosquitoes?

It appears that a malaria vaccine will not be available for some time. According to Reuters,

“The world’s first potential malaria vaccine proved only 30 percent effective in African babies in a crucial trial, calling into question whether it can be a useful weapon in the fight against the deadly disease.”

Reading this reminded me of my own illness with malaria at the end of summer.

Back in September I contracted malaria while on a short trip back home in Kenya. Due to malaria’s incubation period I only started feeling sick after I was back in Palo Alto. My illness set off a total freakout at the Stanford Hospital. No less than four medical students, besides the crowd from the infectious disease unit at the hospital, passed by my hospital bed to ask the EXACT same questions (And of course they wanted to keep me overnight. They had an IV drip already installed in my arm. I tried my best to tell the doctor that I didn’t think I needed to be hospitalized to no avail.) The nurse who took my vitals put a mask on my face the moment I told her that I had malaria (I had to restrain myself from reminding her that malaria is not airborne). A week later the Santa Clara county infectious disease office called me to get my details and ask me if I was feeling better – The government wanted to know where and how I got malaria (The grad student in me was fascinated by this level of state capacity).

A few weeks before my Kenya visit I was in Fort Worth, TX. This was at the height of the West Nile virus outbreak that killed dozens of people. At the time the health authorities in the Dallas-Fort Worth area were in the middle of spraying the area to kill all the vectors (mosquitoes). My girlfriend reminded me of the fact that as recent as when her parents were growing up in Grand Prairie, TX much of the American South still had to be sprayed regularly (with DDT) to get rid of disease-bearing mosquitoes.

The reason I recounted these stories is to illustrate the fact that there is an alternative to pouring tons on money on vaccine research or bed nets. Yes, these may result in cool scientific discoveries or provide excellent opportunities for social scientists to get published on their RCT findings. But the reality is that millions of people are still dying.

Instead of asking those living in high disease burden environments to change their behaviors and sleep under mosquito nets, how about we get rid of the mosquitoes??

If it worked in the American South, and many other places, why can’t it work in Africa?

I would very much love to live in a place free of malaria. Because of my age and health, my malaria infection at the end of summer was a mere nuisance – muscle aches, head aches and fatigue. But for millions of children and post-natal mothers across much of tropical Africa malaria is a fatal disease.

But is DDT the answer? Haven’t we been made to internalize the evils of DDT?

It turns out that what we know about DDT might not be the whole truth. As Gourevitch argues, the environmental impact of DDT might have been overblown by the environmentalists.

Writes Gourevitch:

“Around the same time, the U.S. government launched an ambitious DDT-centered malaria eradication project which by the early ’60s had virtually eliminated malaria from Southern Europe, the Caribbean, and parts of East and South Asia. (In India, for example, annual deaths went from 800,000 to zero.) At the time, DDT was thought to be such an effective and useful substance that in 1948, Muller received a Nobel Prize in medicine. “To only a few chemicals does man owe as great a debt as to DDT,” declared the National Academy of Sciences in a report in 1970. “In little more than two decades, DDT has prevented 500 million human deaths, due to malaria.””

Adding that:

“But over the years, mainstream scientific opinion has absolved DDT of many of its supposed sins. Indeed, the Stockholm Convention partially backfired because it brought to light a slew of studies and literature reviews which contradicted the conventional wisdom on DDT. Like nearly any chemical, DDT is harmful in high enough doses. But when it comes to the kinds of uses once permitted in the United States and abroad, there’s simply no solid scientific evidence that exposure to DDT causes cancer or is otherwise harmful to human beings……

Not a single study linking DDT exposure to human toxicity has ever been replicated.”

But even assuming that the effects were as bad as they were claimed to be, shouldn’t we as humans be able to decide on the relative importance of human lives versus bald eagles?

How many children should be allowed to die so that bird watchers can better enjoy their Sunday afternoons?

hapa na pale (here and there)

Bankelele has a nice post on medical investment in East Africa.

For the business-minded, here is one more reason for Kenyans to vote YES in the August 4th referendum for a new constitution. I remain apprehensive about the size of government that will result from a victory for the YES camp. But as a student of history I am also hopeful that effective government, i.e. creation of grassroots administrative and TAXATION apparatuses in provincial counties, will lead to faster Kenyanization of ALL of Kenya. And who knows, may be the need to finance government will give officials incentives to formulate policies that promote growth and generate revenue.

In other news, EASSy, the third international fibre optic cable to land on the Kenyan shores, will soon roll out, hopefully helping lower the cost of internet connectivity not only in Kenya but in the wider East African region as well.

And lastly, being only nine days away from a short vacation back home I join Magical Kenya in saying JAMBO!

malaria is still around, you know

Researchers have discovered a trend in the habits of mosquitoes. The little insects are feeding on human blood earlier than they used to. This means that more and more people get bitten earlier in the evening before they get to sleep under bed nets – which in turn translates into higher malaria infection rates. Bed nets lower infection rates by a whole 40%. Now researchers are urging people to use mosquito repellents. Personally, I don’t think this will fly. I for one do not like the “tourist smell” of repellents (I still don’t get how tourists stand themselves smelling like that!). I would advocate for a more aggressive approach to eliminating mosquitoes. DDT is bad, I know. But can’t we find other means of doing this? Plus malaria deaths, lost man hours because of disease burden and expenditures on anti-malaria medication may outweigh the cost of eliminating mosquitoes – thereby making the latter the more rational option.

Meanwhile, the WHO in a 2003 report says that malaria is still alive and well and continues to kill 2000 African children every day. That translates to 0.73 million children every year. I need not even add the figures for people over the age of 5.