Ugandan Court Bars Key Weapon Against Malaria

Uganda 2008

By Paul Hendrie

June 10, 2009

Published in CQ Weekly

KAMPALA, UGANDA — Like so much of sub-Saharan Africa, Uganda has long been at the margins of the global economy, although it’s among the continent’s dominant producers of coffee and bananas and is the biggest African exporter of organic produce. Which is why it’s so roiled by the following dilemma: Should it jeopardize the organic certification of its export crops — one of the emerging growth markets for the country’s agricultural economy — by using DDT, a pesticide long banned in the West, to combat the spread of malaria among its 31 million inhabitants?

Malaria is rampant in Uganda for the same reason its farm economy has the potential to blossom: The lush climate yields two growing seasons a year, but it’s also an ideal breeding ground for mosquitoes. The country suffers an average of 320 malaria deaths a day and has the highest infection rate in the world.

The fate of DDT spraying has taken on new urgency in Uganda, thanks to a recent ruling from the nation’s High Court suspending the practice. The decision has far-reaching implications, since the aid agencies of the United States are in the midst of leading a major anti-malarial initiative on the continent. The U.S. Agency for International Development (USAID) funded Uganda’s first major indoor DDT-spraying effort this spring. The funding was obtained through the President’s Malaria Initiative, which became law as part of the annual foreign-aid spending measure for fiscal 2006. The Bush administration’s program aims to spend $1.2 billion by the start of the next decade to halve the number of malaria outbreaks in a targeted group of 15 African nations through indoor spraying, insecticide-treated bed nets, efforts to boost immunity among pregnant women and antimalarial drugs. Of the total, $8.5 million has been budgeted for spraying DDT and other chemicals in Uganda in 2008.

The debate over the safety of indoor spraying has been distorted by some unexpected political questions, experts say. American conservatives have lately championed overseas DDT spraying as a rebuke to environmentalists, while U.S. environmentalists have stressed their ongoing worries over the health hazards of the chemical. As a result, overseas DDT spraying “became very politicized,” said Matthew Lynch, a former USAID team leader on malaria who now directs Voices for a Malaria-Free Future at Johns Hopkins University.

Lynch stresses that he has his own concerns about the potential for the pesticide to spread into the environment. But he notes that, thanks in large measure to the U.S. disputes, Uganda endorsed a misleading shorthand equation for the practice: “Indoor spraying became indoor residual spraying, and that equals ‘DDT’ — even though there are 11 other insecticides that can be used and that should be used,” depending on broader climate conditions and patterns of insect resistance.

Exporters Sue Over DDT

DDT remains a key tool in aid efforts to fight malaria, in part because some scientists believe it can as a mosquito repellent as well as a pesticide. But the chemical’s very potency is what sparks concern among organic farmers. Marck van Esch, a manager for the Dutch organic export concern Bo Weevil, which was among the plaintiffs in the High Court suit that produced the suspension of DDT spraying, contends that the spraying was a hazard, especially since Ugandans often store harvested crops and farm equipment indoors. He said that post-spraying photographs provided to the court show a white powder on clay walls and grass roofs inside peasant huts. After a decade of promoting certified organic farming in the area, Bo Weevil rejected this year’s crop.

Van Esch said the company couldn’t risk paying a premium for organic produce only to later find it tainted with DDT. “We cannot convince our inspection body to certify” as organic crops from farms with spray sites, he said. “And we operate in the business of certified organic products only.”

Some veteran aid officials agree that it’s very hard for agencies to monitor when and where canisters of DDT get sprayed once they’re distributed to users. “The problem is, farmers love DDT because it kills everything,” Lynch said. “It kills all the bugs. So if you’re an underpaid sprayer, the prospect of selling some to a farmer and putting cash in your pocket is very attractive.”

American officials say they’re mindful of how DDT exposure could harm the country’s organic farming exports, valued at $15 million last year — a small fraction of the $1.3 billion Uganda garnered in export revenues last year but a vital growth sector in the beleaguered Ugandan economy. They also say they closely supervised the spring spraying program and that subsequent environmental monitoring found no evidence of DDT contamination. The President’s Malaria Initiative “had many safeguards in place, and they were all adhered to during indoor spraying in Uganda,” said Elissa Beerbohm, a USAID public health adviser who specializes in the environmental impact of the anti-malarial project. “We haven’t heard anything to counter that until the High Court injunction.”

