Most of our preoccupations arise from the modern paradox: while our longevity, health and environment has never been better, we spend more time than ever before worrying about all three. Classic concerns are the various scares—alar, saccharine, breast implants, passive smoking, nuclear power, pesticide residues, children’s vaccines—and more recently, mobile phones, genetically modified foods and global warming. In some of these cases, the concern was completely invalid, in others the scare was blown out of all proportion. Some of the books that I and colleagues have edited over the past four years have been an attempt to expose these falsehoods or exaggerations. But while these scares cost a lot in terms of money and some lives, the prime point of my talk is to point out the extreme harm that our preoccupations in the west have upon the poorest people of the world.

One might think that the less developed countries (LDCs) in the world would not be worried about our preoccupations, such as potential cancer from overhead power-lines, when lack of electricity (for refrigeration of food and medicines, and lighting for education) is a far greater problem. But this isn’t necessarily the case. For example, it’s instructive to see analysis of risk issues in France and the francophone African State of Burkina Faso. The medical, environmental, geographical and political problems of Burkina Faso are radically different from those in France, yet in a study of responses to questions of risk, intellectuals in Burkina Faso and students in France gave markedly similar answers. In fact, intellectuals in Burkina Faso had ‘borrowed’ concerns relevant only to France, and these opinions were reflected in the media.

Why this happens is not properly established, but it appears that media coverage in LDCs is generally likely to follow press coverage from powerful trading partners (such as the USA), or former colonial powers (such as France or Britain). It is also probable that intellectuals and political elites in poorer countries have been educated at western universities and share western concerns. Furthermore, given that in LDCs tertiary educated people are rare, it is likely that the educated are the ones writing the news. (Also, donor agencies frequently fund projects that reflect their priorities back home and not necessarily what is required in the LDC’s, for example seatbelt campaigns in countries that have hardly any cars.) But even where local media address local problems, the solutions proposed will often be driven by western concerns, which may be inappropriate to local conditions.

Where third world leaders do act differently, they often face an unwritten consensus, a tacit international agreement about the ‘correct’ way to deal with an issue, in what is known in the jargon as a ‘status marker’ of opinion. Recent examples include: South African President Thabo Mbeki’s stance on AIDS, Chinese officials’ refusal to sanction a UN convention on tobacco, OPEC states’ refusal to go along with the climate change consensus. In all three examples, dissidents have felt the opprobrium of the English-speaking media—conservative and liberal alike. That’s not to say that these countries’ officials have been correct in what they have done, but it is their diplomatic duty to put their country’s interests first.

However, because of the probability of a hostile media response or political pressure, or for personal aggrandisement, or myriad other reasons, poor country politicians do not always do what is, seemingly, best for their people. There are probably thousands of examples of this, from policy on irrigation and agricultural development to education of women and rights of the child. Analysis is limited in the literature (probably because research costs are so high, not so much in discovering anecdotal examples but in following them through into a detailed study). In the environmental field they are quite rare, and rarely documented properly.

However, a pattern is emerging in the application of the Precautionary Principle (PP) in developing countries. This principle can be interpreted as saying that: where there are potential threats of serious harm from a technology, lack of scientific knowledge shall not be used as a reason for postponing cost-effective measures to prevent harm.

Few actions are either unmitigated disasters or generate unadulterated benefits, and certainty in science is the exception rather than the rule. Therefore, while it may seem reasonable to look before you leap’, the practical interpretation of the PP in many western country policies means that only ‘looking’ is allowed. However, ‘leaping’ is what has allowed humankind to progress beyond the cave.

There are many publications that have addressed this overly precautionary trend. The best is probably Rethinking Risk and the Precautionary Principle (Butterworth Heinemann, 2000), by Julian Morris, my colleague at the International Policy Network. But my concern today is not about its theoretical relevance, or its application in the wealthy world, but in how the application of the principle is being exported from the rich nations to the poorest on the planet, with dire consequences. A key reason for this focus is that the precautionary principle, as currently applied, is unfair, and harms the poor—we should all care about that—and it is a useful weapon to have when fighting those who promote the precautionary principle without due thought.

