Stockholm Convention on Pops - 2012 Report of the Expert Group on the Assessment of the Production and Use of Ddt and Its Alternatives for Disease Vector Control

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SC UNEP/POPS/DDT-EG.4/2

Stockholm Convention

on Persistent Organic

Pollutants

Distr.: General

20 December 2012

English only

Expert Group on the assessment of the production

and use of DDT and its alternatives for

disease vector control

Fourth meeting

Geneva, 3 – 5 December 2012

Report of the Expert Group on the Assessment of the

Production and Use of DDT and its Alternatives for Disease

Vector Control

I. Background

1. The Conference of the Parties to the Stockholm Convention, at its fifth meeting, held in

April 2011, concluded that countries that are relying on DDT for disease vector control mayneed to continue such use until locally appropriate and cost-effective alternatives are available

for a sustainable transition away from DDT. It also decided to evaluate the continued need for

DDT for disease vector control on the basis of scientific, technical, environmental and

economic information, including that provided by the DDT expert group and the Persistent

Organic Pollutants Review Committee (POPRC), at its next meeting with the objective of

accelerating the identification and development of locally appropriate cost-effective and safe

alternatives.

2. Also by the same decision, the Conference of the Parties requested the Secretariat to

take active steps to collect and compile the information necessary to facilitate the work of the

DDT expert group and the POPRC and to enable them to provide guidance to the Conference

of the Parties in making the evaluation at its sixth meeting, to be held in April 2013.

II. Opening

3. The fourth meeting of the DDT expert group on the assessment of the production anduse of DDT and its alternatives for disease vector control was held at the International

Environment House, Geneva from 3 to 5 December, 2012. The meeting was opened by Mr.

Gamini Manuweera, Secretariat of the Stockholm Convention on Persistent Organic Pollutants,

at 9:30 am. on Monday, 3 December. As agreed by the members group during its intersessional

consultations, Mr. Manuweera invited Mr. Gao Qi of China to chair the meeting.

4. The Chair thanked the members for their active participation during the intersessional

work in collecting relevant information and undertaking initial assessments. He highlighted the

importance of the work entrusted to the group by the Conference of the Parties and appealed to

the members to ensure that the outcome of the assessment is scientifically sound and

technically accurate.

5. Opening remarks were made by Mr. Ibrahim Shafii, Acting Chief, Scientific Support

Branch of the Secretariat of the Basel, Rotterdam and Stockholm Conventions, Mr. Timothy J.Kasten, Head, Chemicals Branch, Division of Technology, Industry and Economics (DTIE) of



UNEP/POPS/DDT-EG.4/2

2

United Nations Environment Programme (UNEP Chemicals) and Mr. Michael Macdonald,

Consultant, Global Malaria Programme / Vector Control Unit, World Health Organization

(WHO).

6. Mr. Shafii welcomed participants on behalf of Mr. Jim Willis, Executive Secretary of

the Basel, Rotterdam and Stockholm Conventions. He informed the members that Basel,

Rotterdam and Stockholm Conventions are now implemented by a joint secretariat allowing

more coordinated approach in related activities within the lifecycle of chemicals. In the new

structure of the secretariat, activities related to DDT are lead by the Scientific Support branch.

The matters relating to DDT are considered very important from the point of view of assuringenhanced capacity to control malaria while promoting sustainable solutions to reduce reliance

on DDT. Mr. Shafii reiterated that the Conference of the Parties which evaluates continued

need for DDT for disease vector control is looking forward to the outcome of the assessment by

the DDT expert group for consideration in its deliberations related to DDT.

7. Mr. Kasten of UNEP Chemicals expressed his pleasure of meeting the DDT expert

group especially at a time when the leadership of the Global Alliance for alternatives to DDTwas transitioned to UNEP Chemicals. He noted the importance of working closely with the

DDT expert group in implementing the Global Alliance for efficient delivery of its outcomes.

The Strategic Approach to International Chemicals Management (SAICM) and mercury

programme of UNEP bring more synergy into the efforts of the Global Alliance towardsdeveloping and deploying alternatives to DDT for enhanced capacity of disease endemic

countries to introduce safe and cost effective alternatives.

8. Speaking on behalf of WHO, Mr. Michael Macdonald said that there has been a

remarkable progress during the recent past in malaria control. The success has been mainly due

to increased funding for capacity strengthening in both malaria disease and vector control

programmes. However, there are several challenges ahead that could lead the progress made so

far into a fragile status. Anticipated decline in continued funding for activities due to globaleconomic crises, potential for the development of drug resistance and vector resistance to

pyrethroids were highlighted as impending serious challenges.

9. Mr. Macdonald said that initiatives such as Global Alliance for alternatives to DDT,

President’s Malaria Initiative (PMI), Rollback Malaria programme (RBM) and institutions in

Africa and outside such as International Centre for Insect Physiology and Ecology (icipe),Kenya and the Centre for Disease Control and Prevention, USA have been some of the key

partners in providing support to achieve the global goals in malaria control.

III. Adoption of the agenda

10. The expert group adopted the agenda that had been circulated as document

UNEP/POPS/DDT-EG.4/1.

IV. Attendance

11. The meeting was attended by the following DDT expert group members: Mr. Artak

Khachatryan, Mr. Gary Fan, Mr. Qi Gao, Mr. José Okond’Ahoka, Mr. Antoine Schwoerer, Mr.

Kaushal Kumar, Mr. Rajendra Maharaj, Mr. Robert A. Wirtz, Ms. Maureen Coetzee, Mr.Flemming Konradsen, Mr. Rajander Singh Sharma and Mr. John Githure. Representatives fromUNEP and WHO were also present at the meeting. The list of participants is attached to the

current report as annex I.

V. Introduction to the discussions

12. The Secretariat made a presentation on the decisions of and developments from the

fifth meeting of the Conference of the Parties relevant to DDT. Mr. Gamini Manuweera

recalled that both production and use of DDT for disease vector control had been allowed as

acceptable purposes when DDT was listed in the Convention. The Parties registered for

acceptable purposes may use DDT for disease vector control in accordance with WHOguidelines when locally safe, effective and affordable alternatives are not available. He noted

the decision by the Conference of the Parties at its fifth meeting to evaluate the continued need




3

for disease vector control at its next meeting on the basis of scientific, technical, environmental

and economic information, including that provided by the DDT expert group and the POPRC.

13. To facilitate the work of the DDT expert group, the Secretariat has circulated the DDTquestionnaire on 25 January 2012 in accordance with the process set out in decision SC-3/2 for

reporting by each Party on the production and use of DDT for the period of 2009-2011. WHO

has launched the GEF project on strengthening capacity for reporting to the DDT questionnaire

in selected countries in Africa. During its 7th and 8th meeting, the POPRC undertook an

assessment of POPs characteristics of the chemical alternatives WHO has recommended for

disease vector control. The report on the assessment by POPRC is available for the work ofDDT expert group. He recalled the terms of reference requiring the expert group to make

recommendations to the Conference of the Parties, based on the assessment of factual

information to facilitate its evaluation on the continued need for DDT for disease vector control

and on any actions deemed necessary to reduce the reliance on DDT.

14. Presentations were made on the following: WHO Global Malaria Programme and

Insecticide Resistance (DDT and alternatives) by Michael Macdonald, An update on the DDTRisk Assessment Process of the WHO by Carolyn Vickers, New Alternative Products,

including the Work of the POPRC by Gary Fan, Transition from DDT in Disease Vector

Control by Maureen Coetzee and, Decision Support Tool for Vector Control by Rajendra

Maharaj.

15. In the ensuing discussion, questions were raised on impending decline in funding for

malaria control activities. The group, however, noted that opportunities are still available to

support vector control programmes including that provided through the Global Environment

Facility. On the issue of vector resistance, an urgent need for chemicals with new modes of

actions and long lasting residual effects were highlighted, especially in the light of declining

trend of number of insecticides commercially available in the global market and high cost of

some of the existing alternatives. Among the others, the group discussed on challenges indealing with outdoor malaria transmission and possible way forward to enhance the

contribution from complementary vector control options such as larviciding and biological

control techniques, etc.. The group also noted other influencing factors including climate

change effects on vector dynamics and sound planning and engineering in development

projects. Greater coordination and collaboration of all stakeholders within integrated diseaseand vector management framework with due consideration on community ownership was theconsensus of the group as the sustainable solution for eliminating reliance on DDT for disease

vector control.

