MALARIA CONTROL, AFRICA (Hansard, 11 July 1950)

§ Mr. Arbuthnot (Dover)

I feel it is appropriate that tonight, as a forerunner to the debate tomorrow on Colonial Affairs, we should be discussing malaria control in Africa. No colonial administration can possibly be successful unless a prominant place is given to the health of the Colonies. I put down this subject for discussion this evening because I happen to be a member of the Industrial Advisory Committee of the Ross Institute. One of the duties of that body is to review, from time to time, the progress which is being made in combating the various tropical diseases throughout the world.

One matter which stands out from a review being carried out at present is the great discrepancy between the progress which has been made in malaria control in Africa compared with the rest of the world, Africa unfortunately lagging badly behind the achievements elsewhere. It is no part of my purpose this evening to approach this question from a party point of view. What I want to 1317 do is to try to divide my remarks into three sections: first, to give a summary of world progress; secondly, to give a factual statement of the position in Africa; and thirdly, to offer a few suggestions which I hope the Government may see fit to employ, by which the present position in Africa can be materially improved.

During, and since, the war there is no doubt that the world, through scientific progress, has made enormous strides in its ability to tackle this problem of malaria. The factors responsible for those strides have, I think, been three. First, the discovery and development of the disease-preventing, or prophylactic, drugs, such as paludrine, meppecrine, and drugs of that type. But we have to remember that they are merely stop-gaps; they prevent an individual from contracting malaria, but they do not actually prevent the mosquito from biting the individual, through which malaria is transmitted. The real task is to eradicate the fundamental cause of malaria. The second factor has been the discovery of the residual insecticides, such as gammexane and D.D.T., and the development of modern techniques in the use of them.

The third factor which is worthy of our attention is the setting up of the World Health Organisation, which is an offshoot of the United Nations, with its anti-malarial sub-committee, the task of which is to try to help all nations which ask for its help to combat malaria. One of the methods by which that sub-committee tries to do this is by making available demonstration teams of experts which are prepared to go to countries which may ask for that help, and which need it. But before the malaria sub-committee is prepared to send a team to an individual country there is one vital condition which must be fulfilled, namely, that that country must signify its willingness to carry on the anti-malarial work after the team has withdrawn.

There are seven teams working at present and they have achieved considerable success. In Brazil, 15 million people have been protected from malaria; 500,000 have been protected in British Guiana; four million people in Venezuela; five million have been protected under one of the Indian schemes, and six million have been protected in 1318 Ceylon. I think that it is worth drawing special attention to the efforts made in Ceylon because they are typical of what can be achieved through the proper handling of this malarial problem.

D.D.T. residual spraying was started in Ceylon in 1947, and the results are apparent in the figures for the death rate. Deaths per thousand in the last ten years were at the beginning of the period about 21–21.0, 21.8, 18.8, 21.4, 21.3, 22, and 20.3, are some of the figures for the years immediately before 1947. Residual spraying with D.D.T. was started in 1947, and there was a most remarkable drop in the death rate. Instead of being around 20 or 21, the death rate fell to 14.3; and in 1948, the last year for which figures are available, it was 13.2. Therefore, there is no doubt that in some parts of the world, and in Ceylon in particular, great progress has been made.

The sad part is that when we come to look at the Colonial Empire in Africa, it provides a distressing contrast. Professor Macdonald, Director of the Ross Institute, said on 11th October, 1949, In making such a review it is impossible to blind oneself to the fact that the list of major works does not include anything in East and Central Africa. That is in spite of the fact that malaria is every bit as prevalent in Africa as anywhere else in the world. It is a major public health problem and its incidence exceeds 60 per cent. in most parts of tropical Africa. I know that there have been a number of small schemes, but they have been confined to the towns, in the main, and have been on nothing like the scale required if malaria is to be swept from the African Continent, as it must be.

The really disturbing feature is that where good work has been done it has occurred in those Colonies where there has been strong political pressure brought to bear, such as in British Guiana, Cyprus, or Mauritius, or in self-governing countries such as India, Ceylon, or Venezuela. If, as seems apparent. it is political pressure which is the major factor in getting things done, then I and my hon. Friends on this side of the House …and I think we shall have considerable help from hon. Members opposite…will do all we can to bring that political pressure to bear. The Government may expect a barrage of proddings, urgings. and questions in that direction.

1319 I know we may be told that there are difficulties in Africa which prevent more active measures being taken. One of the excuses offered, and one which makes me blush, is that the Africans acquire an immunity to malaria. To gain immunity in this way is a risk to which one would not put one's own children: it is not fair to ask the Africans to put their children to it. To say that by being exposed to malaria they obtain immunity is, I think, as heinous as to suggest that it would be proper for the people of Britain to drink tubercular milk so that we might develop tubercular glands and joints and thus might acquire an immunity from pulmonary tuberculosis. One factor which is very significant is that members of the self-governing countries will have nothing to do with excuses of that kind.

