Chris Macrea blows my mind! Thanks for pointing to the vital work that must be done.

I do hope malaria network weavers can be persuaded to join the discussion here.

I feel generally convinced that residual spraying of DDT on building walls is an important part of the malaria fight. But I am made uncomfortable by the many connections the promotion of DDT has within rightist think tanks. This is an issue I would love for people to weigh in on, as I've really not got my head around it.

There are a couple of links to articles I'd like to offer: First A New Classification System for the Actions of IRS Chemicals Traditionally Used For Malaria Control provides a good overview of how pesticides are useful in malaria control and a reasonable basis for choosing chemicals. The second concerns bednets, Blanket bednet coverage best, say researchers

The discussions around malaria can get pretty hot. I suppose like most people with friends in malaria regions, malaria makes me so sad when I hear they're sick again. So I feel motivated to learn to talk about malaria better and toavoid or effectively handle the flash points.

Dear Colleagues

The malaria situation in Africa is a disgrace. It is about 100 years ago that Gorgas got control of mosquitoes and malaria during the construction of the Panama Canal using an integrated set of interventions ... and in the following 50 years there was much progress using variants of the integrated approach.

Since the use of DDT to combat malaria was discontinued several decades ago, malaria has become a more serious problem. Excessive use of anti-malarial medications and continuous reinfection has made resistance a problem ... but modern scientific knowledge and funding to implement integrated programs could overcome these difficulties and make malaria history.

In my own work on modeling malaria control, I am struck by how quickly it is possible to achieve progress in malaria reduction ... and equally how little progress is going to be achieved if the data are not used for practical operational decision making ... and how quickly malaria will take hold again until the transmission cycle is broken (to all extent) permanently.

Surprisingly few of the organizations interested in malaria are doing work that will have a cost effective outcome ... single focus bednets or IRS will have limited long term impact and the long term costs are high. Single focus drug treatment does little in situations where reinfection takes place almost instantly. Work on vaccines is scientifically interesting but should not be needed if the Gorgas model is followed.

There is a lot of solid science about mosquitoes and malaria ... but rather less data about costs and the results being achieved. Hopefully this will change as fund flows increase and donors begin to realise that the results being achieved are small relative to the costs.

Sincerely Peter Burgess Tr-Ac-Net

I agree with all concerned in this topic. I have been involved with malaria for over 23 years now and got involved purely because I got it numerous times and also saw the suffering and death it caused.

I would like to say from the outset that reintroducing DDT will have little effect either short-term or long-term. In addition, there has been no data availbale since the introduction of DDT with regards the impact on humans and the environment as to its safety. What are the long term effects on humans should residue spill into drinking water etc?

However, my main aim at joining is the research I have done with regards treated/untreated mosquito bednets. Bednets are a complete waste of time and money and manufacturers are reaping huge profits borne on a fallacy!

During all my years of travelling Africa, I have never once used a bednet due to the following facts, which substantiates the facts about my claims. Mosquitoes become active as soon as the sun sets and they go into a feeding frenzy from about 7:30 onwards. From sundown until villagers go to bed they are openly subjected to mosquito bites and this is the time frame they get malaria - not when they are covered by a bednet when they go to sleep. They socialise, make dinner, sit around the fire and then bath etc - all while mosquioes bite and feed on them. No-where, do they sit or walk around covered in nets. It is a complete shame that millions of $ are spend on utterly usless material and propaganda. I have discovered a complete eradication method using natural waste found in abundance where malaria is rife and this system has many legs! I am about to do a pilot film on these facts within the next week!

I take the point about nets as a short/medium term solution but the evidence from a recent report from Kenya indicates that they do work.

I had already posted a piece on this topic in my personal news so maybe the best way of contributing here is to simply paste the relevant section here.

In my personal news I said:

Who remembers the debate in The Other Place over the proposal to fund Insecticide Treated Nets (ITNs) in the battle against malaria ?