To expose how unfair the PP is to LDCs I will briefly explain a few examples of its application and then concentrate on one in some detail; i.e. the resurgence of malaria due to excess western precaution regarding the use of DDT. Before doing that it’s important to explain the problems with the PP.

Problems with the Precautionary Principle

The Precautionary Principle (PP) purports to be a rule for decision-making in uncertainty. In practice, however, it is quite the opposite: it is a means of imposing arbitrary restrictions on the use of technology, including products, processes, and services.

Some interpreters of the PP demand that a technology should not be admitted until it has been proved to be harmless. This is impossible: it demands a level of knowledge that simply cannot be acquired. The great Aaron Wildavsky observes: “One could well ask whether any technology, including the most benign, would ever have been established if it had been forced to demonstrate that it would do no harm.”

The increasing international use of the PP (such as in United Nations Conventions) is also proving problematic. Proponents of the PP suggest that its application must be open, informed and democratic, and include all affected parties. While this sounds nice in principle, it can be argued that the international agreements that have incorporated the PP have themselves not been arrived at democratically (see Morris, 2000). Furthermore, poor countries are at a disadvantage because many of them lack the financial and human capital to fully evaluate the consequences of these agreements (See Tren and Bate, Malaria and the DDT Story, Institute of Economic Affairs, London, 2001).

While it is true that general application of the PP may prevent people from being exposed to some new risks, it also prevents them from reducing their exposure to existing risks. New technologies generally provide net benefits; if they did not, there would be little incentive to produce them.

Examples of the Dangers of Precaution for the Developing World

1. Concerns about trihalomethanes (compounds created in water chlorination, which are carcinogenic in rats) in drinking water contributed to the Peruvian Government’s decision to reduce the chlorination of drinking water. This led to an outbreak of cholera in Peru in 1991, killing thousands. It then spread across South America with a million cases. As far as is known, trihalomethane compounds have never killed anyone—but they are nasty for rats when drowned in the stuff.
2. A further example is from the development of nuclear power. In many poor African states there are no electricity grid systems (or they are very limited), but there are often dispersed locations that could use significant amounts of energy (an aluminum smelter in Mozambique, for example). Two technologies with potential here are nuclear and solar. South African efforts to bring on line a new technology, the Pebble Bed Modular Reactor, which could be used at the aluminum smelter (and is far safer than previous reactors), are being hampered by international rejection of older nuclear technologies.
3. At Alang in the Gulf of Combay on India’s Arabian Coast, thousands of rusting old ships are run against the beach and broken apart. More than 40,000 highly skilled men work in dangerous conditions to convert half the world’s disused ships into scraps of steel to be used in Indian manufacturing. Instead of using expensive dry docks, Indian entrepreneurs use a readily available natural resource, the beach, and so dramatically reduce the cost of recycling.
   
   But environmentalists, instead of welcoming this approach, have pressured governments around the world to stop the practice. The US navy has stopped sending its ships to Alang. They argue that the practice is dangerous and potentially environmentally harmful. It certainly is dangerous for the workers, but they earn an income many times higher than the alternative, back-breaking work in the fields, and hence make this trade-off gladly. Similarly, there are localised pollution problems, but these affect the people living and working in the region—who are also capable of making that trade-off on their own terms.
4. My last example is of the disease malaria and the use of the pesticide dichlorodiphenyltrichloroethane, commonly known as DDT (see Tren and Bate, 2001, for the full story).

Malaria

Most people consider malaria to be a tropical disease, and indeed today it is. But this has not always been the case. In the period called the Little Ice Age (more than 300 years ago), malaria was common in England. At the time it was called ague.

William Harvey (who discovered the circulation of blood) wrote: “When insects do swarm extraordinarily and when ... agues (especially quartans) appear early as about midsummer, then autumn proves very sickly.”

The diarist Samuel Pepys, famous for his account of the Great Fire of London in 1666, suffered chronic ague. Oliver Cromwell died of ague in a cool September, 1658.

William Shakespeare wrote about it in eight of his plays. Most notably in The Tempest (Act II, Scene II), the slave Caliban curses his master Prospero and hopes that he will be struck down by the disease: “All the infections that the sun sucks up / From bogs, fens, flats, on my master fall and make him / By inch-meal a disease!”