16. Mr. John Githure highlighted the process undertaken during the intersessional period

on the assessment of information by the group. Four intersessional working groups were

established to focus on key areas related to the assessment towards developing the draft

preliminary report. The information provided by parties to the DDT questionnaire which wassent to all 178 Parties for reporting was also included in the draft. As of November 2012, a total

of 24 Parties had responded to the DDT questionnaire for the reporting cycle 2009-2011. Out

of 18 countries registered for the acceptable purposes of DDT, 12 responded to the

questionnaire.

17. The Expert Group agreed to work in three sub-groups to review and further develop thedraft preliminary report and formulate draft conclusions of the assessment. The outcomes of the

sub-groups were presented in the plenary for further deliberations and developed the

conclusions and recommendations to the Conference of the Parties. The group requested the

Secretariat to include the changes made to the draft preliminary report and finalize it with

conclusions and recommendations as the report of the DDT expert group to the Conference of

the Parties for its consideration at its sixth meeting. The report of the DDT expert group isattached to the current report as Annex II.

VI. Closure of the meeting

18. The meeting was declared closed by the Chair at 4.45 p.m. on Wednesday, 5 December.




4

Annex I

List of participants

Party Nominated Members

ARMENIA

Mr. Artak Khachatryan

Head of Inventory and Risk Assessment Division

“Waste Research Center” State Non CommercialOrganization / Ministry of Nature Protection

46 Charents Street

0025 YerevanArmenia

Tel.: +374 (94) 04 99 55Fax: +374 (10) 55 47 32

Email: [email protected]

AUSTRALIA

Mr. Gary FanSenior Policy Officer

Agricultural and Veterinary Chemicals Section

Department of Agriculture, Fisheries and Forestry

GPO Box 858

2601 Canberra

AustraliaTel.: +61 (2) 6272 3964

Fax: +61 (2) 6272 3025


CHINA

Dr. Qi Gao

Professor and Director

Jiangsu Institute of Parasitic Diseases (JIPD)Meiyuan 117

214064 Wuxi JiangsuChina

Tel.: +86 (510) 6878 1001

Fax: +86 (510) 8551 0263


DEMOCRATIC REPUBLIC OF CONGO

Dr. José Okond’Ahoka

Professeur

Faculté de Médecine Vétérinaire

Université Pédagogique Nationale134 Avenue de la Révolution

c/ Ngaliema - VPN, B.P. 16789

Kinshasa

Democratic Republic of CongoTel.: +243 (81) 813 1411

Fax: +243 (81) 8131 411


FRANCE

Mr. Antoine Schwoerer

Policy Advisor

General Directorate for Risk Prevention

Ministry of Ecology

Arche-Paroi Nord

CEDEX La defense92055 Paris

France

Tel.: +33 (1) 40 81 97 82

Fax: +33 (1) 40 81 20 72

Email: antoine.schwoerer@developpement-

durable.gouv.fr

INDIA

Dr. Kaushal Kumar

Head of Department & Joint Director

Centre for Medical Entomology and Vector

Managment National Centre for Disease Control

22, Sham Nath Marg

110054 Delhi

India

Tel.: +91 (11) 2391 2963

Fax: +91 (11) 2391 2963Email: [email protected]




5

SOUTH AFRICA

Dr.. Rajendra Maharaj

Professor and Director

Medical Research Unit

Medical Research Council

P.O. Box 70380

4067 Overport

South Africa

Tel.: +27 (31) 203 4851

Fax: +27 (31) 203 4831


WHO Selected Members

Dr. Robert A. Wirtz

Chief

Entomology Branch / Division of Parasitic Diseases

and Malaria

Centers for Disease Control and Prevention (CDC)MS-G49, 1600 Clifton Road

30329-4018 Atlanta

United States of AmericaTel.: +1 (404) 718 4330

Fax: +1 (404) 718 4335


Dr.(Ms.) Maureen Coetzee

Professor

Malaria Entomology Research Unit

University of the Witwatersrand

P.O. Box 4165

2040 Honeydew

South Africa

Tel.: +27 (11) 386 6480Fax: +27 (11) 386 6481


[email protected]

Secretariat Selected Members Dr. John Ichamwenge GithureScientist

Malaria Division

Ministry of Health

P.O. Box 6201

Kigali

RwandaTel.: +250 (78) 279 7400

Fax:


Dr. Rajander Singh Sharma

Additional Director, Department of Entomology

National Vector Borne Disease Control Programme

Ministry of Health and Family Welfare

22 Sham Nath Marg

110054 Delhi

India

Tel.: +91 (11) 2397 2884

Fax: +91 (11) 2396 8329


Dr. Flemming Konradsen

Professor

International Health Section / Department of

International Health, Immunology and MicrobiologyUniversity of Copenhagen

Øster Farimagsgade 5, Building 9

P.O. Box 2099

1014 Copenhagen K

Denmark

Tel.: +45 (35) 32 76 26

Fax: +45 (35) 32 77 36


mailto:[email protected]







6

Other Agencies

WORLD HEALTH ORGANIZATION

Dr.(Ms.) Carolyn VickersTeam Leader, Chemical Safety

Department of Public Health and Environment

World Health Organization (WHO)

Avenue Appia 20

1211 Geneva

Switzerland

Tel.: +41 (22) 791 1286

Fax: +41 (22) 791 4848


Dr. Michael Macdonald

Consultant

Global Malaria Programme / Vector Control UnitWorld Health Organization (WHO)

22 Avenue Appia

1211 Geneva

SwitzerlandTel.: +1 410 788 2550

Fax:


UNEP / DIVISION OF TECHNOLOGY,

INDUSTRY AND ECONOMICS (DTIE)

Mr. Donald Cooper

Principal Advisor

DTIE / Chemicals Branch

United Nations Environment Programme (UNEP)

International Enviroment House-I

11-13 Chemins des Anémones

1219 Châtelaine (Geneva)

Switzerland

Tel.: +41 (22) 917 8192

Fax:


[email protected]




7

Annex II

Report of the DDT expert group on the assessment of the production

and use of DDT and its alternatives for disease vector control

15 January 2013Geneva




8

Acronyms and Abbreviations

COP Conference of the Parties

DDT Dichloro-diphenyl-trichloroethane

DSS Decision support system

EC Emulsifiable concentrate

EU European Union

FAO Food and Agricultural Organization

GEF Global Environment Facility

GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria

IRS Indoor residual spraying

IRD Institute for Research and Development, France

IVCC Innovative vector control consortium

IVM Integrated vector management

LLINs Long-lasting insecticidal nets

MOH Ministry of Health

NIPs National implementation plans

PMI President’s Malaria Initiative

PHP Public health pesticides

POP Persistent Organic Pollutants

POPRC Persistent Organic Pollutants Review Committee

UNEP United Nations Environment Programme

USAID United States Agency for International Development

WHOPES World Health Organization Pesticide Evaluation Scheme

WP Wettable powder




9

Contents

INTRODUCTION ...................................................................................................................................................... 10

1. SITUATION ANALYSIS OF THE PRODUCTION AND USE OF DDT ....................................................... 12

1.1 Sources and amounts of DDT production and distribution in 2009-2011 ................................................ 12

1.2 Trends in DDT use .................................................................................................................................... 14

1.3 Key programmes and initiatives where DDT is used for vector control ................................................... 15

1.4 Existing mechanisms on purchase, quality control and use of DDT ......................................................... 15

1.5 Hazards related to misuse and environmental contamination .................................................................. 16

1.6 Stockpiles of DDT ..................................................................................................................................... 16

2. AVAILABILITY, SUITABILITY AND IMPLEMENTATION OF ALTERNATIVES TO DDT .................. 16

2.1 Assessment of the strategies to reduce reliance on DDT and progress of introducing new alternative vector

control products ................................................................................................................................................. 16

2.2 Assessment of other chemical and non-chemical products and methods used for vector control ................ 17

3. IMPLEMENTATION OF VECTOR CONTROL STRATEGIES, METHODS AND PRODUCTS ................ 18

3.1 Vector control capacities at national level ......................................................... ...................................... 18

3.2 Insecticide resistance management ......................................................... ................................................. 19

3.3 Implementation of integrated vector management ..................................................... .............................. 20

4. CAPACITIES FOR COUNTRIES TO TRANSIT FROM DDT TO OTHER ALTERNATIVES .................... 20

4.1 Training tools and capacity for proper distribution and use of pesticides ............................................... 20