The debate went round and round with some voices even challenging the use of treated nets at all and the case for garlic as an alternative to ITNs also led to heated debate ... well, I got heated. ;)

So it was interesting to read yesterday that the UK government through our Department for International Development acted in partnership with the WHO to fund free nets in Kenya.

AND

Early results from the Kenyan programme ..... show that in some areas the number of childhood deaths from malaria has fallen by 44%. Three hospitals in the malarial-prone coastal areas reported a drop in admissions of 57% in 2006, compared with 1999.

So, while we discussed and debated in The Other Place good old fashioned straightforward targeted aid saved lives !!

Maybe there's a moral there somewhere. Maybe not. But it certainly is good news.

You can catch up with the full story in The Guardian

Apart from the utter sadness of being in some networks where people die every week of malaria, I would like to declare absolute ignorance about the science of the alternative solutions. That said: I want to reiterate one overarching puzzle as well as pose a question to each of the 2 most opposite contentions

the overarching puzzle is that clearly the mosquito has been (or continuously is being) defeated in some parts of the world (eg Florida) -so why cant we learn from (open source) the "service franchise" successfully used in some localitoes to defeat it everywhere

to those who advocate bed nets: this seems to assume 2 things: 1) that almost all malaria is caught by being bitten while asleep - whilst I can imagine a lot is, would you risk your life to assuming you only need protection while asleep? 2) it assumes that very poor people have sufficient nets, facilities and awareness to continually use nets (eg by facilities are we assuming people have standard size beds that nets can of particular size can be hung round?)

to those looking at the DDT solution , I wish we could put the facts down simply on the pros and cons of ddt because to a scientifically-ignorant person (me!) it seems tragic that these are not listed on one page simply - and instead different emotions are brought for and against which stop objective communal understaning. It would be really sad if over time this thread has hundreds of posts going to and fro on DDT when maybe a small group for and against could connect by email and sum up the 2 opposite sides plus any questions in one slide we could become at elast a starting point for communal consensus.

(PS I do a lot of analysis of what media says over time not article soundbite by soundbite. I have to say 99% of media coverage on malaria just adds to the emotional ingorance on the subject. I am not implying that any particular reference above is part of that 99% but please dont assume that by citing what some journalist says - looking to get people to buy an emotionally hot story - is likely to be what this thread needs as evidence. Media's inconvenient truth is a common crisis in every area that we are at risk of losing huamn sustainability - health, climate , peace etc so please dont take my lack of attention to media references as personal to opinions on this particular issue )

I have been contacted on facebook by a person whose flow begins like this:

*I am busy filming a pilot about malaria and the all revealing misinformation

If malaria is one of your top 3 isssues and you are on facebook why not tell me so we can start an internal email among up to 20 people (facebook's chosen circulation listing size). Of course any progress and new questions we come across will be posted back here too ....

Dear Colleagues

Someone AT xxx.za said:

"I would like to say from the outset that reintroducing DDT will have little effect either short-term or long-term. In addition, there has been no data available since the introduction of DDT with regards the impact on humans and the environment as to its safety. What are the long term effects on humans should residue spill into drinking water etc?"

Bluntly put ... this is a stretch. There is a huge amount of research on the toxicity of DDT, though much of the research has been ignored by writers (such as Rachel Carson, the author of Silent Spring) and policy and rule makers such as the US Environmental Protection Agency especially the EPA under Ruckelhaus in the late 1970s.

In the 1950s and 1960s DDT was used in massive quantities in AGRICULTURE and it did create a growing residual in the environment which did get into the food chain and did cause a lot of concern. In spite of this, there has been only a tiny impact ... essentially none ... on human health. Though many have tried, the connection between DDT and human health deterioration seems small.

On the other hand DDT is very effective when used properly in the arsenal of weapons to combat malaria. DDT is toxic to mosquitoes, though some mosquitoes may have some resistance ... but equally important, mosquitoes do not like DDT and fly away from it (a repellant effect) and resistance to the repellant effect has not been seen.

