Abstract:
Perhaps no other issue has divided the environmental and health communities as
much as DDT. The re-introduction of DDT in several East African countries, as well as the
demand for evidence-based policy, has led researchers at Duke University to develop the
Malaria Decision Analysis Support Tool (MDAST). One facet of the MDAST is to assess
the economic, environmental, and human health risks associated with alternative strategies
for managing malaria. In this pilot survey and elicitation, risks are assessed for the two most
commonly used vector control strategies – indoor residual spraying and insecticide-treated
bednets – in Uganda, Tanzania, and Kenya. The elicitation encompasses a broad range of
hazard pathways and risks, including harm to nontarget species, agricultural trade
restrictions, and vector resistance, some of which are frequently neglected in the policy
debate.
Preliminary results from the survey indicate that decision-makers are highly
concerned with the emergence of vector resistance from ITNs, IRS with DDT, and IRS with
ICON. High levels of concern were present for all additional risks associated with DDT,
including human health impacts, environmental impacts, and trade restrictions. Results from
the elicitation revealed that experts assessing harm to nontarget species and the potential for
trade restrictions attributed the highest level of risk to mismanagement of DDT and ICON.
Results from the elicitation for vector resistance were even more alarming; the expert
assessed high risks of the potential for vector resistance to occur from all pathways
associated with permethrin-treated bednets and IRS with DDT. Again, high risks were
attributed to mismanagement of DDT and ICON, indicating that mismanagement of
insecticides is the riskiest pathway of exposure.