4.2 National policies, guidelines and regulatory measures on DDT use ....................................................... 20

4.3 Available funding opportunities for transition from DDT to alternatives ................................................ 21

4.4. The Global Alliance on alternatives to DDT ................................................................ ............................ 21

4.5 Evidence-based decision support tools for vector control ...................................................................... 21

4.6 Availability and cost effectiveness of DDT and alternatives ............................................................ ........ 22

4.7 Technology transfer and linkages with research and training institutions .............................................. 22

5 ACTION TAKEN BY PARTIES/PARTNERS TO REDUCE RELIANCE ON USE OF DDT ........................... 22

5.1 Polices, guidelines and initiatives to facilitate reducing production and/or use of DDT ............................. 22

5.2 Case examples of successful malaria control ........................................................ ...................................... 23

5.3 Promotion of research and development of alternatives ........................................................... ................... 23

5.4 Resource mobilization strategies for vector control ...................................................... .............................. 24

CONCLUSIONS AND RECOMMENDATIONS ................................................................ ...................................... 25

REFERENCES ........................................................................................................................................................... 27




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Introduction

1. Paragraph 6 of part II of Annex B of the Stockholm Convention on Persistent Organic Pollutants

require that commencing at its first meeting and at least every three years thereafter, the Conference of

the Parties (COP) shall, in consultation with the World Health Organization, evaluate the continuedneed for dichloro-diphenyl-trichloroethane (DDT) for disease vector control on the basis of available

scientific, technical, environmental and economic information. Due to the fact that the COP now has

ordinary meetings every two years, by its decision SC-3/21, undertakes the evaluation of the continued

need for DDT for disease vector control at each ordinary meeting, as provided in the revised process

for DDT reporting, assessment and evaluation contained in Annex I to that decision.

2. To achieve this, the DDT Expert Group is established with the following Terms of Reference:

(a) Undertake a situational analysis on the production and use of DDT and the conditions

for such use, including a review of the responses by countries to the questionnaire;

(b) Evaluate the availability, suitability and implementation of alternative products,

methods and strategies for Parties using DDT;

(c) Evaluate the progress in strengthening the capacity of countries to shift in a safefashion to reliable or suitable alternative products, methods and strategies based on a review of the

opportunities and needs in countries for sustainable transition;(d) Make recommendations on the evaluation and reporting mechanisms set out in

paragraphs 4 and 6 of Part II of Annex B of the Convention;

(e) Consider and assess the actions being taken by Parties to accomplish the following:

(i) Development of regulatory and other mechanisms to ensure that DDT use isrestricted to disease vector control;

(ii) Implementation of suitable alternative products, methods and strategies

including resistance management strategies to ensure the continuing

effectiveness of such alternatives;

(iii) Measures to strengthen health care and to reduce the incidence of the disease

being controlled with DDT;

(iv) Promotion of research and development of safe alternative chemical and non-

chemical products, methods and strategies for Parties using DDT, relevant to

the conditions of those countries with the goal of decreasing the human and

economic burden of disease. Factors to be promoted when considering

alternatives or combination of alternatives shall include the human health risksand environmental implications of such alternatives. Viable alternatives to

DDT shall pose less risk to human health and the environment, be suitable for

disease control based on conditions in the Parties in question and be supported

by monitoring data;

(f) Make recommendations to the Conference of the Parties on the continued need for

DDT for disease vector control and on any actions deemed necessary to reduce the reliance on DDT inthe light of the assessments undertaken pursuant to subparagraphs (a) to (e) above.

3. The COP in its evaluation of continued need for DDT for disease vector control at its fifth meeting

held in 2011, in its decision SC-5/6, concluded that countries that are relying on DDT for disease

vector control may need to continue such use until locally appropriate and cost-effective alternatives

are available for a sustainable transition away from DDT.

4. By the same above decision, the COP decided to evaluate the continued need for DDT for diseasevector control, on the basis of scientific, technical, environmental and economic information,

including that provided by the DDT expert group and the Persistent Organic Pollutants Review

Committee (POPRC).

5. The POPRC focused on the scientific and technical work relating to persistent organic pollutant

characteristics of the chemical alternatives that the World Health Organization (WHO) hasrecommended for disease vector control and has undertaken an assessment in accordance with the

1 UNEP/POPS/COP.3/30, Annex I, Decision SC-3/2.




11

general guidance on considerations related to alternatives and substitutes for listed persistent organic

pollutants and candidate chemicals2. The assessment report of the POPRC is set out in documentUNEP/POPS/POPRC.8/INF/30, the fact sheets on the chemical alternatives are presented in

UNEP/POPS/POPRC.8/INF/31.

6. The DDT expert group, in collaboration with the WHO, conducted an assessment of available

scientific, technical, environmental and economic information related to the production and use of

DDT for disease vector control. Due consideration was taken of the report prepared by the POPRC to

facilitate the COP to undertake an evaluation of continued need for DDT for disease vector control.The assessment considered information, among the others, that was provided by the parties to the

Stockholm Convention to the DDT questionnaire for the three-year reporting period from 2009 to

2011.

7. To start the process of compiling the above information, the DDT Expert Group met through various

channels including the Stockholm Convention POPs Webinars and Social network, online meetings,

emails and teleconferences to discuss and agree on the format and outline of the preliminary report

that forms the framework for the expert group to report to the COP for its consideration during its 6th

meeting.

8. The inter-sessional discussions held by the Group agreed to analyse the following key issues:

(a) Situation analysis of the production and use of DDT;

(b) Availability, suitability and implementation of alternatives to DDT;

(c) Implementation of vector control products, methods and strategies;

(d) Capacities for countries to transit from DDT to other alternatives for vector control;

(e) Action taken by Parties/Partners to reduce reliance on use of DDT for vector control.

2 UNEP/POPS/POPRC.5/10/Add.1.




12

1. Situation Analysis of the Production and Use of DDT

1.1 Sources and amounts of DDT production and distribution in 2009-2011

DDT Questionnaire

9. Paragraph 4 of Part II, Annex B of the Convention requires, every three years, Parties registered foracceptable purposes of DDT to provide to the Secretariat and the World Health Organization

information on the amount used, the conditions of such use and its relevance to that Party’s disease

management strategy, in a format to be decided by the Conference of the Parties in consultation withthe World Health Organization. The process for reporting on and assessment and evaluation of the

continued need for DDT for disease vector control is provided in the Annex I to decision SC-3/2 that

set out the format for reporting on DDT by Parties.

10. The Secretariat to the Stockholm Convention distributed the adopted DDT questionnaire to the 178

member Parties. As of November 2012, a total of 24 Parties responded to the DDT questionnaire for

the reporting cycle 2009-2011(Table 1). Included in these respondents were 12 Parties out of 18

registered for acceptable use/production of DDT. Of the 12 Parties, seven reported use of DDT for

vector control. These are, India, South Africa, Eritrea, Swaziland, Mauritius, Zambia and

Mozambique. As in the last reporting cycle (2006-2008) Gambia, which has not notified the DDTRegister of acceptable purposes, has reported that it has continued to use DDT. The six other countries

in the DDT Register that had not submitted their DDT questionnaires by the time of this report

submission are Botswana, China, Marshall Islands, Namibia, Senegal and Venezuela.

Table 1. Available information on the use of DDT in 2009-2011

Category Parties Status of use

Parties that have notified the Register on

DDT use

India

Eritrea

Zambia

Swaziland

South Africa

Mozambique

MauritiusEthiopia

YemenMorocco

Madagascar

UgandaBotswana

China

Marshall Islands

Namibia

Senegal

Venezuela

Reported use1

Reported use1

Reported use1

Reported use1

Reported use1

Reported use1

Reported use1

Reported no use1

Reported no use

1

Reported no use1

Reported no use1

Reported no use1

No information reported






Parties that use DDT but have not yet notified

the Register

Gambia Reported use

Submitted but not on DDT Register Bahrain Reported no use1

Jordan Reported no use1

Argentina Reported no use

Mexico Reported no use

Albania Reported no use1

Lithuania Reported no use1

Rwanda Reported no use1

Cambodia Reported no use1

Seychelles Reported no use

Monaco Reported no use1

1As reported in the DDT Questionnaire




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Global production

11. The information provided in the questionnaires showed that the total global production of DDT during

the reporting period (2009-2011) was 10,246 tonnes all from India. The global DDT production trend

from 2009 to 2011 shows more or less a steady production of an average of 3,372 tonnes per year with

a slight reduction of production and use in 2011. The annual DDT production during the current

reporting cycle closely matches with the annual global use of DDT and when compared to the

information from the previous reporting cycles, there is a declining trend in the production of DDT

(Figure 1).

