Every three years, Parties that produce or use DDT are obliged to report the conditions of such use to the Secretariat using a DDT questionnaire that was adopted by the COP. Assessment of scientific, technical, environmental and economic information related to DDT and a report is provided to the COP with recommendations so that they are able to evaluate the continued need for DDT for disease vector control. Since a range of countries are still using DDT the compilation of information on DDT alternatives and integrated vector control approaches are important to communicate.
By its decision SC-5/6 on DDT, the COP requested the POPRC, beginning at its eighth meeting, to assess the alternatives to DDT in accordance with the general guidance on considerations related to alternatives and substitutes for listed persistent organic pollutants and candidate chemicals on the basis of factual information provided by Parties and observers.
An ad hoc working group on assessment of alternatives to Endosulfan and DDT was constituted under the POPs Review Committee of the Stockholm Convention. This working group prepared in July 2012 the report on the assessment of chemical alternatives to endosulfan and DDT.
The insecticides recommended by the World Health Organization for disease vector control in indoor residual spraying as alternatives to DDT were assessed for persistent organic pollutant characteristics and other hazard endpoints.
A total of 11 chemical alternatives to DDT, of which 9 were also possible alternatives to endosulfan, were assessed for persistent organic pollutant properties and other hazard indicators. The outcome of the assessment of the alternatives to DDT and of the alternatives to endosulfan is presented in annex IV to the report. In summary, the alternatives were classified as follows:
It is important to note that the assessment of the persistent organic pollutant characteristics and other hazard indicators of the alternatives should not be seen as a comprehensive and detailed assessment of all available information, because only a limited number of databases have been consulted, as indicated in section III of the report. In addition, substances that are not likely to be considered as persistent organic pollutants in the report, on the basis of the numerical criteria in Annex D, might still exhibit hazardous characteristics that should be assessed by Parties before considering such substances as a suitable alternative. Furthermore degradation products have not been considered in the assessment.
Work/report UNEP global alliance for DDT alternatives - chemical alternatives
As presented in the 2012 report of the Expert Group on the Assessment of the Production and Use of DDT and its Alternatives for Disease Vector Control, 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 socio-economic settings.
According to the report, there is in some countries 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.
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.
Insecticide resistance is one of the major threats to global malaria and leishmaniasis control and elimination efforts. There is a lack of new active ingredients with new modes of action and long lasting efficacy to replace DDT.
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. 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.
Inadequate technical, managerial and institutional capacity exists to translate international policies, tools, best practices and guidelines on pesticide management and alternatives to DDT based vector control into locally appropriate programmes.
The Global Alliance for development and deployment of alternatives to DDT serves as one of the important mechanisms for providing assistance to countries in strengthening their capacity towards reducing reliance on DDT.
An “Overview on the global status of DDT and its alternatives for use in vector control to prevent disease” has been prepared as background document for the preparation of the business plan for a global alliance giving an overview on chemical and non-chemical methods for malaria vector control (Table 17).
The publication emphasize that for an integrated approach to malaria control a broadened scope of malaria control would cover a wider set of determinants of disease, some outside the working domain of the health sector thus calling for inter-sector collaboration. Various studies have demonstrated that integration and localized targeting of vector control methods resulted in significant reductions in transmission and morbidity rates of malaria.
Table 17: Alternative methods for malaria vector control, indicating the targeted vector stage, the potential risk, and required resources and delivery mechanisms (UNEP 2008)
A guidance document for a “Framework for strengthening Integrated Vector Management in malaria control programmes” has been published by the Pesticide Action Network (PAN et al. 2013).
The document presents a decision making framework to assist malaria control programme funders achieve a significant reduction in malaria morbidity and mortality through cost-effective, ecologically sound and sustainable Integrated Vector Management (IVM) interventions. The framework is a toolto assess whether new and on-going malaria project applications incorporate least toxic, effective and participatory disease control measures and focuses particularly on three key elements of a holistic IVM strategy (PAN et al. 2013).:
a) evidence-based decision making at community level by community members;
b) social mobilization to support communities becoming primary stakeholders in IVM;
c) use of non-chemical approaches to vector control within community-guided IVM.
The framework presents questions that funders can request applicants to respond to and is based onliterature from disease control programme planning and incorporates lessons from on-the-ground activities that adopt sustainable IVM-based controls (PAN et al. 2013).
In 2008, UNEP, together with WHO and GEF has launched the Global Programme “Demonstrating and Scaling-up of Sustainable Alternatives to DDT in Vector Management (Global DSSA Programme)”. The Global Programme aims at the protection of human health and the environment through the reduction of emission of DDT into the global environment by means of decreasing the use of DDT through introduction, demonstration and scaling-up of sustainable alternatives to DDT in disease vector management, for example for malaria (UNEP 2008) .
For Africa, 5 projects including 18 countries will be involved. The Global Programme aims in a yearly reduction of DDT application in vector management of about 4000 tonnes by the end of the Programme period (2014).
According to this programme one global project was implemented and three regional projects are under the implementation, out of which one in Africa region, one in Middle East and Africa regions and one in Southern Caucasus and Central Asia region
The Africa and Middle East regional project, with September 2013 as end date, is the project “Demonstration of Sustainable Alternatives to DDT and strengthening of National Vector control Capabilities in Middle East and North Africa“. The participating countries are Djibouti, Egypt, Jordan, Morocco, Islamic Republic of Iran, Sudan, Syria, Yemen. The overall development objective of the project is the reduction of DDT use and avoiding the use of DDT in future as well as the sound management of DDT stocks through strengthening of malaria vector control practices in 8 project countries. The project objective is to demonstrate cost effective, environmentally sound, and locally appropriate alternatives to DDT use in malaria control, ensuring their sustainable application through strengthened national and local capacity as well as sustainable management of POPs stocks.