The disease is caused by a parasitic single-cell protozoa—plasmodium (such as Vivax and Falciparum) carried by the female Anopheles mosquito (such as atroparvus or funestus). Depending on the type of plasmodia it either causes periodic fevers or, in some people, death.

The cure, quinine powder, was used for the first time in 1660 (this is why we know ague was malaria, since the symptoms were the same, as was the cure). It became known as Jesuit’s Powder, and helped cure French King Louis XIV’s son. Interestingly, Protestants didn’t like to use the powder as it was seen as a Catholic cure.

Even though the cure was known, and the disease declined in importance due to better drainage (removal of mosquito habitat, often through planting eucalyptus trees), there were still major epidemics in all of Europe up to the early part of the 1920s. There were even Russian epidemics as far north as Archangel on the Arctic Circle, and also in Holland and Britain, as well as in many U.S. states. Malaria was endemic to the southern United States, Italy and Greece.

These countries completely eradicated malaria after the Second World War when widespread vector control (insecticidal spraying to kill the mosquito) was undertaken—especially using DDT.

History of DDT

DDT was first synthesised in the 1870s, but its insecticidal properties were not rediscovered until the Swiss chemist Paul Muller was looking for a new agricultural pesticide. Muller won the Nobel Prize in 1948 for this discovery. DDT had been introduced for malaria, typhus and other insecticide-carried disease control by the U.S. military by 1944. After the end of the Second World War, DDT was in widespread use around the world for vector (mosquito) control and in agriculture. The use of the pesticide led to enormous optimism and the belief that malaria could be eradicated from the entire globe.

The reasons for this optimism were not hard to see. DDT was, and is, highly effective in killing the malaria vector and interrupting the transfer of the malaria parasite. It is also cheap and easy to use, which put it within reach of even the poorest countries’ health budgets. Shortly after the end of the Second World War there was also a conviction that vector control, and in particular pesticide spraying, was the only way in which the disease could be tackled.

The early successes of DDT were nothing short of spectacular. In Europe and North America, DDT was widely used and within a few years, the disease had been eradicated from both continents. It is thought that in one year alone, the transmission of malaria in Greece came to a halt. One historian even suggested that malaria eradication “was the most important single fact in the whole of modern Italian history.”

Perhaps the most remarkable success story, however, was to be found in Sri Lanka (then Ceylon). DDT spraying began in 1946 and, as with South Africa, was an instant success, with the island’s death rate from malaria falling dramatically. Within 10 years, DDT use had cut the incidence of malaria down from around three million cases to 7,300 and had eliminated all malaria deaths. By 1964, the number of malaria cases had been reduced to just 29 and at the time it was assumed that the war against malaria in Sri Lanka had been won.

India also used the pesticide to great effect. India at the time had a particularly bad malaria problem, where every year around 75 million people contracted the disease and about 800,000 died. Almost the entire country was malarial, except for the mountainous areas, and there were, and still are, six Anopheline mosquito vectors. By using DDT, India managed to bring the number of cases down from the estimated 75 million in 1951 to around 50,000 in 1961. The achievement of reducing the number of infections to this degree cannot be overstated; however, the success in India as in many other countries was to be short-lived.

Success for Some

Complete eradication of malaria was achieved in only 10 countries, four of which were in Europe, and the other six in the Americas and the Caribbean. The international strategy of eliminating malaria from the globe was led by the World Health Organization (WHO) and largely funded by the United States Agency for International Development (USAID). USAID contributed $1.2 billion to the program between 1950 and 1972. The WHO contributed far less, with $20.3 million between 1956 and 1963, of which $17.5 million was contributed by the United States. All other countries combined contributed only $2.8 million.

These efforts were not directed significantly at Africa, where the vast majority of cases occurred and indeed still occur. It had been hoped that the swift and decisive use of DDT through well planned and funded malaria control programs throughout the world would achieve success. For some countries, particularly those in Europe and the Americas, it did. For others, the plans were not appropriate. While vector control using DDT certainly is effective, many countries (especially in Africa) did not have the infrastructure and capacity to ensure that the spraying programs were carried out systematically and effectively. However, today the infrastructure is better and an eradication program would be more likely to succeed.

