Malarial Hacks
Pierre Tristam / Candide’s Notebooks, May 16, 2007

Bi-partisan plague

Front Page, the web version of Bill O’Reilly’s all-spin zone, features a piece by Bill Steigerwald on malaria and DDT (flagged in the comments here by our own closet liberal al_D). The piece makes a fair point: DDT can be an effective tool against malaria. The vilification of DDT in the 1970s proved overblown. The return of DDT should be welcomed, not obstructed. But the purpose of the piece, it turns out, is not to advance understanding in the battle against malaria (a battle that once looked promising but has since become a dismal example of mismanagement and lost opportunities). It’s to belittle Bill Gates and his foundation. Strange how the single-biggest private force in the fight on AIDS and poverty, including malaria, comes under Front Page's monomaniacal criticism of all things "liberal" for not wording its spending appropriately on its web site—despite spending $1 billion on the fight against malaria. It's intellectual pettiness like that that makes Front Page and its likes indistinguishable from the intellectual honesty of a third-rate Mullah in a fourth-rate Iranian madrassa.

That aside, the Front Page piece gets major facts wrong. Far from a “wonder,” DDT had its value, but it was, and is, limited. As Ellen R. Shell wrote in an Atlantic piece documenting the resurgence of malaria ten years ago, “It soon became clear that spraying was most effective in areas that were only marginally malarious -- areas such as Egypt and southern Europe, where the parasite had only a slippery hold. Meanwhile, for complex reasons, mosquitoes where malaria was solidly endemic started showing resistance to the insecticides.” The other reason malaria dropped massively in the United States and elsewhere last century: prosperity, as people migrated from swamps and rural zones to cities, not public health efforts. These days it isn’t DDT but the drug artemisinin, and only in combination with other drugs and properly treated mosquito netting, that does wonders against the disease—and does, when anti-malaria money is well spent. But the drug cocktail is expensive. Companies that Don't count on it when USAID, the US government's overseas version of FEMA, is in charge. From the Washington Monthly last year:

“USAID's malaria budget increased from $22 million in 1998 to $90 million by 2005. Last year, members of Congress held hearings to determine what that money had produced. The results weren't pretty. After interrogations from Sen. Tom Coburn and others, it emerged that in fiscal year 2004, USAID spent just 5 percent of its malaria budget on antimalarial drugs. The rest of the budget went to various "technical assistance" projects (such as a $65 million program for "social marketing" of mosquito nets to impoverished Africans), as well as salaries of U.S. consultants, travel expenses, training, and other services provided by American contractors. "We spent most of our money telling people how to use the cheap and effective tools to fight malaria," said Coburn at another hearing this January, "and very little money actually providing them those tools and very little money actually saving lives." Coburn has also questioned why the U.S. sinks its malaria cash into USAID, instead of supporting the Global Fund to Fight AIDS, Tuberculosis and Malaria, the major international organization that finances the purchase of malaria drugs. Bate concludes that most of USAID's malaria funds "either never left the United States ... or funded the employment of U.S. citizens." Former USAID head Andrew Natsios admitted in 2003 that the organization has relied on contractors, but lacks the resources to oversee them: "We don't have enough officers to do the work," he told Government Executive magazine.

There is slight hope: “Stung by criticism from Republican senators for spending most of its $90 million malaria control budget on consultants, conferences and travel,” the Times reported in January, “the main United States foreign aid agency by next year will spend half the money on drugs, mosquito nets and insecticide spraying.” There is less hope that Front Page’s malarial hacks will get their facts and contexts straight.