Sick and deadly double standards

Posted: Nov 03, 2007 12:00 AM
Sick and deadly double standards

If “corporate social responsibility” is to be more than a brilliant strategy for compelling companies to follow the dictates of “progressive” pressure groups, it must apply defensible ethical principles to all organizations. That is not now the case.

The current system targets companies for pollution, carcinogens, endocrine disruptors, climate change and other transgressions. A host of activists, academics, journalists, lawyers, politicians, regulators, judges and Hollywood producers help ferret out wrongdoers – actual, alleged and fictitious.

Where the wrongs are real, and the ethical guidelines are valid, society is well served. That this is not always the case is well documented. But there is another, more serious problem with CSR.

Its guidelines are often malleable, politically motivated and applied only to for-profit corporations.

If an accident kills wildlife or people, the law and basic ethics require that punishment is meted out and restitution made. But when it comes to policies and programs that sicken and kill millions of parents and children a year, society and the CSR warriors are not just silent. They see little reason why government agencies or multinational activist corporations should be held to the same standards of ethics, honesty, transparency or accountability as for-profit companies.

There may be no better example than malaria, to illustrate why they should be.

More than 2 billion people worldwide are at risk of getting this disease, and 350-500 million contract it every year, mostly in Sub-Saharan Africa. Malaria kills up to a million African children annually, making it the continent’s biggest killer of children under age five.

In Uganda alone, a nation of 30 million people, 60 million cases of malaria caused 110,000 deaths in 2005. In its Apac District, a person is likely to be bitten 1,560 times a year by mosquitoes infected with malaria parasites. The disease also perpetuates poverty (sick people can’t work) and increases deaths from HIV/AIDS, tuberculosis, diarrhea and malnutrition.

Controlling and eradicating this serial killer ought to be a global priority. But far too many organizations fail to take sufficient measures, while others actively oppose critically needed interventions.

UNICEF partners with Malaria No More to raise money from donors, distribute long-lasting insecticide-treted bednets and educational materials, provide anti-malarial drugs, and save lives. “Sometimes” they organize teams to spray insecticides on the inside walls of houses, to “kill the female mosquito after she feeds on a person” (and frequently infects him or her). Under “some special circumstances,” they support treating mosquito breeding sites, if the larvacides are “environmentally friendly.”

All these interventions will help reduce the disease and death tolls. They will garner plaudits from environmentalists and CSR activists. But there is no way such limited measures will result in No More Malaria. Unless and until they include outdoor spraying to control mosquitoes and DDT to keep them out of houses, they will not even come close to reducing malaria cases and deaths to what a moral person would deem tolerable levels: ie, close to zero.

Widespread distribution of insecticide-treated nets cut malaria deaths in half in Kenya, at least in the short run, when regular compliance was monitored. But that means 15,000 people are still dying each year. For Uganda, a 50% reduction via nets would mean 30,000 million cases and 55,000 deaths.

If the United States had Uganda’s malaria rates, we would have 600,000,000 cases and 1,100,000 deaths per year. Halving that would result in “only” 300,000,000 cases and 550,000 deaths annually. One would hope that not even Pesticide Action Network would deem that “acceptable.”

The US conducts aerial spraying on a regular basis – and uses Air Force tanker aircraft to spray insecticides after hurricanes – to prevent West Nile virus, which kills about 100 Americans a year. That’s one-third of what malaria kills in Uganda each day!

And yet misguided aid agencies, radical environmentalists and CSR activists are telling Africa that nets, “sometimes” use of limited insecticides, and at best a 50% reduction in malaria cases and deaths is something they should live with in perpetuity – because too many people in malaria-free countries are uncomfortable about using insecticides and DDT.

Equally unacceptable, 60% of African child malaria victims are still being “treated” with chloroquine, which no longer kills African plasmodium parasites. The typical justification is that chloroquine is much less expensive than Artemisia-based combination therapies (ACT drugs) that actually work.

In other words, medical malpractitioners are saying it is better to give millions of children cheap drugs that don’t work, and let thousands of them die – than it is to give fewer children more expensive drugs that do work, and ensure that they live. By failing to support chemical mosquito killers and repellants, they are also guaranteeing tens of millions of needless malaria cases every year, continued shortfalls of effective medicines, and countless unnecessary deaths.

That is unforgivable, unconscionable and immoral.

To achieve moral levels of malaria, countries need comprehensive, integrated programs that include every weapon in the arsenal. None is appropriate in all places, at all times. But all must be available, so that they can be employed at the proper time and place. That is why the U.S. Agency for International Development, President’s Malaria Initiative and World Health Organization declared that these chemical weapons are vital in the war on malaria, and safe for people and the environment.

Larvacides, insecticides and DDT – in conjunction with nets and other interventions – can reduce the number of malaria victims dramatically, and ensure that people who still get malaria can be treated with ACT drugs like Coartem. These truly integrated strategies have enabled South Africa, Botswana, Swaziland and Zanzibar to largely eradicate malaria.

Uganda, where I just spent a week on an anti-malaria mission, is using larvacides, insecticides, nets and other interventions. It has sprayed 95% of households in Kabale District (with Icon) – and slashed the prevalence of malaria parasites in residents from 30% before spraying to 3% afterward.

Three other districts have also been sprayed, and Uganda’s Ministry of Health plans to spray another 15 highly endemic areas in 2008, including the Apac District. In January, it will add DDT to its program, for indoor residual spraying that are expected to keep at least 70% of mosquitoes from entering homes for up to six or eight months, with a single spraying.

Radical environmentalists are trying to stir up opposition to DDT and other spraying programs, but the country is adamant about ending the needless slaughter of its children and parents. President Yoweri Museveni, Director General of Health Services Sam Zaramba and other leaders know DDT has worked in Africa, Bolivia and other regions – and will save many lives in Uganda.

Anti-pesticide activists claim insecticide spraying is not sustainable. What are not sustainable are nothing-but-nets programs that require constant monitoring to ensure daily use and moderate success – while raising the risk that mosquitoes will become resistant to pyrethroid pesticides that impregnate the nets. What are truly not sustainable are unconscionable malaria death tolls that result from PC policies that can best be described as lethal experimentation on African children.

That is why we need the same ethical and accountability guidelines for everyone.