DELEGATES' REPORT

REGIONAL CONSULTATION TO PREPARE AFRICAN COUNTRIES TOWARDS REDUCTION OF RELIANCE ON DDT FOR MALARIA CONTROL

Harare, Zimbabwe
8-10 February 2000

STATEMENT OF THE DELEGATES

We, the Delegates to the Regional consultation to prepare African countries towards reduction of reliance on DDT for malaria control having considered;

1. reports of the Intergovernmental Negotiating Committee (INC) for an International Legally Binding Instrument for Implementing International Action on Certain Persistent Organic Pollutants (POPs),
2. World Health Assembly Resolution (WHA50.13) on the Promotion of chemical safety, with special attention to persistent organic pollutants,
3. the Statement of African Ministers of Health at the Regional Committee for Africa, 49^th Session,
4. the Draft WHO action plan for the reduction of reliance on DDT use for public health purposes, and,
5. the programmatic experience and current use of DDT for malaria vector control in our countries,

make the following observations:

1.     Present Use of DDT for Malaria Vector Control
In our countries malaria is a significant cause of morbidity and mortality and an impediment to economic development. Indoor residual spraying of DDT continues to be an important tool in efforts to control malaria in areas of unstable transmission and to prevent or respond to epidemics. Documented programmatic experience in Africa with proposed alternatives does not, at present, indicate a potential for rapid elimination of reliance on DDT for malaria vector control.

2.     DDT and the POPs Negotiations:
We note the presence of a general exemption on DDT production and use limited to vector control in the present draft convention text included in the report of INC-3 and unanimously support the inclusion of this exemption in the future Treaty.

We further support proposed mechanisms within the Treaty (i.e. Articles J and K) to assure that technical assistance and adequate financial resources are available to countries for action to reduce and/or eliminate reliance on DDT.

We support the elimination of DDT for agricultural uses as specified in Annex A of the Treaty.

ACTIONS TO LIMIT DDT TO PUBLIC HEALTH USE AND REDUCE RELIANCE ON DDT FOR MALARIA VECTOR CONTROL REQUIRES:

1.     Improving Current Public Health Use of DDT:

• Countries currently using DDT for malaria vector control must establish and maintain a regulatory basis to assure that DDT is used for public health purposes only. Countries will further need to strengthen capacity to monitor and enforce compliance with these regulations

• Technical assistance and capacity building is needed for strengthening countries' abilities to develop surveillance systems for epidemiological monitoring, epidemic forecasting, and detection of insecticide resistance so as to target and selectively apply insecticides for indoor residual spraying purposes.

• Countries need reliable access to quality DDT and alternative insecticides and mechanisms for quality assurance.

• When DDT is replaced by an alternate insecticide, re-introduction of DDT should remain an option if vector resistance to the alternative occurs.

2.     Reducing Reliance on DDT for Malaria Vector Control:

• Countries recognize that reducing reliance on DDT involves a complex set of activities over a potentially long time frame. Strategies and interventions must be developed and/or adapted to country specific scenarios and will require sustained mobilization of financial and technical resources.

2.1.   Evidence Base for Decision Making and Planning:

• Evidence is needed on the environmental and health impacts associated with current use of DDT for malaria control in African countries.

• Evidence is also needed on the environmental and health impacts associated with DDT alternatives for malaria control in African countries.

• Decisions to replace DDT with potential alternatives should be based on a complete assessment of the costs, effectiveness, feasibility, and environmental and health impacts of DDT and alternatives under local conditions.

• A priority research agenda must be developed to address information needs of malaria control programmes.

• More investment in research for the development of effective and affordable alternatives to DDT is urgently needed.

• The involvement of industry is necessary to facilitate the development of safe and low-cost alternative insecticides.

• Field-based research and careful monitoring and evaluation of alternatives are essential in order to evaluate cost-effectiveness and safety under operational conditions.

2.2   Characteristics of Alternatives and Conditions for Implementation

• Viable alternatives to DDT should pose less risk to the environment and human health and be equally or more cost effective for malaria vector control.

