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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1 Distr.: General 20 December 2012 SC Stockholm Convention on Persistent Organic Pollutants 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 may need 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 II. Opening 3. The fourth meeting of the DDT expert group on the assessment of the production and use of DDT and its alternatives for disease vector control was held at the International Environment House, Geneva from 3 to 5 December, 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

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 assuring enhanced 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 DDT was 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 towards developing 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 global economic 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 from UNEP 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 WHO guidelines 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 2

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 DDT questionnaire 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 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 of DDT 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 DDT Risk 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 in dealing 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 disease and vector management framework with due consideration on community ownership was the consensus 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 was sent 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 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 the draft 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 is attached 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. 3

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 Commercial Organization / Ministry of Nature Protection 46 Charents Street 0025 Yerevan Armenia Tel.: +374 (94) Fax: +374 (10) khachart7@yahoo.com AUSTRALIA Mr. Gary Fan Senior Policy Officer Agricultural and Veterinary Chemicals Section Department of Agriculture, Fisheries and Forestry GPO Box Canberra Australia Tel.: +61 (2) Fax: +61 (2) gary.fan@daff.gov.au CHINA Dr. Qi Gao Professor and Director Jiangsu Institute of Parasitic Diseases (JIPD) Meiyuan Wuxi Jiangsu China Tel.: +86 (510) Fax: +86 (510) gaoqi54@hotmail.com DEMOCRATIC REPUBLIC OF CONGO Dr. José Okond Ahoka Professeur Faculté de Médecine Vétérinaire Université Pédagogique Nationale 134 Avenue de la Révolution c/ Ngaliema - VPN, B.P Kinshasa Democratic Republic of Congo Tel.: +243 (81) Fax: +243 (81) jose.okondahoka@upn.ac.cd FRANCE Mr. Antoine Schwoerer Policy Advisor General Directorate for Risk Prevention Ministry of Ecology Arche-Paroi Nord CEDEX La defense Paris France Tel.: +33 (1) Fax: +33 (1) antoine.schwoerer@developpementdurable.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 Delhi India Tel.: +91 (11) Fax: +91 (11) dr.kaushalk@yahoo.com 4

5 SOUTH AFRICA Dr.. Rajendra Maharaj Professor and Director Medical Research Unit Medical Research Council P.O. Box Overport South Africa Tel.: +27 (31) Fax: +27 (31) 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 Atlanta United States of America Tel.: +1 (404) Fax: +1 (404) rwirtz@cdc.gov Dr.(Ms.) Maureen Coetzee Professor Malaria Entomology Research Unit University of the Witwatersrand P.O. Box Honeydew South Africa Tel.: +27 (11) Fax: +27 (11) maureenc@nicd.ac.za maureen.coetzee@wits.ac.za Secretariat Selected Members Dr. John Ichamwenge Githure Scientist Malaria Division Ministry of Health P.O. Box 6201 Kigali Rwanda Tel.: +250 (78) Fax: jgithure@gmail.com Dr. Flemming Konradsen Professor International Health Section / Department of International Health, Immunology and Microbiology University of Copenhagen Øster Farimagsgade 5, Building 9 P.O. Box Copenhagen K Denmark Tel.: +45 (35) Fax: +45 (35) hain@sund.ku.dk 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 Delhi India Tel.: +91 (11) Fax: +91 (11) ranjandersharma@gmail.com 5

6 Other Agencies WORLD HEALTH ORGANIZATION Dr.(Ms.) Carolyn Vickers Team Leader, Chemical Safety Department of Public Health and Environment World Health Organization (WHO) Avenue Appia Geneva Switzerland Tel.: +41 (22) Fax: +41 (22) Dr. Michael Macdonald Consultant Global Malaria Programme / Vector Control Unit World Health Organization (WHO) 22 Avenue Appia 1211 Geneva Switzerland Tel.: Fax: macdonaldm@who.int 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 Chemins des Anémones 1219 Châtelaine (Geneva) Switzerland Tel.: +41 (22) Fax: dcooper@pops.int dcooper@pic.int 6

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 2013 Geneva 7

8 Acronyms and Abbreviations COP DDT DSS EC EU FAO GEF GFATM IRS IRD IVCC IVM LLINs MOH NIPs PMI PHP POP POPRC UNEP USAID WHOPES WP Conference of the Parties Dichloro-diphenyl-trichloroethane Decision support system Emulsifiable concentrate European Union Food and Agricultural Organization Global Environment Facility Global Fund to Fight AIDS, Tuberculosis and Malaria Indoor residual spraying Institute for Research and Development, France Innovative vector control consortium Integrated vector management Long-lasting insecticidal nets Ministry of Health National implementation plans President s Malaria Initiative Public health pesticides Persistent Organic Pollutants Persistent Organic Pollutants Review Committee United Nations Environment Programme United States Agency for International Development World Health Organization Pesticide Evaluation Scheme Wettable powder 8

9 Contents INTRODUCTION SITUATION ANALYSIS OF THE PRODUCTION AND USE OF DDT Sources and amounts of DDT production and distribution in Trends in DDT use Key programmes and initiatives where DDT is used for vector control Existing mechanisms on purchase, quality control and use of DDT Hazards related to misuse and environmental contamination Stockpiles of DDT AVAILABILITY, SUITABILITY AND IMPLEMENTATION OF ALTERNATIVES TO DDT Assessment of the strategies to reduce reliance on DDT and progress of introducing new alternative vector control products Assessment of other chemical and non-chemical products and methods used for vector control IMPLEMENTATION OF VECTOR CONTROL STRATEGIES, METHODS AND PRODUCTS Vector control capacities at national level Insecticide resistance management Implementation of integrated vector management CAPACITIES FOR COUNTRIES TO TRANSIT FROM DDT TO OTHER ALTERNATIVES Training tools and capacity for proper distribution and use of pesticides National policies, guidelines and regulatory measures on DDT use Available funding opportunities for transition from DDT to alternatives The Global Alliance on alternatives to DDT Evidence-based decision support tools for vector control Availability and cost effectiveness of DDT and alternatives Technology transfer and linkages with research and training institutions ACTION TAKEN BY PARTIES/PARTNERS TO REDUCE RELIANCE ON USE OF DDT Polices, guidelines and initiatives to facilitate reducing production and/or use of DDT Case examples of successful malaria control Promotion of research and development of alternatives Resource mobilization strategies for vector control CONCLUSIONS AND RECOMMENDATIONS REFERENCES