WHO pushed for rapid implementation of DDT spraying to eliminate the pool of parasites before mosquito-resistance to DDT developed. But by the mid 1960s, complacency, poor-training, poor DDT formulation, poor medical detection of cases, poor entomological data and lack of political will had led to the demise of the Global Malaria Eradication Campaign which had been adopted by the World Health Assembly in May 1955.

DDT was remarkably successful in almost all the countries in which it was used, however, it was never likely to work as a magic bullet. Malaria is a disease that is influenced by a number of factors, such as climate and the migration of people, in addition to control strategies. Developing a malaria control strategy that was solely reliant on vector control and in particular on the use of one pesticide (DDT) was optimistic at best and foolish at worst. And, hence, DDT became associated with failure, although the failure was one of policy, not of the chemical.

But, in addition to rapidly rising donor fatigue and some limited DDT mosquito- resistance, other reasons for the demise of DDT included the environmental and health concerns about DDT (many of which have been later been shown to be exaggerated).

Green Backlash and its Impact Today

While DDT was being used in malaria control campaigns and also massively in agriculture, concerns were raised about the environmental impacts of the pesticide when used in agriculture. Perhaps the most well known attack on DDT was Rachel Carson’s book Silent Spring, which was published in 1962. The book popularized the scare associated with DDT and claimed that it would have devastating impacts on birdlife, particularly those higher up the food chain. The fears were based on the fact that DDT and its metabolites, DDE and DDD, accumulate in the body fat of animals. Despite the fact that many of the fears surrounding DDT were unfounded and the studies upon which they were based were unscientific, DDT was banned by the U.S. Environmental Protection Agency (EPA) in 1972. The blurb on the back of the 1972 edition of Silent Spring says:

“ No single book did more to awaken and alarm the world than Rachel Carson’s Silent Spring. It makes no difference that some of the fears she expressed ten years ago have proved groundless or that here and there she may have been wrong in detail. Her case still stands, sometimes with different facts to support it.”

In reality her case does not stand and, as the blurb states, is purely alarmist.

The EPA administrator, William Ruckelshaus, overturned scientific reports and evidence given by numerous expert witnesses, the conclusions of which were firmly against a ban on DDT and argued in favour of its continued use. The U.S. National Academy of Sciences claimed that DDT had saved over 50 million lives from malaria. But Ruckelshaus argued that the pesticide was “...a warning that man may be exposing himself to a substance that may ultimately have a serious effect on his health.” Ruckelshaus’s preoccupations with potentially negative environmental and health impacts, despite all the evidence to the contrary, and his refusal to accept the scientific advice offered most certainly condemned millions to death in malarial countries by denying them access to this life saving pesticide.

The green movement’s attitude to DDT in disease control was, and is, nothing short of callous and couched in a neo-Malthusian idea that global populations are growing out of control and that resources are running out. Malaria is, therefore, perversely seen as a saving grace from impending environmental disaster.

Critically, the EPA did not sufficiently point out that the dose of DDT used in vector control is tiny compared with the amount that was being used in agriculture. And the dose of DDT received is vital for any harm to occur. There simply is no danger to the environment or human beings from using DDT in vector control, even if there was from agricultural use.

DDT is Banned

Most developed countries soon imposed outright bans on the chemical for all uses. Some developing countries also imposed a complete ban of the pesticide for agricultural use, and some for all uses. For example, South Africa banned it for agricultural use in 1974. Sri Lankan officials stopped using DDT in 1964, believing the malaria problem was solved, but by 1969 the number of cases had risen from the low of 17 (achieved when DDT was used) to over a half million.

Pressure not to use DDT was applied by western donors, and arguments of insect resistance used, as they were politically convenient. But recent evidence shows that even where resistance to DDT has emerged, the ‘excito-repellancy’ of DDT causes mosquitoes not to enter buildings which have been sprayed. In other words, mosquitoes don’t like settling on areas sprayed with DDT. Hence, it is unlikely that malaria rates would have increased (significantly), even if resistance were found.

Malaria Recovery

The failure to eradicate malaria led to calls for stabilisation; but without the use of DDT in many countries (banned because of environmental concerns), malaria rates have bounced back. Nearly all developing countries have seen cases and deaths rise significantly.

