The secretariat has the honour to transmit to the Intergovernmental Negotiating Committee, in the annex to the present note, information provided by the secretariat of the World Health Organization (WHO). The information is provided as submitted by the secretariat of WHO and has not been formally edited.

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE

Information Document for the First Session of the Intergovernmental Negotiating Committee on Persistent Organic Pollutants

The Fiftieth World Health Assembly (May 1997) endorsed the recommendations made by the Intergovernmental Forum on Chemical Safety to the World Health Assembly on persistent organic pollutants and adopted a resolution on "Promotion of chemical safety with special attention to persistent organic pollutants". While the resolution addresses a wide range of issues and activities, of particular note concerning persistent organic pollutants, it calls upon Member States, inter alia:

to involve appropriate health officials in national efforts to follow-up and implement decisions of the UNEP and WHO governing bodies relating to the currently identified persistent organic pollutants;

to take steps to reduce the reliance on insecticides for vector-borne disease control through promotion of integrated pest management approaches in accordance with WHO guidelines and through support for the development and adaptation of viable alternative methods of disease vector control;

to ensure that the use of DDT is only authorized by governments for public health purposes only, and that, in those instances, such use is limited to government authorized programmes that take an integrated approach and that strong steps are taken to ensure there is no diversion of DDT to entities in the private sector.

The resolution also requested the Director General, inter alia, "to participate actively in the intergovernmental negotiating committees on the currently identified persistent organic pollutants (...) in particular on the use of pesticides for vector control, in order to ensure that international commitments on hazardous chemicals are realistic, effective and protect of human health and the environment".

WHO’s Response

While WHO responds in many ways to different items of the resolution, emphasis is given here on how WHO is addressing those items which relate to POPs and the use of DDT for vector disease control.

It is recognized that vector disease control, including malaria control, is not just about addressing a health problem, but that it has wide ramifications with development in terms of poverty alleviation and socioeconomic and environmental issues. Thus, an intersectoral approach is essential for successful control. Global coordination of action against malaria is essential and vital for the more efficient use of resources.

In response, WHO as the world’s directing and coordinating authority in public health, is developing an expert report that will provide an assessment of the current situation concerning the use of DDT in the prevention and control of malaria and propose a future course of action designed to strengthened disease-vector control alternatives.

The process of developing the expert report will bring together a multi disciplinary expert group representing different public sectors to develop a plan of action for the reduction of reliance on DDT for Public Health, and to advise on means of developing sufficient national capacities to execute an effective, integrated vector control programme. A draft report will be subjected to a written peer review procedure involving experts from all disciplines concerned and finalized at an expert group meeting. The process, thus sets the stage for safely reducing the reliance on DDT for public health.

The strategy should draw on the successful approaches to integrated pest management (IPM) in agriculture, and the development of effective integrated vector control should run, as much as possible, parallel to IPM with the ultimate goal of the two converging into one strategy where possible, but with due regard to the important differences that distinguish control of human disease vectors from the management of agricultural pests.

An outline of the report to be developed is presented on the following pages. It is planned to have the report available as a contribution to the second session of the Intergovernmental Negotiating Committee.

WHO Expert Report - Effective, integrated vector control programmes and the development of a plan of action for the reduction of reliance on ddt for public health.

Proposed Annotated Outline

1. Malaria - nature and magnitude of present day crisis (brief overview)

Information (facts and figures) on extent of the malaria epidemic, e.g. malaria ranks third among major infectious disease threats, 300-500 million cases of malaria each year resulting in an estimated 1.5 to 2.7 million deaths, mainly of children under five years old in Africa - the estimated direct and indirect cost of malaria in Africa was

US$ 1.8 billion in 1995.

Issues concerning drug resistance and vaccine development.

Linkages of the disease to the movement of refugees or populations seeking work and to environmental change, including forestry, mining, water development projects and global climate change.

2. Vector Control in Malaria prevention and control

WHO current guidance on vector control as an element in the Global Malaria Control Strategy (GMCS) which envisages the selective, integrated use of the available vector control methods, taking into consideration the technical and operational feasibilities, the resources and infrastructures. The available vector control methods are based on environmental management, biological control, and the use of chemicals - adapted to the specific requirements of local conditions and temporal fluctuations in transmission patterns.

Conditions when vector control may be considered for application.

Vector control options that are currently available.

Conditions to be met for indoor residual spraying to be appropriate.

Use of DDT:

experience with DDT (advantages, problems):

- efficacy, resistance, risks when used according to WHO specifications;

current situation.

Effects of DDT on human health and the environment - covering known, suspected and perceived effects.

Applicability and availability of viable alternatives to DDT - taking into consideration that disease vector control must be fine-tuned to the local epidemiological reality and socio-economic conditions: alternative residual insecticides, bioenvironmental methods, impregnated bednets.

3. Current obstacles to effective vector control:

vector resistance and multiple vectors;

complexity of the decision making required;

lack of effective institutional arrangements/intersectoral dialogue;

lack of research & development;

lack of trained personnel;

vested financial interest.

4. Plan of action

"To control malaria, better ways must be found to apply existing control methods, improved tools must be developed and solutions need to be identified to circumvent and combat emerging problems."

Factors/issues to be addressed:

Guidance on the selection of replacements for DDT should be developed; the guidance should cover non-chemical as well as chemical alternatives and include well-defined decision making criteria on the factors to be considered in choosing alternatives and sources of information for an integrated approach.

Disease (vector) control as an integral part of those processes that contribute to increasing disease transmission and risk - malaria control must be implemented as an integral part of a wider developmental effort to ensure its social, economic and ecological integrity.

Cooperation between the health and other Government departments, such as agriculture, education, finance, forestry, irrigation and public works.

The development and evaluation of alternative methods.

Strengthening of national capacities to implement proposed methods.

Mexico - a model approach to phase out the use of DDT and to substitute an "integrated pest management approach for malaria control for the heavy dependence on pesticides." Improved sanitation, surveillance and minimum use of pesticides to control mosquitoes and larvae are considered key elements in this new approach.

The responsibility and capacity of the international community to assist countries to make the transition from the reliance on DDT.