The Africa’s regional project, which is currently under implementation, is “Demonstrating Cost-effectiveness and Sustainability of Environmentally Sound and Locally Appropriate Alternatives to DDT for Malaria Vector Control in Africa” project. The project started in 2009 and will run until 2014 having as participating countries Ethiopia, Eritrea and Madagascar. This project will demonstrate cost-effective, environmentally sound, and locally appropriate alternatives to DDT for malaria vector control, ensuring their sustainable use through strengthened national and local capacity for malaria control. The project strategy is to enhance the capacity of the participating countries to effectively plan, implement, monitor and evaluate vector control interventions, which are not relying on DDT. The project activities will be implemented in a number of demonstration districts in the three project countries. In this project the following alternatives to DDT will be demonstrated based on the Integrated Vector Management (IVM) approach: - Residual house spraying with insecticides alternative to DDT; - Insecticide Treated Nets (ITNs); - Environmental management (including management of groundwater, irrigation schemes, dams, roads and building construction); and Mosquito larviciding.
The Southern Caucasus and Central Asia regional project, called “Demonstrating and Scaling Up Sustainable Alternatives to DDT for the control of vector borne diseases in Southern Caucasus and Central Asia“, is currently under implementation, having as end date December 2014. The participating countries within the project are Georgia, Tajikistan, Kyrgyzstan. The long-term developmental objective of the project is to reduce potential threads from POPs to humans and to the environment. The project objective is to eliminate the possibility to apply DDT in vector management without increasing the occurrence of Vector Borne Diseases, while at the same time to promote appropriate vector control management practices through strengthened capacities of countries and to sustain scaled-up implementation of environmentally sound alternatives.
The 2nd extended edition of the “Environmental strategies to replace DDT and control malaria” concluded that new low-risk insecticides, drugs and vaccines are not likely to become available in the near future, and consequently alternative approaches have to be strengthened. The report emphasizes and describe that a broad range of non-chemical malaria control approaches are known to be effective. These vary from multiple malaria control interventions, which relied strongly on environmental management strategies (Zambia) to bioenvironmental malaria control (Kenya, Sri Lanka and India).
The report stresses that successful switching to alternatives should be accompanied by community participation, awareness raising, surveillance, decentralization, local capacity building, inter-sectoral collaboration, improvement of public health system, income generation, involvement of civil society organizations, support by local research and regional cooperation.
The publication on “Phasing in Alternatives to DDT” presents examples of success stories in controlling malaria without DDT from Asia (Sri Lanka and Vietnam), Africa (Kenya) and Latin America (Mexico) and synthesizes the available alternatives to DDT including environmental management, non-chemical personal protection, and biological control.
The PAN publication “Combating Malaria without DDT: An ecosystem and community approach in Beer, Senegal”, presents the results of the pilot project to raise awareness of the causes of malaria and initiate non-chemical methods and activities for its prevention.
Biovision Foundation, recipient of the “Alternative Nobel Prize” in 2013, is funding a comprehensive malaria programme which is implemented by icipe and Kemri. The program promotes and supports the implementation of Integrated Vector Management (IVM) at community and district level at 3 sites in Ethiopia and Kenya ., and currently runs research on the different components effectiveness on larvae and mosquito reduction and hence malaria control. As insecticide treated bed nets are distributed and IRS carried out regularly through the ministry of health, the contribution of the programme lies in entomological surveillance, environmental management of breeding sites and biological larviciding with Bacillus thuringiensis israelensis (bti) . Research and formulations on new local biopesticides such as neem oil is ongoing and is being tested in field trials.
The effectiveness and importance of biological larvae control alongside other IVM tools has been observed at different project sites with a significant reduction in the vector. Community based organizations and health officers are trained in detecting, eliminating and monitoring breeding sites by covering up open water sources and eliminate littering, reclamation of land, stocking of fish ponds and applying bti to open water bodies such as swimming pools in touristic areas or large water bodies in the community environment with the effect of reducing larvae and adults mosquitos drastically. As the challenge of these methods lies in its labor intensive activities, linkages of environmental management and larviciding activities with income generating activities at community level as well as up-taking of these regular activities through the public health system are crucial.
 Kibe LW. et al. (2006) Community based vector control in Malindi, Kenya, African Health Sciences 6(4): 240-247.
 Tusting LS et al. (2013), Mosquito larval source management for controlling malaria (Review), The Cochrane Library 2013, Issue 8.
WHO developed a “Training module on malaria control: Entomology and vector control” to improve the knowledge and skills of entomologists and vector control staff as well as of managers/senior health officers involved in malaria vector control at programme level.
The module consists of two parts, the Guide for participants and the Guide for tutors, and provides guidance on relevant aspects of malaria entomology and vector control including identification and sampling of malaria vectors, incrimination of malaria vectors, selection between different vector control options, and monitoring and management of insecticide resistance.
The tool offers to a limited extent training on the non-chemicals alternatives but does not include yet training on a framework for strengthening the IVM in malaria control and related alternatives (WHO 2013).