• Evaluation of alternatives to DDT must include assessment of technical characteristics, acceptability by communities and health workers, potential sustainability in terms of cost, effectiveness and the potential for resistance development (e.g. extent of concomitant use in agriculture), availability, environmental impact and human safety.

• Alternatives to DDT should be introduced gradually into Malaria Control Programmes after investigation of insecticide resistance, status and prospects.

• Monitoring and management of insecticide resistance should be strengthened and coordinated at national and regional levels.

• Insecticide policy, legislation and inter-sectoral collaboration should enforce protection of alternative insecticides.

2.3   Enhancing Availability and Affordability of DDT and Alternatives

• All strategies with the potential for sustaining reductions in cost and enhancing the availability of malaria and vector control tools should be, evaluated and promoted. These strategies include, but are not limited to, the reduction or elimination of taxes and tariffs on public health commodities, and the transfer of technology to promote development of endemic country and/or regional production of these tools.

3.     Strengthening Health Systems

• All activities to reduce reliance on DDT for malaria vector control (including planning, operational research, implementation, monitoring and evaluation) as well as national efforts to strengthen malaria control and health systems should be an integral component of health systems development.

• Strengthening integrated epidemiological surveillance systems is essential to any process of assessment and implementation of alternatives to DDT.

• Comprehensive "Country Needs Assessments" that describe the current epidemiological situation, disease control and health care practices and the national health infrastructure are required for planning and strengthening malaria control activities.

4.     Cross-Sectoral and Cross-Border Strategies

• Inter-sectoral and regional collaboration should strengthen surveillance, research and planning activities and linkages should be established between health, environment, agriculture, and other sectors.

5.     Advocacy

• Political commitment and community participation, mobilized through advocacy and awareness raising, is necessary to implement an integrated strategy for malaria control that reduces reliance on DDT.

6.     Resource Requirements

• Country activities related to needs assessment, planning, research and evaluation of potential alternatives to DDT require the immediate mobilisation of significant external resources.

• The global community, through both existing mechanisms and new mechanisms to be established under a future POPs treaty, should ensure that financial and technical assistance required to reduce reliance on DDT without compromising effective malaria control is available to countries for immediate and longer term action.

RECOMMENDATIONS TO COUNTRIES:

• Countries currently using DDT for malaria vector control must establish and maintain a regulatory basis to ensure that DDT is used for public health purposes only. Countries will further need to strengthen capacity to monitor and enforce compliance with these regulations.

• All strategies with the potential for sustaining reductions in cost and enhancing the availability of malaria and vector control tools should be evaluated and promoted.

• Alternatives to DDT should be introduced gradually into Malaria Control Programmes after investigation of insecticide resistance, status and prospects.

• Monitoring and management of insecticide resistance should be strengthened and coordinated at national and regional levels.

• Insecticide policy, legislation and inter-sectoral collaboration should enforce protection of alternative insecticides.

• Inter-sectoral and regional collaboration should strengthen surveillance, research and planning activities and linkages should be established between health, environment, agriculture, and other sectors.

• Delegates to this consultative meeting should inform the INC negotiators of their respective countries participating in the next INC meetings of the technical, economic, health and environmental issues in the use of DDT and potential alternatives for malaria control in preparation for the forthcoming INC meetings.

RECOMMENDATIONS TO WHO

• WHO should advocate and highlight, at any relevant and appropriate forum, the deep concerns of the participating member states on the possible economic and health implications of any restriction made on DDT use for malaria control.

• WHO, in collaboration with partners, should ensure that the necessary technical and financial support is available to member states for implementation of integrated, evidence based and cost effective vector control programs to ensure sustainable reduction of malaria burden.

• WHO, with its partners, should support investments in research to develop new affordable, cost-effective and sustainable vector control methods including effective and affordable alternative insecticides.

• WHO should commission a consolidated review of potential economic, environmental and health consequences for African countries of replacing DDT with alternative insecticides for vector control.