Every day Dr. Lizette du Plessis, one of three doctors at the company clinic of Mozal, the state of the art aluminum smelter near Maputo in Mozambique, treats staff with malaria. Mozal’s doctors diagnose 10 cases every day and 10 people a week are evacuated for emergency treatment. Since construction began in 1998, there have been 10 deaths in the expatriate community (deaths of locals are unavailable). Since there have been over 3,400 ex-pat cases (and 3,200 local cases) in that time, more deaths would be expected. In fact, the health of the Mozal workforce is just one of the remarkable successes of this project, which is rightly taking its place as a template of how to structure projects in poor countries. Harvard Business School has even made a case study of Mozal, which began operations in June, six months ahead of schedule.
And last week it was officially opened by the Mozambican premier, Joachin Chissano. But the success and future of this project, and many others, hinges on reducing the threat from resurging tropical diseases, especially malaria. Its hard to keep expert staff from Western countries in a location where they and their families are at serious risk from malaria. And without these expatriates, investment and everything that comes with it vanishes. But far from helping, the developed world is about to reduce the weapons that combat malaria, most notably by banning the pesticide that environmentalists love to hate -- dichlordiphenyltrichlorethane, or DDT. Western agencies have been opposed to DDT use for decades because they mistakenly believe that DDT in low doses is dangerous to humans and the environment. True, DDT harms wildlife when used in massive quantities (such as on U.S. cotton farms in the 1950s). But when sprayed indoors there is no evidence of any harm to humans or environment. Nevertheless, the United Nations Environment Program is proposing that uses of DDT, which according to the U.S. National Academy of Sciences has saved “over 500 million lives from malaria,” should be heavily restricted under a treaty to be agreed in December in South Africa. For Mozambique, this treaty could slow, or even stop, foreign investment -- a disaster in a country that has already suffered so much.
‘Most Important Project’
The Mozal aluminum smelter is obviously vital. According to Sergio Macamo, of the Mozambican Ministry of Industry and Commerce, the Mozal smelter is “the most important project in Mozambique’s recent history.” Investment (equity and debt) of $1.3 billion, has come from international sources including Mitsubishi, the Investment Finance Corporation, the Mozambican Government and the South Africa Industrial Development Corporation. But 47% of the investment, and all the management, has come from the London-based mining group, Billiton. These investors, and especially the experts at Billiton, knew that they had to overcome numerous problems for the Mozal project to succeed. Infrastructure in Mozambique, one of the poorest countries of the world, is fragile and limited because of nearly two decades of civil war that ended in 1992. For example, the smelter alone will increase the power requirements of the whole country by 200%, and the existing harbor is hard-pressed to accommodate the number and size of ships that would bring the refined alumina to, and aluminum from, the smelter. Yet new, rapidly built power lines are bringing the electricity from the South African grid, and the harbor problem is being resolved by the construction of a new terminal and privatization to the British Mersey Docks company. One problem they anticipated, but Mozal Chairman Rob Barbour admits they underestimated, was the danger from malaria. The most dangerous form of malarial parasite, plasmodium falciparum, is carried in the blood of 80% of the locals. They can work when infected, but productivity is naturally much lower. For the expatriates (mainly British or South Africans), who have never built up tolerance to the parasite, working is impossible. The Mozal and Billiton Management therefore had to prevent the workforce from encountering the anopheles funestus mosquito, the main vector of malaria. Preventing the mosquito from reaching humans is the most important part of any anti-malaria strategy since workers cannot take anti-malarial prophylactic drugs for more than a few months without the likelihood of side effects. Billiton employed South African entomology expert Graham Kloke to solve the problem, as he had done at other locations, including Billiton’s sister smelter, at Hillside, Richard’s Bay, in South Africa. Mozal established a cordon sanitaire of one mile around the plant by spraying inside buildings with the synthetic pyrethroid pesticide, Deltamethrin, and applying organophosphate pesticides to mosquito breeding areas. This proved successful enough to reduce the number of mosquitoes reaching the plant to about 7% of normal concentration. Inside the plant’s tall buildings they use innovative spraying techniques that send pesticide in ultralow volumes over 20 meters, eliminating all mosquitoes. Yet the malaria problem persists and is worsening. The funestus mosquito is becoming resistant to Deltamethrin, and as the smelter will operate 24 hours a day, those working the night shift will be at risk if mosquitoes are not killed in the smelter buildings. This problem was resolved in South Africa by DDT spraying, which was opposed by green pressure groups because of the historic environmental problems of DDT. The spraying at Billiton’s Hillside smelter was overseen by toxicity expert, Gerhard Verdooren of the South African Endangered Wildlife Trust, to ensure that Hillside, like the rest of South African spraying operations, followed international guidelines. According to Danette Lombard of South Africa’s Department of Health, the quantities of DDT used are very low compared with those that caused problems in the past, and they also are sprayed only inside buildings, so there is unlikely to be any environmental harm from its use. And spraying is essential because malaria cases have increased 300% in the past two years. But Mozambique may not follow South Africa’s example, even though resistance to Deltamethrin is being observed. Western donor agencies have pressured developing countries such as Belize and Madagascar into not using DDT for malaria control, even though alternatives were much more expensive and less effective. Dr. Samuel Mabunda, head of Mozambique’s malaria-control program, claims that similar pressure has been applied to Mozambique. Given that their entire health budget is provided by donor agencies such as Unicef, WHO and the Swedish Government, they have to listen. This pressure, based on Western environmentalist sentiment and not on sound scientific knowledge, has undoubtedly killed thousands of Africans. So far the aid agencies have escaped blame since Dr. Mabunda, and his counterparts in other countries, are not likely to name names.
Thousands of Lives
But the costs of not resolving the malaria problem in Africa could be enormous. Jeffrey Sachs, Director of Harvard’s Center for International Development, estimates that the cost of malaria to African countries is at least 1% of domestic growth. Richard Tren of the South Africa pro-DDT pressure group, Africa Fighting Malaria, claims that not using DDT could cost hundreds of millions of dollars and thousands of lives a year in Southern Africa alone. For Billiton it may be the difference between doubling the plant’s capacity in 2002 or not. “We must resolve the problem, and I’m sure we will,” says Mr. Barbour. For the locals around Maputo, the opportunity cost of failure to control malaria could include this $800 million dollar investment and its 1,000 permanent jobs. What is certain is that tourists are reluctant to travel to malarial areas, and, as the Mozambican economy is increasingly dependent on tourism, the impact on an economy struggling to rebuild itself after February’s floods will be very severe. Donor agencies and the UNEP should beware of denying Africans DDT -- it will kill thousands and delay development. But given that African health officials are unlikely to risk losing aid money by speaking out, and that the left-leaning media cannot bare to say anything positive about DDT, they will probably get away with it.
Thursday, October 5, 2000
Op-Ed in WSJ Europe