The use of DDT as the one and only pesticide against mosquitoes would be a bad approach ... just as use of bednets or use of IRS as a single intervention is costly and ineffective. But DDT use is cost effective and when used correctly improves results enormously and quite rapidly. The experience in Kwa-Zulu Natal is a case in point and I believe that a similar strategy will be used in other parts of Southern Africa, including Zambia, in the near future.

It is interesting to note that when it comes to "toxicity", drugs like Chloriquine are more toxic to humans (mammals) than the pesticides that are used for adulticiding mosquitoes and for larviciding ... yet there is no outcry against using anti-malarial drugs.

It is also interesting to note that issues around the use of DDT constantly are being discussed, yet the potential for side effects from the use of pesticide in bednets is rarely talked about. One hypothesis is that it really does not matter, because bednets are so rarely used anyway ... (sarcasm ... the lowest form of with!).

My personal hope is that there will soon be some solid track record of performance in the global anti-malaria effort with data about costs and results collected, analyzed and available to the public at large. It is not certain that this will happen ... but there is more discussion about this now than at any time in the last 40 years.

Sincerely Peter Burgess Tr-Ac-Net and the Integrated Malaria Management Consortium (IMMC)

Peter, aren't you kicking down an open door here ?

The World Health Organisation (WHO) reversed its 30-year policy on the use of DDT as an indoor residual spray last year.

The WHO also supported the successful free distribution of treated nets in Kenya that I have reported above.

In short, it seems that the WHO are not being dogmatic. They recommend the use of both sprays and nets. They also seem to be prepared to examine and (re-examine) the evidence and change their mind and their policy.

All of which may take too long and their efforts might also seem ineffective when judged on a cost/benefit basis but WHO initiatives are at least saving lives while others are counting the beans or waving the flag for their favoured 'solution'.

And one final thought : Is a cost/benefit analysis of saved lives possible or even desirable ?

I would like to add my 2 cents worth...........I live in Africa and contracted malaria many times. Travelling Africa for the past 40-odd years has taught me not to take everything with a pinch of salt! This includes so-called research data.

My research (self funded) for the past 23 years shows me a complete different picture as apposed to what "real data" is out there. The fact remains that malaria is on the increase and not a decrease is evident by one single fact - WHO and Roll Back Malaria lie and will continue to lie. I would suggest to sceptics or advocaters to go and live in a village where malaria is rife.....even if they have mosquito nets.

Mosquitoes start biting from sundown and no-one walks around with a bednet over their heads - so where is the logic that they work? Many bednet distributors "crook their books" to keep donor money coming in. I have seen first hand mosquitoes sitting on a newly opened treated bednet. Do we now have a mosquito mutant and will we not have one from DDT?

I have lived with villagers in many parts of Africa and will like to state that no-where have I ever seen a deterrent or any form of barrier where mosquitoes have not bitten us all from sundown until we go to bed. My question is: does this mean that bednets work during this period? Whomever believes this is definately not on this planet!

Chris,

I am the person on Facebook who is about to film the bednet fallacy and will start shooting tomorrow.

Louie, WHO research statistics (just as any other research) is based on specific projects. I simply quoted the results of one project in Kenya.

You may not like those results but I am simply reporting them here and I have also said that the WHO also now recommends the use of DDT as an indoor residual spray.

If your research and/or anecdotal evidence indicates that there are other solutions - apart from a widely available and cheap vaccine - I'm sure that everyone would be interested to learn more.

John,

Thanks for your comments. It is not a case of me not liking any research results as there are some ligit figures out there by NGO's committed to their cause. I am refering to hard facts I have seen many times with my own eyes (backed up by my colleague!) There are field workers who sit on their butts and when it comes to end of quarter report time - they go to one village or one remote clinic and ask questions. Some don't even do that, but merely suck figures out of the sky. I have seen field workers sit and drink beer with locals and write reports. These facts are not just pointed at WHO, but many other organisations. I can write pages, but what will that help?

