Who's to blame? The tsunami's aftermath.(The World)(preventing malaria in Sri Lanka)

Galle, Sri Lanka

THE last time I was here in Galle, England had just played a great cricket match against the Sri Lankans, the local economy was bustling, and the great threat--from the Tamil Tiger rebels--was losing its force. But today, the cricket pitch lacks a single blade of grass, the economy is in tatters, and there are over 31,000 dead from the tsunami. The only things that remains the same in this southern port--75 miles southeast of Colombo--are the heat and humidity. One alarming new difference is that malaria is back, and is poised to strike down still more of the children, many orphaned, of this wretched place. It can be stopped, but only if ill-informed prejudice against DDT, the insecticide, is dropped.

As I fly over the port, I think the devastation does not look as bad as the pictures I've seen of Banda Aceh, Indonesia, which Secretary of State Colin Powell described as resembling the aftermath of a nuclear explosion. But Galle is still a terrible mess. Though Aceh, as the worst-affected region, is rightly getting most of the attention, private-aid groups have acted swiftly in Galle as well. Thanks to their food drops and water provisions, its inhabitants have managed to survive the immediate aftershocks of the tsunami's devastations. But the malaria-control program is being compromised by outdated thinking, especially from the world's leading health and government-aid agencies.

The prime example of their folly is found in a paper, "Malaria Risk and Malaria Control in Asian Countries Affected by the Tsunami," in which the World Health Organization (WHO) outlines its policy for the affected region. While a relatively sound document, it does perpetuate mistakes, which are then copied by everyone else operating in Sri Lanka and the rest of Asia.

In Sri Lanka, malaria is transmitted by the female anopheles culcifacies mosquito. The species breeds in rock pools and rice fields, and is a fairly efficient vector of the disease. Historically, the primary method of malaria control has been Indoor Residual Spraying (IRS)--the spraying of house walls with tiny amounts of an insecticide, usually DDT. IRS often kills mosquitoes, but more important, it creates a barrier between man and mosquito. Studies show the vast majority of mosquitoes won't enter a DDT-sprayed building, and this chemical barrier prevents transmission of the disease, much as prophylactic drugs or bed nets do, but more cheaply. Such an approach was highly successful in Sri Lanka. Owing to DDT, malaria rates fell from three million cases a year in the 1940s to fewer than 50 in 1963.

But then environmental pressures against DDT led to its abandonment, first in Western countries and then in most other parts of the world. Although it was obvious that it was the massive use of DDT in farming, not the small amounts used in public-health applications, that caused the environmental problems, the issue of scale was ignored by policymakers.

Aid agencies' failure to fund DDT was not the only problem. Studies showed that Sri Lankan mosquitoes may be developing resistance to DDT, which meant that some ...