Figure 1. Global production and use trend of DDT

Export of DDT

12. India exported a total of 231.87 tonnes of 75% wettable powder (WP) to Mozambique, Gambia and

Namibia during the reporting period (Table 3). In 2009, South Africa ordered 206 tonnes of DDT 95%

technical grade from China but received 199.7 tonnes. It has also received 24.25 tonnes of DDT 75%

WP from India in 2011. South Africa was the only country reported to formulate and package DDT. In

2009, it formulated and packaged 252.95 tonnes of DDT 75% WP and exported 32.82 tonnes to

Zambia, 100 tonnes to Namibia, 13.02 tonnes to Swaziland and 0.60 tonnes to Botswana.




14

Table 3. Amounts of DDT exports

Source Destination Year Amount of 75% WP

(tonnes)

India (Hindustan Insecticide Ltd) Mozambique 2009

20102011

165.18

32.244.25

Total 201.67

Gambia 2009

2010

2011

0

0

14.00

Total 14.00

Namibia 2009

2010

2011

16.12

0.04

0.04

Total 16.20

South Africa (AVIMA Ltd) Zambia 2009

2010

2011

Total

23.82

9.00

0

32.82

Namibia 20092010

2011

0100.00

0

Total 100.00

Swaziland 20092010

2011

5.664.01

3.35

Total 13.02

Botswana 20092010

2011

0.600

0

Total 0.60

1.2 Trends in DDT use

13. According to the country responses for the reporting period 2009-2011, seven out of the 18 countries

in the DDT Register reported use of it for disease vector control with India being by far the largest

user (10520 tonnes of 95% DDT equivalent) followed by South Africa (132.67 tonnes of 95% DDT

equivalent), Zambia (44.76 tonnes of 95% DDT equivalent) and Eritrea (42.64 tonnes of 95% DDT

equivalent) (Table 4).

14. A report on the global trend of insecticide use conducted for the period 2000-2009 showed that 82% ofDDT was used in India, 11.3% in Ethiopia, 2.2% in Mozambique, 1.3% in Namibia, 1.2% in South

Africa, while the combined use in Zimbabwe, Zambia, Madagascar, Eritrea, Uganda and Mauritius

accounted for less than 1% of the global use (Henk et al . 2012).

15. As per the country responses, a total of 10,246.17 tonnes of active ingredient of DDT was used for

disease vector control mainly for malaria and leishmaniasis vectors during the three-year reporting period (2009-2011). According to the questionnaires, India is the only country that reported using

DDT for both malaria and leishmaniasis vectors control while Mauritius reported using it for malaria

vectors in addition to control of Chikungunya/ dengue Aedes albopictus vectors.




15

Table 4. Amount of DDT used by countries during the reporting cycle 2009-2011.

Country Year

Amount of formulated material used

(tonnes )

95% DDT

technical

grade

equivalent

amounts

(tonnes)Annual Reporting cycle

India 2009 6,830.00*

19,970.00*

3594.74

2010 6,694.00* 3523.16

2011 6,446.00* 3392.63

Eritrea 2009 13.00

54.00

10.26

2010 18.30 14.45

2011 22.70 17.92

Zambia 2009 32.00

56.69

25.26

2010 24.69 19.49

2011 0 0.00

Mauritius 2009 0.28

0.85

0.22

2010 0.57 0.45

2011 0 0.00

Swaziland 2009 5.00

11.00

3.95

2010 2.50 1.97

2011 3.50 2.76

South Africa 2009 84.56

168.04

66.76

2010 21.37 16.87

2011 62.11 49.04

Gambia 2009 20.89

50.89

16.49

2010 14.88 11.75

2011 15.12 11.94

Mozambique 2009 1.40

6.73

1.11

2010 2.20 1.74

2011 3.13 2.47

Grand total 20,318.22 10785.44

* Note: The percentage of active ingredient of DDT in the formulation used in India is 50% whereas that of the

other countries is 75%

1.3 Key programmes and initiatives where DDT is used for vector control

16. DDT is only used by the health ministries for indoor residual spraying against mosquitoes and sand

flies. Malaria was the primary disease targeted in all the respondent countries followed byleishmaniasis control in India. At national level, increased technical and human resources capacity is

required for effective monitoring of insecticide resistance. Some development partners, such as,

USAID/PMI and Global Fund supports the use of DDT for disease vector control and resistancemonitoring.

1.4 Existing mechanisms on purchase, quality control and use of DDT

17. The importation, packaging, registration, transportation and storage of DDT and other public health pesticides is based on WHO Pesticide Management guidelines and within country rules and

regulations, according to the provisions of the Stockholm Convention on POPs. In some countries

where disease vector control programmes are supported by development partners such as PMI, the

spray operators of insecticides are trained in safe use, mixing, handling and disposal to minimize

human exposure and environmental contamination in accordance with WHO guidelines. Such

programmes also include quality assurance on application of insecticide by follow-up bio-efficacyverifications. For countries where facilities are inadequate to undertake product quality assurance of




16

insecticides used, including DDT, options are available to send the samples abroad for quality testing

such as South Africa and Europe.

18. WHO has published Guidelines on Procuring Public Health Pesticides that elaborate on purchaserequirements and quality control (WHO 2012). The objective of the guidelines is to provide guidance

in the procurement of appropriate high quality public health products. The manual promotes fairness,

transparency, integrity, accountability and quality assurance in procurement. The document is meant to

assist the governments and stakeholders in preparing their own local standard operating procedure on

procurement and quality control of pesticides.

19. India has developed and implemented an Environmental Management Plan (EMP) with support by the

World Bank. The EMP has six codes of practices, namely, i) transport of insecticides for IRS

activities, ii) storage and management of insecticide stocks, iii) community responsibility during IRS

activities, iv) use and maintenance of personal protective equipment, v) indoor residual spraying, and

vi) disposal of waste water, empty bags/containers & biomedical wastes.

1.5 Hazards related to misuse and environmental contamination

20. On human and environmental safety issues, the eight DDT using countries, except Eritrea and

Mauritius, reported that they have a community awareness programme in place on the safety issues

relating to DDT use. However, only a few of them (India, Gambia and Uganda) have a system in place

for monitoring exposure to DDT. The agencies in charge of assessing the risks are the Health andEnvironment ministries.

21. The WHO recently updated the 2001 Joint FAO/WHO meeting report on Pesticide Residue on humanhealth focusing on DDT use in indoor residual spraying in order to provide specific advice to the

Conference of the Parties. The report highlights issues relating to hazard assessment, exposure

assessment and risk characterization on use of DDT in disease vector control. A detailed analysis ofthe human health risks is available in the WHO (2011a) report.

22. Another WHO project titled; “Reduction of health risks through sound management of pesticides”conducted in 12 countries (Ecuador, Guatemala, Cambodia, Cameroon, Kenya, Madagascar, Morocco,

Mozambique, Senegal, Sudan, Thailand and Tanzania) which aims to prevent potential exposure

linked to pesticide management will shed more light when the results are made available by WHO.

1.6 Stockpiles of DDT

23. Only five out of 24 countries reported on the stockpiles of DDT. Parties that reported having

stockpiles of DDT included: South Africa with 36.0 tonnes of DDT 75% WP that is stocked at securededicated facilities; India with 2,046.0 tonnes of DDT 50% WP; Jordan with 25 tonnes of DDT 75%

WP stored at the MoH warehouses; Gambia with 14 tonnes of 75% WP in good and usable condition;

and Mauritius with 5 tonnes of technical grade DDT. Swaziland reported that it has unspecified stocks

of obsolete DDT that need to be disposed of.

24. The national implementation plans (NIPs) submitted to the Stockholm Convention requires that

countries provide indications of the quantity, quality and location of DDT stockpiles and obsolete

DDT in their countries. They are also required to address illegal trafficking and use of DDT for

purposes other than public health vector control. Operations are ongoing to clean up and safely dispose

of obsolete pesticide stocks under the auspices of the Africa Stockpiles Programme (ASP 2010). A

research article on DDT substitutes by Rahman (2012) indicates that Bangladesh has 602,389 metric

tonnes of obsolete DDT stockpiled in storage facilities that are inadequate resulting in seepage,

pilferage, weathering and misuse, leading to environment contamination and health hazards. Inaddition there may be other countries not reporting in the DDT questionnaire that may have significant

stockpiles.