I am not an investigative film maker and neither do I purport to do that. I was merely giving a bit of what is out there.

With reference to your insertion of a "widely available and cheap vaccine" can you please tell me where to get it as I haven't seen it anywhere here in Africa?

If you are interested to know about an alternative I am working on using natural waste to eradicate malaria for good, then go to Facebook and look under the button 'Groups'. I have put a topic there titled: Swimming the Zambezi, which is about me putting my life at risk to raise funds for charity. The eradication process is explained there. It is also explained on www.ted.com and www.asmallworld.net and at least a dozen more sites.

My IT partner is busy with the Food Against Diseases (FAD) website, which we unfortunately lost via a server and never backed it up. I look forward to your comments and input and please don't get me wrong. I am not being vindictive as that is not my nature, but merely adding what I have experienced in my 43 years of travels. Take care. Louie

Louie, just to clarify.

I did not say there was a 'widely available and cheap vaccine' - although the Gates Foundation, for example, are funding research on this 'ideal' solution - I was simply asking if there was any evidence to support solutions other than those currently recommended by the WHO.

how is your film going Louie? where will it be shown?

it seems to me that the 2 countries where the most revolutionary grassroots efforts to end malaria could happen are Kenya and Uganda

If anyone reading this can actually help grassroots revolutionaries in these 2 countries, please do say. If conversely you know another african country where people are weaving wholly new networks to end malaria, please say where

Malaria is hitting a lot of news at the moment; i believe it is constructive to look at both the gaps and bridges between the news coverage and the deeper realities our threadsters here are asking for your transparency and help to flow

Incidentally malaria was one of the collaboration cafes http://worldcitizen.tv/_wsn/page4.html to feature at New York's first fall festival of collaboration cafes - a format that is fast flowing bwherever world citizens want to debate the future truth differences between sustainable globalsiation and extinction. The news from malaria world and accompanying solaroof world http://www.ned.com/group/solaroo f/ was amazing - in the latter's case every nation could be clean energy independent if it just focused on changing the roofs of its buildings. For an impudent scot like me I have no idea why that truth is so inconvenient that neither mass media nor Nobel Gore dare let us know about it.If you have an idea why tha story is censored , please share

Examples of recent scientific progress by Gates Foundation guarantees include the following:

Vaccines: New study results from the PATH Malaria Vaccine Initiative, published today by The Lancet, show that the experimental malaria vaccine RTS,S is safe and may significantly reduce risk of malaria infection in infants. In the study of 200 infants, the vaccine reduced new infections by 65% over three-and-a-half months. A large- scale Phase III trial of the vaccine will begin next year in 10 African trial sites.

Medicines: The Medicines for Malaria Venture, which is researching treatments to overcome resistance to existing drugs, has developed the largest malaria drug portfolio in history, and expects regulatory approval next year for an improved treatment for children.

Mosquito control: The Innovative Vector Control Consortium is developing new and improved insecticides to control the mosquitoes that transmit malaria.

New vaccines, medicines, and insecticides will help "break the cycle of transmission and eradicate the disease," said Mrs. Gates. "Both private industry and public research institutions must continue to invest in new tools in order to make malaria eradication possible."

Mr. and Mrs. Gates delivered the remarks at a meeting comprised of malaria researchers, global health leaders, policy experts, and government officials from around the world, taking place October 16-18 at the Sheraton Hotel in Seattle.

Selected sessions of the meeting will be webcast at http://www.kaisernetwork.org/hea lthcast/malariaforum2007 .

Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people's health, and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people, especially those with the fewest resources, have access to the opportunities they need to succeed in school and life. Based in Seattle, the foundation is led by CEO Patty Stonesifer and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett.

For further information: Jenny Sorensen of Bill and Melinda Gates

Foundation

+1-206-709-3400, media@gatesfoundation.org