Microsoft co-founder Bill Gates is fascinating.

Written by Wafa Mohammed

Topics: News

Microsoft co-founder Bill Gates is fascinating. So is the 19-page annual letter that describes the work of the Bill and Melinda Gates Foundation, the world’s largest philanthropy. But for someone as smart as Gates, who can afford to hire experts on any subject under the sun, some of his foundation’s strategies are baffling.  Consider his foundation’s approach to malaria, which focuses on bed nets, a low-tech, only modestly effective intervention, and on the development of a vaccine, a high-tech solution that has eluded intensive efforts for decades. This approach dismisses an old, cheap, and safe way to control the vector – the Anopheles mosquito – that spreads the disease: the chemical DDT. Malaria is a scourge, particularly for inhabitants of poor tropical countries. Forty one percent of the world’s population lives in areas where malaria is transmitted, with 35000 million cases each year. The disease imposes substantial costs on individuals, families, and governments. Costs to individuals and their families include drugs, travel to and treatment at clinics, lost time at work and school, and expenses for preventive measures. Costs to governments include maintenance of health facilities, purchases of drugs and supplies, public-health interventions such as spraying insecticide or   distributing insecticide-treated bed nets, and lost revenue from taxes and tourism. Such costs are a huge economic burden on malaria-prone countries and impede their development. It has been estimated that annual economic growth in countries with a high incidence of malaria is 1.3 percentage points lower than that of other countries. Drugs called artemisinins are safe and exhibit potent, rapid anti-malarial activity. In combination with other anti-malarias, they have been used effectively for several years to treat multiple-drug-resistant malaria. But resistance has arisen and will surely increase,

so that in the absence of a vaccine, elimination of the mosquitoes that spread the disease is the key to preventing epidemics. Unfortunately, flawed public policy limits the available options. In 1972, on the basis of data on toxicity to fish and migrating birds (but not to humans), the United States Environmental Protection Agency banned virtually all uses of DDT, an inexpensive and effective pesticide once widely deployed to kill disease carrying insects. DDT was subsequently banned for agricultural use worldwide under the 2001 Stockholm Convention on Persistent Organic Pollutants, which stigmatized the   chemical and effectively constituted a prohibition. Abasic principle of toxicology is that the dose makes the poison. Although DDT is a (modestly) toxic substance, there is a  world of difference between applying large amounts of it in the environment – as farmers did before it was banned – and using it carefully and sparingly to fight mosquitoes and other disease carrying insects. (When it is used at all now, it is now sprayed indoors in small amounts to prevent mosquitoes from nesting). The regulators who banned DDT also.

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