10 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 continued need 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-3/2 1, 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 safe fashion 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) (ii) (iii) (iv) Development of regulatory and other mechanisms to ensure that DDT use is restricted to disease vector control; Implementation of suitable alternative products, methods and strategies including resistance management strategies to ensure the continuing effectiveness of such alternatives; Measures to strengthen health care and to reduce the incidence of the disease being controlled with DDT; Promotion of research and development of safe alternative chemical and nonchemical 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 risks and 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 in the 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 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). 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) has recommended 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. 10

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 document UNEP/POPS/POPRC.8/INF/30, the fact sheets on the chemical alternatives are presented in UNEP/POPS/POPRC.8/INF/ 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 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, s 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) (b) (c) (d) (e) Situation analysis of the production and use of DDT; Availability, suitability and implementation of alternatives to DDT; Implementation of vector control products, methods and strategies; Capacities for countries to transit from DDT to other alternatives for vector control; Action taken by Parties/Partners to reduce reliance on use of DDT for vector control. 2 UNEP/POPS/POPRC.5/10/Add.1. 11

12 1. Situation Analysis of the Production and Use of DDT 1.1 Sources and amounts of DDT production and distribution in DDT Questionnaire 9. Paragraph 4 of Part II, Annex B of the Convention requires, every three years, Parties registered for acceptable 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 with the 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 (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 ( ) Gambia, which has not notified the DDT Register 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 Category Parties Status of use Parties that have notified the Register on DDT use India Eritrea Zambia Swaziland South Africa Mozambique Mauritius Ethiopia Yemen Morocco Madagascar Uganda Botswana China Marshall Islands Namibia Senegal Venezuela Reported use 1 Reported use 1 Reported use 1 Reported use 1 Reported use 1 Reported use 1 Reported use 1 Reported no use 1 Reported no use 1 Reported no use 1 Reported no use 1 Reported no use 1 No information reported No information reported No information reported No information reported No information reported No information reported Parties that use DDT but have not yet notified Gambia Reported use 1 the Register Submitted but not on DDT Register Bahrain Reported no use 1 1 As reported in the DDT Questionnaire Jordan Reported no use 1 Argentina Reported no use 1 Mexico Reported no use 1 Albania Reported no use 1 Lithuania Reported no use 1 Rwanda Reported no use 1 Cambodia Reported no use 1 Seychelles Reported no use 1 Monaco Reported no use 1 12

13 Global production 11. The information provided in the questionnaires showed that the total global production of DDT during the reporting period ( ) 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 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 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 tonnes. It has also received tonnes of DDT 75% WP from India in South Africa was the only country reported to formulate and package DDT. In 2009, it formulated and packaged tonnes of DDT 75% WP and exported tonnes to Zambia, 100 tonnes to Namibia, tonnes to Swaziland and 0.60 tonnes to Botswana. 13

14 Table 3. Amounts of DDT exports Source Destination Year Amount of 75% WP (tonnes) India (Hindustan Insecticide Ltd) Mozambique Total Gambia Total Namibia Total South Africa (AVIMA Ltd) Zambia Total Namibia Trends in DDT use Swaziland Total Total Botswana Total According to the country responses for the reporting period , 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 ( 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 showed that 82% of DDT 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, tonnes of active ingredient of DDT was used for disease vector control mainly for malaria and leishmaniasis vectors during the three-year reporting period ( ). 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. 14

15 Table 4. Amount of DDT used by countries during the reporting cycle Country Year Amount of formulated material used (tonnes ) Annual India ,830.00* Reporting cycle 95% DDT technical grade equivalent amounts (tonnes) ,694.00* ,446.00* 19,970.00* Eritrea Zambia Mauritius Swaziland South Africa Gambia Mozambique Grand total 20, * 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 by leishmaniasis 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 resistance monitoring. 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-efficacy verifications. For countries where facilities are inadequate to undertake product quality assurance of 15

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 purchase requirements 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 and Environment ministries. 21. The WHO recently updated the 2001 Joint FAO/WHO meeting report on Pesticide Residue on human health 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 of the 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 secure dedicated 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. In addition there may be other countries not reporting in the DDT questionnaire that may have significant stockpiles 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 have already 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 socioeconomic 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 and integrated approaches to vector control.

17 26. IVM, defined as a rational decision making process 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 - ( 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 that could 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 as alternatives 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 accelerated development 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 vector control 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 on DDT 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 different formulations 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 (lambdacyhalothrin-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 universal coverage 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 17

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 have now 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) and insecticidal 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 biological control, 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 environmental management 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 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 in targeting vector control measures, especially in epidemic-prone areas. As most malaria affected countries 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 medical entomologists, 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 public health 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 IRS operations 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 vectors such 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 ongoing 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 for Swaziland 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 DDT and 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 longest and biggest user of DDT in Africa) that forced the country to switch to pyrethroids starting from 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 many countries 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 stakeholders agreed 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 19