2. Availability, Suitability and Implementation of Alternatives to DDT

2.1 Assessment of the strategies to reduce reliance on DDT and progress of introducing new

alternative vector control products

25. In order to mitigate the burden of vector borne diseases without relying on DDT, many countries havealready started introducing alternative products and strategies. However, information on the

applicability and cost-effectiveness of alternatives has been limited, thus, not allowing the countries to

effectively design application of alternatives in local environmental, epidemiological and socio-

economic settings. Furthermore, limited national capacity has led to inadequate analysis of available

alternatives, insufficient consideration of alternatives in national policy and a lack of coherent andintegrated approaches to vector control.




17

26. IVM, defined as “a rational decision making pr ocess for the optimal use of resources for vector

control” can help countries make evidence-based decisions on the use of pesticides, including DDT.Mexico is one of the countries highlighted to have reduced its reliance on pesticides, including DDT,

due to multiple resistance in the vector populations by implementing alternative strategies. IVM

provides the appropriate framework for more judicious use of pesticides, including DDT and

alternatives and use of evidence-based vector control interventions.

27. WHOPES recommends 12 insecticides for IRS as listed in the website -

(http://www.who.int/whopes/Insecticides_IRS_Malaria_09.pdf ).The alternative classes of insecticides to DDT are the organophosphates, pyrethroids and carbamates

that usually have a shorter residual efficacy and therefore require more than one round of application

per year. There are, however, a number of research organizations and pesticide development

companies that are exploiting chemical technology to come up with new, longer-lasting formulations

of pesticides for public health use (see section 5.2). A number of products are being investigated thatcould eventually be used to replace DDT or reduce reliance on DDT. Primiphos-methyl CS has

recently been introduced on the market but is significantly more expensive than DDT. Likewise,

bendiocarb which has been on the market for a number of years is significantly more expensive and

much shorter acting duration than DDT. Newer, longer lasting formulations of pyrethroids, such as

deltamethrin WG and lambda-cyhalothrin CS are available at a price competitive with DDT, but

because of insecticide resistance, may not be suitable alternatives

28.

The IVCC and commercial partners are currently working on novel insecticides that could be used asalternatives to the current WHOPES approved insecticides for IRS. The IVCC is a Product

Development Partnership (PDP) established as a not for profit company and registered charity to

overcome the barriers to innovation in the development of new insecticides for public health vector

control and to develop information systems and tools that will enable new and existing pesticides to be

used more effectively. Their mission is to improve health by enabling partnerships for the accelerateddevelopment and delivery of new products and tools that increase the effectiveness and efficiency of

the control of insects that transmit disease. In addition to the IVCC, other commercial and

government entities are conducting research to develop new public health pesticides.

2.2 Assessment of other chemical and non-chemical products and methods used for vectorcontrol

29. Long lasting insecticidal nets and indoor residual spraying are the current major chemical based vector

control interventions in most malaria endemic countries. The countries that continue to use and rely onDDT for vector control justify its use by stating that locally safe, effective, long residual efficacy and

affordable alternatives are not available. The use of DDT primarily relates to resistance management

and less to operational costs. There is an urgent need for chemical products with similar effectiveness

to DDT and limited environmental persistence to be made available to disease control programmes.

Chemical control

30. The WHO has recommended 12 insecticides including DDT for use in indoor residual spraying and

although 11 chemicals are recommended as alternatives to DDT, only six of these are commonly used.

Apart from DDT, most of the other insecticides do not have the desired residual persistency of more

than 6 months. However, the choice of any of these depends on the susceptibility of vector

populations, the length of the disease transmission season, the type of surfaces to be sprayed, the

commercial availability and the ability of the governments to procure and handle the insecticide.

Historically, the first choice for all countries when they consider IRS is to use the differentformulations of the pyrethroid class of insecticides because of their low cost, low toxicity to mammals,

effectiveness and community compliance. The shift to carbamates and organophosphates has been

necessitated by development of pyrethroid resistance and also to preserve the effectiveness of LLINs

that use the same class of insecticide. There are however some formulations recently approved by

WHOPES that could be used to manage resistance. These are slow-release capsule (lambda-

cyhalothrin-CS) and granule (deltamethrin-WG) formulations that are available for indoor residual

spraying (WHO, 2010) but the data indicate that the residual efficacy of these formulations is about 3

– 6 months.

31. Long-lasting insecticidal nets which have been shown through a number of trials to be effective in

reducing malaria morbidity and mortality can reduce the reliance on indoor residual spraying. As part

of the Global Malaria Action Plan, universal coverage of LLINs (defined as one net for every two

persons) is recommended for all populations at risk of malaria. Some countries have attained universalcoverage for the entire population in the country or regions within the countries. All of the LLINs are

treated with pyrethroids, but resistance is developing in some countries that may limit their

http://www.who.int/whopes/Insecticides_IRS_Malaria_09.pdf







18

effectiveness as alternatives to IRS. Furthermore, recent studies indicate that LLINs remain effective

substantially less than the expected 3 to 4 years due to lack of physical durability. It is encouraging to

note that there are at least eight LLINs and one kit for re-treatment of nets submitted by various

companies to WHOPES for laboratory and field evaluation before coming to the market.

32. In highly endemic malaria areas, LLINs and IRS have been used to interrupt transmission. Universal

coverage with nets is meant to protect the entire community and therefore it is important for countries

that have attained this coverage to determine the added impact of IRS. It should however be noted that

these two interventions which target indoor mosquitoes may be less effective in areas where

mosquitoes rest and bite outdoors or are resistant to the insecticides being used. Some studies havenow indicated that there are vectors biting outdoors and also in the early part of the night (Reddy et al.

2011). However, it is has not been proven whether this selection among vector populations has any

impact on the effectiveness of well established vector control methods such as LLINs and IRS

(Bradley et al. 2012).

33. Other products that may protect entire households are durable wall linings (Messenger et al. 2012) andinsecticidal paint products that function similarly to IRS but for longer periods. These are being

evaluated and large-scale systematic trials and cost-effectiveness studies need to be completed

(Amelotti et al. 2009; Mosqueira et al . 2010a, 2010b).

34. Chemical larviciding with organophosphates (e.g., Temephos) has been used by a few countries to

control mosquito larvae. South Africa, Eritrea and Swaziland reported use of this product. In settings

where breeding sites of Anopheles spp. are “few, fixed and findable”, antilarval activities with

chemical and non-chemical methods could be explored as a supplementary measure to IRS and LLINs, provided there is evidence that this is a cost-effective and operationally feasible measure. For

resistance management purposes, if an organophosphate is used for larviciding, a different class of

insecticide should be used for adult control.

Non-chemical control

35. Larval source management, which includes environmental management, microbicides and biologicalcontrol, aims to suppress vector population size and subsequently human-vector contact. Most of these

methods have been documented to be effective in reducing malaria transmission in those specific

settings where conditions were appropriate for their use (Killeen et al. 2002; Keiser et al. 2005;

Fillinger and Lindsay, 2011). The Roll Back Malaria larval source management work-stream 2012 has

supported case study reports on larval source management in urban areas in Mauritius, Sudan, India

and Tanzania. Before the introduction of DDT, engineering and environment-based interventions

contributed to the prevention of malaria, especially in Asia. Studies indicate that environmentalmanagement approaches can be cost-effective components to add to integrated control programmes if

there are sufficient resources and technical capacity to plan, implement and evaluate the intervention

(Konradsen et al. 2004; Pedercin et al. 2011).

36. Another strategy has been the use of microbicides, including Baccillus thuringiensis israelensis (Bti).One pilot study in Africa has demonstrated the effectiveness of Bti in reducing malaria morbidity

(Fillinger, et al. 2009). Gambia, Mauritius, Swaziland and India reported that Bti and environmental

management were deployed with variable success.

3. Implementation of Vector Control Strategies, Methods and Products

3.1 Vector control capacities at national level

37. Good infrastructure and preparedness planning are essential for rapid response and flexibility intargeting vector control measures, especially in epidemic-prone areas. As most malaria affectedcountries are in the control phase of the malaria elimination continuum, the scaling up of vector

control activities is required. These activities should be standardised in the country and co-ordinated

by the National Malaria Control Programme. At a national level, most countries have inadequate

human capacity and infrastructure for implementing evidence based vector control activities.

