Dear Concerned Citizen,

Perhaps the most tragic aspect of the disease is how simply it can be prevented and cured with available technology. Indoor Residual Spraying—the spraying of house walls with tiny amounts of an insecticide, traditionally DDT— can prevent mosquitoes from reaching their human targets (by deterring them from entering dwellings and killing those that do). If a person does become infected, a plethora of medications, especially artemesin based combination therapy (ACT), can effectively remedy his illness.

DDT for malaria control causes no environmental problems because such tiny amounts are used. But from the 1980s aid agencies have been loathe to fund its use, given the concerns raised by Rachel Carson and others about egg-shell thinning. Only nations not dependent on aid (such as South Africa) or the private sector (such as Konkola Copper Mines in one small part of Northern Zambia) defy international opinion and use DDT. The result in South Africa is an 80% reduction in cases and an 85% reduction in deaths (primarily due to use of ACT drugs), and in the Chingola and Chililobombwe districts of Northern Zambia a 75% reduction in cases and an astonishing 100% reduction in deaths.

Meanwhile the WHO and the world’s aid agencies don’t buy DDT, but oversee a global rise of about 10% in malaria cases in the past 5 years.

So what do these agencies buy with their funds?

The largest donor is the United States Agency for International Development (USAID). USAID spent nearly $80 million to fight malaria worldwide, and over $40 million in Africa alone in 2004. It spent roughly $5 million on actual purchases of malaria drugs, bed nets, larvaciding or IRS equipment (it probably buys no actual insecticides and certainly no DDT) in 2004. That’s only 7 percent of its entire non-research budget for malaria on the interventions that are proven to save lives.

Those numbers come directly from figures provided by USAID after years of ambiguity over the agency’s use of malaria funds. In order to persuade the agency to properly account for the figures, Senators Feingold (D-WI) and Gregg (R-NH) had to first call for a General Accountability Office investigation into the matter, and former Assistant Administrator Anne Peterson had to be embarrassed at a Congressional hearing for failing to provide Senator Brownback (R-KS) an adequate explanation for the destination of USAID malaria funds.

Now that USAID has delivered some basic numbers, in a document replete with mistakes and ambiguities, a plethora of questions still remain. From its disclosures, what USAID does NOT spend money on—IRS, nets, larvaciding, and drugs—is much clearer than what it does support. Indeed, descriptions of funded activities are filled with ambiguous phrases like “supporting the provision of technical assistance” and “strengthen the overall capacity.”

Though vague in describing an actual program, these terms are clear euphemisms for the kind of training and policy programs that require teams of American consultants racking up frequent flyer miles. Surely, USAID’s contracting agencies must love this kind of work, but is this the best way for America to use its considerable financial resources to fight malaria?

Though it is extremely important that basic health systems are adequate to absorb aid, simply improving policies and strengthening capacity does not save lives. The balance USAID has struck with regard to providing resources and strengthening capacity—virtually none of the former and nearly exclusively the latter—is unconscionable for a wealthy country.

The US has opted to fund capacity building programs with no hope of actually easing health burdens. For example, programs that win grants from USAID’s ‘Child Survival Program’, a key component of USAID’s on-the-ground malaria programming, do not even bother to measure if they have had any impact on child mortality. With no money for buying drugs, ITNs or IRS, what would be the point?

If President Bush wants to live up to his promise of “extending American compassion throughout the world” and delivering aid because “it’s the right thing to do,” he should start funding malaria programs that actually have a chance to succeed. That means ignoring pressure from uninformed environmentalists who rail against the use of DDT, buying the most effective drugs available, and ensuring that the tools to combat malaria are made available.

USAID must reallocate its budget by targeting countries with the ability and willingness to absorb health aid—like Botswana and Ghana, for instance—but simply lacking in money. Current funding is so scattered and disorganized—not even USAID’s “Malaria Team” can fully account for all the programs—that each existing initiative has little chance of achieving sustainable success.

Four children have probably died unnecessarily while you read this article. Its time to reintroduce DDT and to fire the entire malaria team at USAID.