In a recent analysis of the US Presidential Malaria Initiative (PMI) by Richard Oxborough, it was pointed out that indoor spraying is being reduced and even abandoned as a control measure because of resistance to the cheaper insecticides. In Angola, they have completely abandoned indoor spraying as a method. The newer insecticides are too expensive.
It is alarming that now the only effective control method available is drugs. What will happen when drug resistance spreads? Is PMI prepared for this?
The decrease and even abandonment of indoor spraying by the otherwise carefully managed attack on malaria by PMI in Africa is no surprise, in fact we predicted it when we helped start PMI in Angola in 2005. But why have our recommended solutions been ignored by the management of PMI? It was clear even in the beginning that the money wasted on temporary pesticides and temporary bednets could better have been used in permanent elimination of breeding sites, as well permanent improvements in housing such as improved eaves and metallic screens.
Bednets last 2-3 years, but metallic screens last 10-20 years. Sprayed insecticides last a few months, but drainage and filling of breeding sites lasts decades. The economic advantages of permanent measures are clear, especially when the temporary measures have been used now for 11 years and many millions are wasted every year on these temporary fixes. The seductive appeal of the quick-fixes of spraying and bednets during the early years of PMI should no longer be tolerated because they are neither durable nor economic. As Oxborough describes the current PMI strategy, it is "fragile" and could easily be washed away like the insecticides.
For 11 years pesticides and bednets have been purchased with billions of US dollars, with no permanent changes being made in the ecology or epidemiology of transmission. Thus the decreases in malaria transmission are temporary and precarious. And about a billion US dollars have been used for these temporary measures. Was that wise?
Admiral Ziemer and friends in Washington should start making permanent changes in the transmission scene. Ziemer recently expressed admiration for the anti-malarial work described by Margaret Humphrey in her recent book on malaria contol in the USA before 1951. This was accomplished before the widespread use of DDT and chloroquine, by permanent environmental improvements. Such an approach is not only more durable, but also more economic.
If the same billions had been invested in permanent changes in Africa such as drainage and housing improvements, the progress made in the last 11 years would not be at risk.
Isn't it obvious by now?
Bill Jobin of Blue Nile Associates