Furthermore, the collection and reporting of information for monitoring and quality assurance of

disease vector control programs needs further improvements. In-country institutional capacity to

educate and train skilled staff to create the necessary pool of expertise to capacitate national vector

borne disease control programs is also needed.

38. It is desirable that the national control programme is supported by a multi-stakeholder cross-sector

advisory group which provides oversight on policies, planning, financing and reporting. The advisory

group should consist of members from the national malaria control programs, especially medicalentomologists, national research institutes, key government sectors, local authorities, civil society,




19

WHO in country teams, the private sector, development partners and any interested

partner/stakeholders.

3.2 Insecticide resistance management

39. The reliance on indoor interventions (LLINs and IRS) for vector control has raised concerns about

insecticide resistance. A major concern is the widespread use of pyrethroids in agriculture and publichealth that could select for the mechanisms that confer resistance to pyrethroids and DDT (Chandre et

al . 1999; Hargreaves et al. 2000). Pyrethroids have been the insecticides of choice in almost all IRSoperations due to low mammalian toxicity and low cost, while 100% of all the LLINs used are

impregnated with pyrethroids. Resistance to pyrethroids therefore poses the greatest threat to malaria

control and could significantly reverse the gains so far made and result in resurgence of malaria in

areas where it has been reduced (Govere et al. 2002).

40. All of the eight DDT using countries reported that they conduct insecticide resistance monitoring

using the WHO susceptibility test. While the report indicated that mosquitoes tested were highly

susceptible (100% mortality) to DDT in South Africa, Swaziland, Gambia and Zambia with varying

results of susceptibility in Mauritius and Uganda, it is known that there is wide variability depending

on the location and species tested. Resistance to DDT was recorded in Eritrea (75% mortality in An.

arabiensis) and India (8-73% mortality in An. culicifacies). In the case of India, other malaria vectorssuch as An. minimus and An. dirus remain highly susceptible to DDT in addition to sand fly vectors of

leishmaniasis (Barma et al. 2004; Kent et al. 1999). The results in India and Eritrea show that on-

going resistance monitoring scheme is essential for insecticide selection.

41. The countries also recorded resistance to other insecticides, with pyrethroid resistance being

predominant in South Africa, India, Eritrea, Mauritius, Uganda and Zambia. No data was provided forSwaziland and Gambia. Resistance to carbamates was recorded in South Africa, Uganda and Zambia

while resistance to organophosphates was recorded in India, Uganda and Zambia. As has been

recognized all along, these results send a definite warning that the insecticides so much relied upon by

both agriculture and public health are at risk of being rendered potentially less effective for malaria

control.

42. Eritrea reported in 2012 (after the reporting period) that due to a decline in the efficacy of DDT to

below the threshold of 80%, the Ministry of Health has decided to switch to pyrethroids for IRS but

did not give the timeframe to do so. An. arabiensis showed resistance above 20% for permethrin 50%

EC and it can be expected that this resistance will increase when pyrethroids are used for IRS.

43. Uganda reported a switch to carbamates and Zambia also reported that it stopped using DDT in 2011

but in the report did not indicate whether it was due to resistance. However, both published reports

(Chanda et al. 2011) and unpublished results from the national programs indicated high levels of DDTand pyrethroid resistance in the local vector populations.

44. The national malaria control programmes need to monitor development of resistance at an early stage

so as to curtail its spread. However, insecticide resistance is not adequately addressed by programme

managers and at times the geographical spread of vector populations in their countries is poorly

understood. A case in point is the widespread resistance to DDT in Ethiopia (previously the longestand biggest user of DDT in Africa) that forced the country to switch to pyrethroids starting from 2009.

This highlights the need for entomological monitoring and surveillance of insecticide susceptibility

status of the local vector populations. This will allow early detection of resistance development and

provide evidence to guide decisions on vector control options. It is therefore critical that monitoring of behavioural and chemical resistance is in place in all countries using pesticides for vector control

(Donnelly et al. 2005).

45. PMI supports many of the IRS programmes in Africa and has invested in building capacity for

insecticide resistance monitoring. The WHO Global Malaria Programme has developed a Global Plan

for Insecticide Resistance Management in malaria vectors to guide countries in resistance management

(WHO, 2012a). Continuous monitoring for early signs of insecticide resistance and the adoption of

carefully considered resistance management strategies are therefore required.The key message to get

across is that countries should implement resistance management before the resistance arises. In manycountries this is already too late and resistance management strategies ought to be in place and

implemented.

46. A stakeholders meeting organized by IVCC in Paris in March 2012 brought together experts and

industries on the subject of fostering innovations in vector control (IVCC 2012a). The stakeholdersagreed to work together to develop innovative, effective and safe vector control tools and accelerate

bringing them to needy communities. They set for themselves an ambitious target of cutting down the




20

time from proof of concept to introduction of a new product in endemic countries by 30% while

maintaining the highest standards in terms of safety, efficacy and acceptability and promised to bring

such products into the market sooner rather than later.

3.3 Implementation of integrated vector management

47. In the past five years, some progress has been made by the WHO in the implementation of IVM in

several of its regions, especially in the Eastern Mediterranean, South East Asia and Africa. There are

five key elements of IVM that should be implemented so as to address all aspects of vector

management. These are; i) advocacy, social mobilization and legislation; ii) collaboration within thehealth sector and with other sectors; iii) integrated and multi-disease approach; iv) evidence based

decision making, and v) capacity building, with monitoring and evaluation cutting across all the

elements. IVM aims to improve the efficiency, cost-effectiveness and ecological soundness of vector

control interventions. In many of the countries transitioning to IVM, political commitment has led to

increased training on IVM principles and operational and structural arrangements within the ministries

of health. The Global Alliance for development and deployment of alternatives to DDT conducted a

global survey on the status of IVM implementation in order to assess capacity assistance needs (UNEP

2011). The survey found that most of the countries that claim to implement IVM did not fully

understand IVM principals and as such, recommended training in vector control needs assessment as

outlined in the WHO guidelines (WHO 2003) and the IVM core curriculum (WHO 2012b). Sudan,Rwanda, Kenya and Zambia are some of the very few countries in the African region that are

transitioning to IVM in accordance with the WHO framework (WHO 2004).

48. In the past decade, a number of countries previously using DDT have discontinued its use after thesuccessful elimination of malaria. Mexico is one of the case studies cited but other countries such as

Morocco that was certified malaria free in 2010 have adopted an IVM approach using alternatives toDDT to control leishmaniasis and prevent re-introduction of malaria. Elimination of malaria in these

countries should be a strong indicator of effective ways of reducing reliance on insecticides, including

DDT. Many of the countries currently using DDT are in low transmission settings and have set targets

for malaria elimination within the next 3 to 10 years. Other countries such as Ethiopia, Uganda and

Sudan stopped using DDT due to wide-spread resistance in mosquitoes and are in some cases using

more expensive carbamates and organophosphates while orientating towards an IVM approach.

4. Capacities for Countries to Transit from DDT to other Alternatives

4.1 Training tools and capacity for proper distribution and use of pesticides

49. The FAO International Code of Conduct on Pesticides Management (see

http://www.fao.org/docrep/meeting/026/mf070e.pdf ), which provides more information on pesticide

use, is being revised and a final version is expected at the 38th

FAO Conference in June 2013. Another

manual, a Public Health Pesticide Toolbox is being developed by the Public Health Pesticide Program

(IR-4 PHP) (http://www.zoomerang.com/survey/web22ghmghsv3l). PMI has also developed a “BestManagement Practices” for insecticides used in IRS (www.pmi.gov).

50. A Malaria Decision Support System (MDSS) tool on vector control was developed by the IVCC. The

tool is a computer package that collates data on disease incidence, vector populations (including

density and insecticide resistance) and intervention activities and presents this information in a web-

based, real-time geographical format (IVCC 2012b). However, the feasibility and suitability of this

tool in a vector borne disease endemic country needs to be assessed.

51. The Global Alliance of the Stockholm Convention was established to enhance implementation ofalternatives to DDT. The Alliance in collaboration with WHO has organized two regional meetings at

ICIPE, Kenya in 2010 and 2012 for African countries to transition to DDT alternatives. Key

recommendation of the meetings was to mobilize resources and encourage the countries to conduct

vector control needs assessment towards implementation of IVM as an evidence-based strategy for

vector control.

