Fighting malaria with one hand tied
Jeffrey Sachs, development economist extraordinaire and director of Columbia University's Earth Institute, has just released a humongous United Nations report filled with recommendations for how to cut global levels of extreme poverty in half by 2015. The report, called Investing in Development: A Practical Plan to Achieve the Millennium Development Goals, points out that 2.7 billion people live on less than $2.15 per day. Of that number, 1.1 billion live on less than $1.08 per day. Infant mortality rates remain over 120 per thousand live births in most of sub-Saharan Africa.
The Millennium Development Goals of Sachs' title were agreed to by the U.N. during the Millennium Summit in 2000. Achieving those goals would mean that 500 million fewer people would be living in extreme poverty, 300 million fewer would be suffering from chronic hunger, 350 million fewer would be without safe drinking water, and 650 million people would have access to basic sanitation.
Whatever one thinks of Sachs' policy prescriptions, these are all worthy goals. One of particular interest is targeting the control of great pandemic diseases like malaria. In an article entitled "Achieving the Millennium Development Goals—The Case of Malaria" in the current issue of the New England Journal of Medicine, Sachs notes that the disease kills up to 3 million people each year, most of them African children. Sachs calculates that every 10 percent reduction in malaria increases economic growth by 0.3 percent. Clearly, controlling malaria will not only end the misery and death caused by the disease itself, but also go a long way toward alleviating the poverty that afflicts so much of sub-Saharan Africa.
So spending on malaria reduction offers a lot of development bang for the buck. Current annual spending on malaria control is between $100 million and $200 million globally. Sachs reports that his colleagues who worked on the malaria issue for Investing in Development found that "$2 billion to $3 billion each year is in fact needed to enable poor African countries to achieve substantial control over the disease."
So far so good; but then Sachs gives in to out-dated environmental correctness.
"A scaled-up control effort would include the free distribution of bed nets and effective medicines to impoverished rural Africans, who cannot afford to buy the nets even at highly subsidized prices," Sachs writes. He adds, "In repeated trials in villages in Africa, insecticide-impregnated bed nets have proved highly effective in reducing morbidity and mortality, especially when an entire village uses the nets and thereby reaps the benefit of mass community effects."
Bed nets can certainly be effective in helping to control malaria-carrying mosquitoes. But Sachs delicately overlooks an even cheaper way to control them—DDT. Bed nets protect only at night and only two people at a time. By failing to include DDT in his malaria-control strategy, is Sachs seeking to appease ideological environmentalists who demonized DDT for decades, beginning most famously with Rachel Carson's Silent Spring? No replicated studies have ever shown that DDT harms people. However, broadcast spraying of the pesticide on crops did lead to the decline of some raptor species by causing their eggshells to thin. Let's be clear: No one is advocating the return of DDT as an agricultural chemical. But spraying the inner walls of a house twice a year with the demonized pesticide protects a whole family from malaria-spreading mosquitoes all day all at once and will cause no harm to wildlife. DDT is still in many cases the most cost effective method of controlling malaria mosquitoes and should be part of any serious malaria-control strategy. Die-hard ideological environmentalists have reconciled themselves to this conclusion. The question is, why are Jeffrey Sachs and the U.N. reluctant to do so?