Some have claimed that the resurgence in the disease in the past 20 years has been because of changes in climate due to man’s activities. But according to world expert Dr Paul Reiter, head of Vector Control at the U.S. Centers for Disease Control in Puerto Rico:

“Increase has been attributed to population increase, forest clearance, irrigation and other agricultural activities, ecologic change, movement of people, urbanization, deterioration of public health services, resistance to insecticides and anti-malarial drugs, deterioration of vector control operations, and disruptions from war, civil strife, and natural disasters. Claims that malaria resurgence is due to climate change ignore these realities and disregard history.”

Economic Costs

Other than obvious humanitarian reasons, controlling malaria is vital because the economic costs are significant. Professor Jeffrey Sachs at the Harvard University Center for International Development has analyzed the effects of malaria on 27 African economies from 1965 to 1990. The study found that the disease cut one percentage point a year from the annual growth rates of those economies. If malaria had been eliminated in 1965, Africa’s annual gross domestic product would be $400 billion now, rather than $300 billion, the study estimated.

The models did more than just assess the costs of treatment and losses associated with death. They also estimated the losses from tourists and foreign investors avoiding malaria-prone countries, the damage done by large numbers of sick children missing school and the increase in population and impoverishment that ensues when parents decide to have extra children because they know some will die. Sachs study confirms research done by Richard Tren of the Non-Governmental Organization (NGO) Africa Fighting Malaria that shows the cost to Southern Africa is several billion dollars a year, and this figure was far higher in the past.

What is important for our discussion is that fewer deaths and, hence, economic loss is associated with countries that have continued to use DDT.

Indeed, DDT has quietly been used in some developing countries, such as South Africa, Botswana, Ecuador, Indonesia and India for the past three decades, almost without comment. In 1997, however, the United Nations Environment Programme (UNEP) decided to promote a treaty—a framework convention—that would ban 12 persistent organic pollutants (POPs), including DDT.

The Rise of Conventions: The International Community Has its Way

A UN Framework Convention sets the ground rules and tone of the whole treaty process. It usually establishes conditions that are easy to agree among the parties. In the POPs treaty process (as in all UNEP treaties), the developed world, mainly European and American interests, is promoting the agenda and draft text. Since these countries do not produce any of the 12 chemicals to be targeted, it was simple for them to promote a total ban, as part of a PP approach. It was equally predictable for green groups and politicians to claim an important victory that would help to increase coffers and attract voters.

The only reason the language is not completely prohibitionist is because of three factors: Western industry pressure, which is based on the concern that once the initial 12 chemicals are banned, the green pressure groups and the treaty secretariat will target other chemicals in future protocols, which are produced in the west; pressure from officials from developing countries that do produce/use some of the 12 chemicals listed; and pressure from two or three pro-DDT anti-malaria groups who are concerned about the fate of DDT.

The Status of the Convention

In May this year in Stockholm, 91 countries signed the United Nations Persistent Organic Pollutants Convention to banish 12 organic chemicals over the next decade. Most of the chemicals will be phased out relatively quickly, but one, the pesticide DDT, has been reprieved for use in controlling malaria for the foreseeable future. Malthusian environmentalists may be privately relieved to know that the reprieve is not really working because even though DDT use is accepted, both under the Treaty and by the World Health Organisation, it is becoming harder to procure. It seems that simply being listed under the Treaty is discouraging production and use in malarial countries. Mistaken concerns about DDT are depriving Africans of a safer and longer life.

DDT was probably harmful to wildlife when used in massive doses on cotton farms in the 1950s in America, although not as harmful as Carson and her followers made out, but it has never been proved to harm humans except those who tried to commit suicide with it. And in any event, any possible harm to wildlife in America and Europe has been reversed. Furthermore, malaria control requires only that the insides of houses be sprayed; used properly there is very little chance of DDT being released into the environment. Yet myths persist about the harm it causes. Many Zambians think it causes male impotence, most westerners think it causes cancer, and nearly everyone forgets that only in massive doses can DDT cause problems. Like vitamin A, it is useful in low doses and potentially fatal, to birds of prey, at very high concentrations.