52. To facilitate the countries to adopt IVM for disease vector control, WHO has developed guidelines

that are available for countries. These are: Guidelines for vector control needs assessment (WHO

2003), IVM Core curriculum (WHO, 2012b), IVM Handbook (WHO, 2012c), IVM Policy guidance

(WHO, 2012d) and M&E indicators for IVM (WHO, 2012e).

4.2 National policies, guidelines and regulatory measures on DDT use

53.

All the 24 respondent countries indicated that they have national regulations on DDT and while themajority indicated that they have capacity to also conduct or assess quality control of DDT in their

http://www.fao.org/docrep/meeting/026/mf070e.pdf


http://www.zoomerang.com/survey/web22ghmghsv3l



http://www.pmi.gov/

http://www.pmi.gov/

http://www.pmi.gov/

http://www.pmi.gov/






21

countries, Eritrea and Swaziland indicated that they have no capability to do so. According to a survey

report by WHOPES, 16% of responding countries did not have legislation on pesticides and that 28-44% of the respondents lacked regulation on storage, transportation and disposal of pesticides (WHO,

2010a).

54. The Ministry of Agriculture in many countries is the sector responsible for regulating importation, use

and disposal of pesticides, including public health pesticides. It is apparent in most countries that both

the health ministry which is largely responsible for disease control and the environment ministry

responsible for regulatory issues have insufficient communication with the Ministry of Agriculture toharmonize regulations and pesticide management practices so as to minimize human and

environmental contamination.

4.3 Available funding opportunities for transition from DDT to alternatives

55. Most of the countries prioritize in their national implementation plan (NIP), the importance of capacity

building for pesticide management for disease vector control. The NIPs are the basis for which

assessment is made to solicit for UNEP/GEF funding (UNEP, 2010). The UNEP/GEF partnership

supports an international effort to promote alternatives to DDT. The opportunities available for the

countries in the African region include about US$ 15.5m to “Strengthen government and non-

governmental organizations to demonstrate and scale up diverse innovative interventions in the

framework of IVM” in 17 countries. Two other projects of US$ 980,000 and US$ 662,000 targeting a

total of 10 African countries aim at respectively, “Demonstrating sustainable non-chemical

alternatives for malaria control in the household environment” and “Cost-effectiveness of vector

management approaches to control malaria”. In the Asia-pacific region, India has a GEF funded

project of about US$ 1.7m to “Develop and promote non-chemical alternatives to DDT” whileAzerbaijan has US$ 999,000 earmarked for a project on “Demonstrating and scaling up sustainablealternatives to DDT for the control of vector borne diseases”. At the global level, WHO is executing aUS$ 1.0m GEF project on “Coordination and analysis for demonstrating and scaling up of sustainablealternatives (DSSA)”. These and other funding opportunities are available for countries to st rengthen

systems for disease vector control with alternatives to DDT.

4.4. The Global Alliance on alternatives to DDT

56. The Global Alliance with its four thematic areas and the WHO initiatives on IVM provide other

opportunities for countries to transition to DDT alternatives for disease vector control. Regional

consultations are held annually to identify needs and gaps for the countries to build capacity for

pesticides and DDT alternatives. The fourth meeting of the Interim Steering Committee of the Global

Alliance for the development and deployment of alternatives to DDT for disease vector control was

held at the ICIPE in Nairobi, Kenya, from 27 - 28 August, 2012. The meeting noted that despite the

success of malaria vector control over the past decades, insecticide resistance is one of the great

concerns for sustainability and recommended that resistance monitoring should be a key activity of the

disease control programmes as new and better insecticides are being developed for the market.

Enhanced capacity for public health entomologists, biologists and vector control professionals at all

levels is critical for data collection, species identification and susceptibility assays that are important in

designing control measures. The Nairobi meeting recommended that the Global Alliance should invite

the COP of the Stockholm Convention to mandate the Regional Centres to facilitate the harmonization

of the new chemicals and non-chemical processes approval mechanisms (UNEP 2012).

4.5 Evidence-based decision support tools for vector control

57. There is lack of capacity to conduct entomological monitoring in the African region or utilize the

collected evidence for decision-making on vector control. The lack of evidence on efficacy, feasibility

and cost-effectiveness of some of the vector control interventions hampers rational decision making.For example, some countries have used DDT and other insecticides, especially pyrethroids long after

insecticide resistance became a wide-spread problem. Likewise, other forms of vector control,

including larviciding or environmental management are conducted without adequate monitoring of

effectiveness. The establishment of entomological monitoring programs and reference laboratories will

help to strengthen resistance monitoring and evidence-based decision-making for disease vector

control.

58. Adequate capacity to define an operational research agenda and to conduct targeted research is critical

for the development and implementation of IVM and the assessment of viable alternatives to DDT.

Evidence on the effectiveness of alternatives for disease vector control programmes is critical, not only

for reducing reliance on DDT but also for effective reduction in disease transmission. The capacity to




22

assess the cost-effectiveness and impact of alternatives to DDT should also be available to national

disease control programmes.

59. Decision support systems (DSS) may be an appropriate approach of organizing and presenting

information to assist disease control managers in decision making. However, the implementation of a

DSS would require substantial GIS capacity and database development. There has been a lot of

emphasis in WHO documents that provide guidance and support to national vector control programmes. Probably the most highlighted example of a decision support tool used in controlling a

vector- borne disease is the WHO’s experience for over 25 years in the Onchocerciasis Control

Program (OCP) whose key to success was the use of a DSS which allowed users to project the diseasereduction impacts of different intervention strategies (Kim and Benton, 1995; WHO 2011).In addition,

a number of other national programmes, including South Africa and India have developed geographic

information systems and decision-support tools to help guide planning, implementation and evaluationof vector control measures (Coleman et al. 2006).

60. “Decision-making for the judicious use of insecticides” (WHO 2004a) is another tool that addresscost-effectiveness criteria in choosing the what, how, when, and where to apply insecticide-based

vector control interventions. Another tool that was recently developed through the support of the

UNEP/GEF is a Malaria Decision Analysis Support Tool (MDAST).This tool, combines scientific

knowledge about malaria transmission with economic and decision analysis principles in order to project the health, environmental and economic impacts of a given malaria intervention package

(Kramer et al. 2009). This approach is being implemented by Kenya, Uganda, Equatorial Guinea and

Tanzania to allow the governments to evaluate health, social and environmental impacts of diseases.

4.6 Availability and cost effectiveness of DDT and alternatives

61. Both the costs and the effectiveness of DDT are dependent on local settings and merit careful

consideration concerning alternative products or methods. The 5th

meeting of the Conference of the

Parties requested the POPRC to assess the alternatives to DDT in accordance with the general

guidance on considerations related to alternatives and substitutes. The POPRC assessment of the 11

WHO recommended alternatives to DDT reported that 10 insecticides3 were considered not likely to

meet all the Annex D criteria for persistence, bioaccumulation, toxicity and long range environmental

transport in a preliminary screening assessment. However, the POPRC considered bifenthrin might

meet all Annex D criteria but remained undetermined due to equivocal or insufficient data in a

preliminary screening assessment (POPRC Report, 2012).

62. In order to compare alternative vector control strategies using a cost-effective analysis, a commonmeasure of impact assessment must be adopted. For vector control interventions, defining such a

measure requires care, since the epidemiology of vector-borne diseases is complex. In cases where a

new intervention is being proposed, there may be inadequate resources or time to scientifically test the

impact of a given vector control intervention using the entomological indicators. For these situations, a

number of mathematical models have been developed to evaluate the predicted effectiveness of vector

control interventions, including IRS with DDT and pyrethroids and the distribution of LLINs (Chitniset al. 2010). These models are based on a number of peer-reviewed studies of malaria epidemiology

and the effectiveness of the widely used IRS and LLINs interventions.

4.7 Technology transfer and linkages with research and training institutions

63. Career development opportunities and regular training for vector control officers should be made

available in order to develop and maintain trained and experienced staff to address their local disease

problems. Collaboration between national vector borne disease control programs, universities andother research organizations is much needed. All the 24 respondent countries, except Lithuania,

indicated that they have training facilities for insecticide use and that they have established inter-

sectoral collaboration in disease vector control. Only a few responding countries have entomology

laboratories for vector resistance monitoring.