The U.S. policy is not to force DDT on unwilling African nations but to offer it as one of several options where its use would be effective and where there is a capacity to spray safely. But DDT is favored for its longevity and lower cost, especially since most African countries vulnerable to the spread of malaria are also desperately poor. In 2006, in the first year of funding for the initiative, USAID spent $20 million on indoor insecticide spraying in Africa, up from just $1 million the year before.

Some Ugandan political leaders are increasingly skeptical of the rationale for indoor DDT spraying. “It is not well explained to the people,” said Beatrice A. Atim, a member of Uganda’s parliament for the opposition Forum for Democratic Change party and its shadow minister for water and the environment. “Will we be able to take organic products and access the international market if we use DDT? I don’t think we have exhausted all the alternatives.”

Silent Spring, Revised

DDT is an especially effective tool against the spread of malaria, because it can thoroughly and cheaply safeguard domestic interiors from the female anopheles mosquito, which carries the disease and typically preys on humans at night. Used in concert with bed nets treated in long-lasting insecticide, DDT could be a key weapon in the arsenal to eradicate malaria, lasting on indoor surfaces for up to a year.

Advocates say the judicious use of DDT for malaria control poses little danger to humans. “The coffee you are taking is more carcinogenic than DDT,” said J.B. Rwakimari, manager of the National Malaria Control Program in Uganda’s Health Ministry. Rwakimari says that a comprehensive plan employing indoor DDT spraying could wipe out malaria within five years.

But DDT spraying also faces significant resistance based on the pesticide’s history in the West. Since 1962, when Rachel Carson published her landmark environmental study, “Silent Spring,” DDT has been a virtual byword for hazardous chemical agriculture. Carson described how the chemical damaged human and animal health by entering the food chain and accumulating in fatty tissue. The United States and at least 37 other countries banned or severely restricted use of the pesticide in the 1970s and 1980s, and in 2001, the Stockholm Convention on Persistent Organic Pollutants listed it among its “dirty dozen” chemicals slated for eventual elimination.

Still, even the Stockholm Convention allowed limited indoor DDT use for malaria control. The President’s Malaria Initiative further extended the practice, contingent on its approval in target countries, supporting DDT spraying in Zambia, Ethiopia, Mozambique and Uganda. The World Health Organization, which phased out widespread DDT use to control malaria in the early 1980s, issued a position paper in 2007 endorsing controlled indoor residual spraying of the chemical in areas with high infection rates.

Meanwhile, the same Western nations banning DDT eventually spawned a global market for organic food. In the United States alone, sales of organic food and beverages have grown more than fivefold in the past decade, to an estimated $20 billion last year, and are projected to increase 18 percent each year for the rest of the decade, according to the Massachusetts-based Organic Trade Association.

Most Ugandan farmers work holdings of 10 acres or smaller and are too poor to buy chemical pesticides and fertilizers. As a result, most of Uganda’s agriculture is organic.

In spite of a host of logistical obstacles to further growth, Uganda today boasts the most-developed certified organic production in all of Africa. The value of organic exports — which include coffee, cotton, fresh and dried fruits and vegetables, and sesame — jumped about 67 percent between 2001 and 2003. Western donor agencies and governments, including the United States, have supported organic farming development.

But Uganda’s organic farmers know that exposure to pesticides such as DDT would badly damage their access to Western markets. Uganda’s biggest trade partner is the European Union, which warned in 2005 that the use of DDT could have serious trade consequences. Similar concerns have prompted Kenya — Europe’s biggest supplier of cut flowers — and Rwanda to reject DDT, and in Malawi opposition has been led by tobacco producers. Meanwhile, Ethiopia, Mozambique and Zambia have accepted indoor DDT spraying, and Tanzania has expressed interest.

Still, U.S. officials note that malaria deaths and illnesses are a leading drain on the country’s productivity and argue that fighting malaria with DDT doesn’t impede the growth of the country’s organic export trade. “We see them as both promoting the same goal in boosting Uganda’s economy,” USAID’s Beerbohm said.

Paul Hendrie was in Uganda in May on a fellowship from the International Reporting Project at Johns Hopkins University.

FOR FURTHER READING: Foreign aid and U.S. image abroad, CQ Weekly, p. 2656; Africa AIDS initiative, p. 424; Bush’s fiscal 2009 foreign aid budget request, p. 383; fiscal 2006 foreign aid spending (PL 109-102), 2005 CQ Almanac, p. 2-25.