So why isn’t the developing world using it? To recap, there are several reasons, and all are interrelated. First, western pressure groups have maintained a PP campaign for 30 years against this green totem. Second, aid agencies, now staffed by many environmentalists, have not approved funds in recent years for procurement of DDT. Some, such as USAID, have even pressured countries (notably Bolivia) not to use it. Third, governments of the developed world, and increasingly of poor countries, stopped production of DDT, so that only India and China currently produce it in any quantities. Fourth, countries such as Botswana switched to other pesticides in 1998 when they could not procure any DDT from dwindling world markets. Fifth, the elites in even the poorest countries, such as Mozambique, think it almost unseemly to use a pesticide that has been banned in the North and is due for elimination under the POPs Treaty. Last, most people cannot believe that DDT is still the best pesticide to control malaria vectors, even though it was developed nearly 60 years ago.

Only countries with enough political clout and sense are still using DDT, notably South Africa. Even South Africa stopped using DDT in 1996 under pressure to join the world’s green community and switched to the next best alternative—the synthetic pyrethroids (3 times the price and effective over a shorter time span). South Africa decided to resume DDT spraying last year when malaria cases jumped by 1,000 percent in between times due to mosquito resistance to the synthetic pyrethroids. A further inducement was that the mosquitoes that transmit malaria had become resistant to the pesticide that replaced DDT.

The only real hope comes from some companies operating in countries that allow DDT to be used. The malaria control program run by metals company Billiton in Richard’s Bay in South Africa, and by various other mining companies in Zambia, are examples of the continuing efficacy of DDT. In all places where DDT is being used malaria rates are falling back to levels not seen for over a decade. It is possible that the current supplies of DDT will run out, forcing these excellent operations to switch to the more expensive and less effective alternatives. This will mean that fewer lives may be protected in the future.

While the delegates of the countries who signed the POPs Treaty think they have been magnanimous in exempting DDT from an immediate ban, they have unwittingly consigned many faceless children to death in Africa.

So on the basis of precaution, predicated upon the notion that DDT might possibly harm those in the North sometime in the future, the UN is encouraging policies that will certainly cause Africans to die today.

Conclusion

The rise of the use of the Precautionary Principle is stifling development in Europe and to a lesser, but increasing, extent in America¹. One only has to look at the demise of the Swedish chemical industry (based on the first precautionary legislation in 1969) to see where the rest of the world is heading. Development of new products is being hampered so much that companies are moving to other jurisdictions. Company/industry displacement from the most risk-averse country to those less risk-averse cannot continue forever because development has to occur somewhere. It is not an option to have no chemical industry.

While this process is worrisome, it pales in significance to the death its application is already causing in the poorest parts of the world. Concerns about chlorination and the push for a DDT ban are merely the most obvious examples of this phenomenon. In my opinion, the Precautionary Principle should not be used to make decisions, especially those that affect people not actively involved in the decision-making process. However, if the Precautionary Principle is to be adopted more broadly, its interpretation must genuinely be made by those worst affected by its implementation—with full cost-benefit/risk-risk trade-offs acknowledged.

This is easier said than done. The initial reason for using the Precautionary Principle was to enable decisions to be made when there was considerable uncertainty about the impact of a technology. But the attempt to be rational, use the best science available and balance the possible outcomes is essential. If not, application by western green groups and western governments will kill more people than the malaria-carrying Anopheles mosquito.

1. The recent concern about vaccines (especially MMR, measles, mumps and rubella) is a case in point. While there is an association between child febrile seizures (shaking when in fever) and the vaccine, there is no link to any harm in the later life of the child. However, this association has led to parents refusing to allow their children to be vaccinated, and for them calling for MMR vaccines to be abandoned. Some pressure groups have argued that a precautionary approach should be taken and the vaccines withdrawn. But this would have catastrophic consequences. Nearly 900,000 children die from measles every year around the world. And in countries where vaccination coverage drops below 80 percent, the uptake of the disease is significant.
   
   In Britain 30 years ago similar arguments were made against whooping cough vaccinations, coverage fell from 80 percent to 30 percent, and the result was an epidemic of 100,000 cases. There may be a minute risk to some children from vaccinations—but the diseases are far, far worse. Precautionary vaccination propaganda that results in individual and government action harms, and sometimes even kills, children.

Roger Bate works for the International Policy Network in London.