If the United States wants to help people in tsunami-hit countries like Sri Lanka and Indonesia _ not to mention other poor countries in Africa _ there's one step that would cost us nothing and would save hundreds of thousands of lives.
It would be to allow DDT in malaria-ravaged countries.
I'm thrilled that we're pouring hundreds of millions of dollars into the relief effort, but the tsunami was only a blip in Third World mortality. Mosquitoes kill 20 times more people each year than the tsunami did, and in the long war between humans and mosquitoes, it looks as if mosquitoes are winning.
One reason is that the United States and other rich countries are siding with the mosquitoes against the world's poor _ by opposing the use of DDT.
"It's a colossal tragedy," says Donald Roberts, a professor of tropical public health at Uniformed Services University of the Health Sciences. "And it's embroiled in environmental politics and incompetent bureaucracies."
In the 1950s, '60s and early '70s, DDT was used to reduce malaria around the world, even eliminating it in places like Taiwan. But then the growing recognition of the harm DDT can cause in the environment _ threatening the extinction of the bald eagle, for example _ led DDT to be banned in the West and stigmatized worldwide. Ever since, malaria has been on the rise.
The poor countries that were able to keep malaria in check tend to be the same few that continued to use DDT, like Ecuador. Similarly, in Mexico, malaria rose and fell with the use of DDT. South Africa brought back DDT in 2000, after a switch to other pesticides had led to a surge in malaria, and now the disease is under control again. The evidence is overwhelming: DDT saves lives.
But most Western aid agencies will not pay for antimalarial programs that use DDT, and that pretty much ensures that DDT will not be used. Instead, the United Nations and Western donors encourage use of insecticide-treated bed nets and medicine to cure malaria.
Bed nets and medicines are critical tools in fighting malaria, but they're not enough. The existing antimalaria strategy is an underfinanced failure, with malaria probably killing 2-million or 3-million people each year.
DDT doesn't work everywhere. It wasn't nearly as effective in West African savannah as it was in southern Africa, and it's hard to apply in remote villages. And some countries, like Vietnam, have managed to curb malaria without DDT.
But overall, one of the best ways to protect people is to spray the inside of a hut, about once a year, with DDT. This uses tiny amounts of DDT _ 450,000 people can be protected with the same amount that was applied in the 1960s to a single 1,000-acre American cotton farm.
Is it safe? DDT was sprayed in America in the 1950s as children played in the spray, and up to 80,000 tons a year were sprayed on American crops. There is some research suggesting that it could lead to premature births, but humans are far better off exposed to DDT than exposed to malaria.
I called the World Wildlife Fund, thinking I would get a fight. But Richard Liroff, its expert on toxins, said he could accept the use of DDT when necessary in antimalaria programs.
"South Africa was right to use DDT," he said. "If the alternatives to DDT aren't working, as they weren't in South Africa, geez, you've got to use it. In South Africa it prevented tens of thousands of malaria cases and saved lots of lives."
At Greenpeace, Rick Hind noted reasons to be wary of DDT, but added: "If there's nothing else and it's going to save lives, we're all for it. Nobody's dogmatic about it."
So why do the United Nations and donor agencies, including the U.S. Agency for International Development, generally avoid financing DDT programs? The main obstacle seems to be bureaucratic caution and inertia. President Bush should cut through that and lead an effort to fight malaria using all necessary tools _ including DDT.
One of my most exhilarating moments with my children came when we were backpacking together and spotted a bald eagle. It was a tragedy that we nearly allowed DDT to wipe out such magnificent birds, and we should continue to ban DDT in the United States.
But it's also tragic that our squeamishness about DDT is killing more people in poor countries, year in and year out, than even a once-in-a-century tsunami.
Nicholas D. Kristof is a New York Times columnist.
New York Times