5. Actions Taken by Parties/Partners to Reduce Reliance on Use of

DDT

5.1 Polices, guidelines and initiatives to facilitate reducing production and/or use of DDT

3 Alpha-cypermethrin, cyfluthrin, lambda-cyhalothrin, deltamethrin, etofenprox, fenitrothion, malathion,

pirimiphos-methyl, bendiocarb and propoxur.




23

64. A number of initiatives have been set up by WHO and partners to improve malaria control including

judicious use of all approved insecticides (including DDT). These initiatives include advocating foruniversal coverage with LLINs, promoting effective diagnosis and treatment of all malaria cases,

promoting IVM as a sustainable approach to disease prevention and allowing countries to use DDT as

long as there is no viable alternative.

65. National legislation addressing the management and use of pesticides should strengthen the ability of

countries to promote the proper quality control and use of pesticides in both the public and private

sectors and to implement the Stockholm Convention including regulatory and other mechanisms toensure DDT use is restricted to disease vector control. Legislation should address the production, use,

and importation of pesticides and eliminate trade barriers (e.g. tariffs) that inhibit the importation of

public health pesticides and other vector control products. Key technical and management capacity is

needed at national level to support the translation of international best practices, policies and

guidelines on pesticide management and evidence based vector control into locally appropriate programmes with a focus on alternatives to DDT.

5.2 Case examples of successful malaria control

66. Case examples of countries that have used DDT to effectively control malaria are South Africa,

Morocco and Mauritius. Some countries such as Mauritius, Botswana, Senegal and Venezuela haveopted to keep DDT for emergency purposes. For the most part, those countries that stopped using

DDT in the past have done so either because they eradicated malaria, or because they were forced to

do so because of resistance in the vectors. While Morocco and Mauritius have successfully eradicatedmalaria in the recent past using DDT, Sri Lanka has replaced DDT with malathion in 1975 due to

resistance and successfully reduced malaria cases towards its elimination stage using alternatives toDDT including other control measures such as treated nets (WHO 2012f).

67. Rwanda, a landlocked country, has made significant achievements in reducing morbidity and mortality

due to malaria and is currently strategizing on the pre-elimination phase of malaria by adopting IVM

as the most viable sustainable method for malaria prevention. In 2012, Myanmar notified its

withdrawal from the DDT Register on acceptable purposes of the Stockholm Convention as they no

longer use DDT for disease vector control.

68. It should however be noted that apart from insecticide resistance, other variables such as climate

change and land use change may have extrinsic influence on vector populations and affect the

effectiveness of vector control interventions. In such cases, interventions such as case management

play a great role in reducing disease transmission.

5.3 Promotion of research and development of alternatives

69. The IVCC has ongoing research projects to develop novel insecticides to overcome resistance and

reduce application costs of insecticides as well as develop information systems and tools that allow

effective use of insecticides. A presentation to the DDT Expert Group by Dr. Robert Sloss of the

IVCC indicated that it is developing four promising active ingredients that could augment the currentclasses of insecticides for IRS but require further research before being ready for field testing. There is

also work on new longer-lasting formulations of existing active ingredients. For example, the

organophosphate pirimiphos-methyl CS is a long residual insecticide that is now being tested in

Ghana. Other commercial partners have developed a long residual deltamethrin WG for IRS, which is

now on the market. There is however a likelihood that some IRS products that are currently being

evaluated by WHOPES will be available soon. These are: alpha-cypermethrin WG by Tagros India,chlorfenapyr SC by BASF, France, pirimiphos-methyl CS by Syngenta, Switzerland and deltamethrin

SC by Bayer, France. On the horizon, there is ongoing research on the development of

entomopathogenic fungi, insect growth regulators, durable wall linings, toxic sugar baits and

insecticidal paints.

70. The Global Alliance and WHO are in contact with development partners to secure funding for research

on DDT alternatives. The Global Fund, UNEP/GEF, Bill and Melinda Gates Foundation, the US

Government, EU and IRD are some of the key donors that fund vector control and research.




24

5.4 Resource mobilization strategies for vector control

71. Collaboration with sectors such as agriculture, environment, energy and public works could ensure

that their activities do not result in increased vector densities and disease transmission. Although

successful experiences involving resource mobilization in public health programmes such as

HIV/AIDS exist, effective mobilization for disease vector control and in particular, search for

alternatives to DDT, is still a challenge in many countries. Since 2004, the main supporters of malariacontrol programmes have been the GFATM, the WHO, the Bill and Melinda Gates Foundation

(BMGF), the US and UK governments, and the World Bank. Most of these donors coordinate their

activities through the Roll Back Malaria (RBM) partnership and WHO.

72. An inter-departmental and inter-sectoral approach would coordinate effective vector control since

actions or inactions by other sectors may add to vector breeding sites, increasing vector populations

and hence increase malaria transmission. Inter-sectoral collaboration and public private partnerships

are encouraged as key elements of IVM and countries that are transitioning to DDT alternatives should

exploit this opportunity. As such, resource mobilization and cost-sharing by all the relevant in-country

sectors would gradually boost the available vector control funding and make the countries more

independent from external support.




25

Conclusions and Recommendations

Conclusions:1. In certain settings, there is a continued need for DDT for disease vector control in accordance

with WHO recommendations and guidelines on the use of DDT, until locally appropriate and

cost-effective alternatives are deployed for a sustainable transition away from DDT;

2. Increased capacity is needed for sound management of DDT, including obsolete stocks, inaccordance with international guidelines;

3. Within this reporting period of 2009-2011, the global trend of DDT production and use has

varied, with a decrease compared to previous years;

4. Long Lasting Insecticidal Nets (LLINs) is one of the effective alternative methods to Indoor

Residual Spray (IRS) in vector control programmes when optimum coverage, use and

effectiveness are achieved;

5. Insecticide resistance is one of the major threats to global malaria and leishmaniasis control

and elimination efforts;

6. There is a lack of new active ingredients with new modes of action and long lasting efficacy to

replace DDT;

7. A number of new formulations of insecticides, such as alpha-cypermethrin, pirimiphos-methyl

and deltamethrin, are in the WHO evaluation process and are potential alternatives to DDT;

8. Research is on-going on non-chemical alternatives, methods and strategies for disease vector

control but these are yet to be established as tools in disease vector control programmes;

9. Inadequate technical, managerial and institutional capacity exists:

a. to translate international policies, tools, best practices and guidelines on pesticidemanagement and alternatives to DDT based vector control into locally appropriate

programmes;

b. at national level, to implement disease vector control programmes including

monitoring, evaluation, entomological/ecological assessments and quality assurance to

assess the performance and impact of interventions and strategies;c. at national level, to conduct operational research for evidence-based decision-making

on disease vector control.

10. Funding opportunities will be available to build capacity in several vector borne disease

endemic countries to strengthen national capacity for innovative implementation of integrated

vector management:

11. The Global Alliance for development and deployment of alternatives to DDT serves as one ofthe important mechanisms for providing assistance to countries in strengthening their capacity

towards reducing reliance on DDT.




26

Recommendations:

1. The DDT Expert Group recognizes that there is a continued need for DDT in specific settings

for disease vector control where effective or safer alternatives are still lacking;

2. Where DDT use is continued, mechanisms should be in place to effectively ensure that DDT isused strictly within the WHO recommendations and guidelines for disease vector control;

3. The use of DDT in IRS should be limited only to the most appropriate situations based on

operational feasibility, epidemiological impact of disease transmission, entomological data and

insecticide resistance management;

4. Countries and partners should be encouraged to evaluate new insecticide formulations as

suitable alternatives to DDT in IRS;

5. Countries should undertake further research and implementation of non-chemical methods and

strategies for disease vector control to supplement reduced reliance on DDT;

6. Funding should be made available to support countries to transition away from the reliance on

DDT for disease vector control, with the highest priority to assure that adequate systems and

institutional capacity are in place to train and support skilled staff for entomologicalmonitoring, operational research, evidence-based decision-making and to monitor programme

performance;

7. Funding should be made available to increase the national policy and management capacity for

translating international best practices on disease vector control and implementing quality

assurance systems to assess programme performance and impact;

8. The Secretariat of the Stockholm Convention should continue to facilitate activities onstrengthening capacity to transition away from the reliance on DDT for disease vector control.




27

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Documents

Stockholm Convention on Pops - 2012 Report of the Expert Group on the Assessment of the Production and Use of Ddt and Its Alternatives for Disease Vector Control