Why the World Needs Help

The year 2000 was a time of plague for the South African town of Ndumo, on the border of Mozambique. That March, while the world was focused on AIDS, more than 7,000 people came to the local health clinic with malaria. The South African Defense Force was called in, and soldiers set up tents outside the clinic to treat the sick. At the district hospital 30 miles away in Mosvold, the wards filled with patients suffering with the headache, weakness and fever of malaria -- 2,303 patients that month. ''I thought we were going to get buried in malaria,'' said Hervey Vaughan Williams, the hospital's medical manager.

Today, malaria has all but vanished in Ndumo. In March 2003, the clinic treated nine malaria cases; Mosvold Hospital, only three.

As malaria surges once again in Africa, victories are few. But South Africa is beating the disease with a simple remedy: spraying the inside walls of houses in affected regions once a year. Several insecticides can be used, but South Africa has chosen the most effective one. It lasts twice as long as the alternatives. It repels mosquitoes in addition to killing them, which delays the onset of pesticide-resistance. It costs a quarter as much as the next cheapest insecticide. It is DDT.

KwaZulu-Natal, the province of South Africa where Ndumo and Mosvold are located, sprayed with DDT until 1996, then stopped, in part under pressure from other nations, and switched to another insecticide. But mosquitoes proved to be resistant to the new insecticide, and malaria cases soared. Since DDT was brought back in 2000, malaria is once again under control. To South Africans, DDT is their best defense against a killer disease.

To Americans, DDT is simply a killer. Ask Americans over 40 to name the most dangerous chemical they know, and chances are that they will say DDT. Dichloro-diphenyl-trichloroethane was banned in the United States in 1972. The chemical was once sprayed in huge quantities over cities and fields of cotton and other crops. Its persistence in the ecosystem, where it builds up to kill birds and fish, has become a symbol of the dangers of playing God with nature, an icon of human arrogance. Countries throughout the world have signed a treaty promising to phase out its use.

Yet what really merits outrage about DDT today is not that South Africa still uses it, as do about five other countries for routine malaria control and about 10 more for emergencies. It is that dozens more do not. Malaria is a disease Westerners no longer have to think about. Independent malariologists believe it kills two million people a year, mainly children under 5 and 90 percent of them in Africa. Until it was overtaken by AIDS in 1999, it was Africa's leading killer. One in 20 African children dies of malaria, and many of those who survive are brain-damaged. Each