I believe that there is some possibility that the Malarial Committee of the World Health Organisation may be going to meet in East Africa this autumn. I ask the Minister whether that is so. I hope it is. Before that conference takes place, I suggest to the Government that one of the really valuable things they can do is to ask the World Health Organisation specifically to make a report on the protective immunity in Africans and to assess its value to the African community and also to assess the cost to the community in acquiring it. I believe that if the World Health Organisation is asked by the Government to make that report, we shall scotch once and for all that appalling excuse which is such a discredit to those who make it.

Then we are told that the size of the African Continent is a prohibiting factor from doing anything effective. India has very much the same problem and has tackled it effectively and. as I pointed out, in one of the Indian schemes five million people have been protected. So I do not think there is much in the excuse about the size of Africa making it necessary for us to sit still and do nothing. It is suggested as an excuse that research work is going on. That may be, but none of these excuses is valid or adequate to account for the failure to set up a major scheme in Africa for tackling the malarial problem.

I therefore appeal to the Government to institute without further delay major schemes, one for East Africa and one for 1320 West Africa, much on the lines of the schemes tested elsewhere and found so successful. We have the experts in this country. We have all the facilities to put these schemes into operation and there is absolutely no excuse why schemes on these lines to cover the large rural populations of the African Continent should not be started.

I believe that it is a serious indictment that we, with our large Colonial Empire, should find ourselves being outstripped in this effort to combat malaria by countries with much less experience than ourselves in Colonial government. We must cease our present attitude of being like the Duke of Plazatoro and leading the regiment from behind because we find it less exciting. We should be in the forefront in the development of malarial schemes. The only justification for colonial administration is to do it well and put all the effort we have got into it. If this Debate succeeds in kindling the public conscience and if it sets alight a train of action that will save the lives of some of His Majesty's African subjects, it will not have been in vain. I therefore appeal to the Government to get on with the job and start anti-malarial schemes which will make Africa lead and not be led, by other nations.

§ The Under-Secretary of State for the Colonies (Mr. Cook)

We are obliged to the hon. Member for Dover (Mr. Arbuthnot) for raising this very important subject. I assure him and the House immediately that the need for political pressure in this instance is not so urgent as he seemed to indicate. There is no one more alive to the problem than the Colonial Office, allowing for the fact that we have to know a great deal more of this position in Africa because there are difficulties in Africa which do not apply to other areas.

It can be said in general that there is a marked improvement in the health situation in Africa as a result of more effective control of what is still the chief killing disease in the world. The benefits of this control are twofold: firstly and particularly, from the health point of view, and secondly from the economic point of view. Elimination, especially in rural areas, involves a corresponding increase in general productivity, particularly of food supplies. Eradication from 1321 Africa in areas favourable to settlement and development means a tremendous asset to the welfare of mankind.

I want to stress the fact that the Colonial Governments and His Majesty's Government are fully alive to this very serious problem of effective control. We are alive to it, and complete eradication is the ultimate aim. Since 1940 over £600,000 has been provided from Colonial Development and Welfare Funds for control schemes in these territories. More than £250,000 has been devoted from the same source for research into insecticides and for drainage and irrigation. In addition to these figures, considerable amounts have been provided by the Colonial Governments themselves. This gives a reliable idea of the size of the problem and the importance attached to its solution.

The problem of malaria control in Africa presents greater difficulties than does the same problem elsewhere in so far as there are in Africa two types of malaria-bearing mosquito One breeds under shade and the other in the open: thus neither bush clearance nor artificial shade is efficacious. The African malarial mosquito is peculiarly difficult to control. A great deal of research is still required before a progressive and enlightened anti-malaria policy can be formulated.

In mixed communities the standard of control has risen steadily during the past 10 years. In large centres malaria risk has been reduced to a negligible level and there has been steady progress in smaller centres. Progress largely depends on the standard of training of the African staff and careful attention is paid to this aspect. For example, the East African Malaria Control Unit was set up to train Africans, to engage in a study of malaria generally and to provide specialised technical advice. These are all things on the credit side. Control measures are an essential feature of medical plans in African territories.

Considerable progress has been achieved in the larger centres of population by clearing the streams, permanent drainage, oiling and the use of other anti-larval methods. Gammexane and D.D.T. are employed wherever practicable. There has been a spectacular decline in malaria incidence in the Lagos area of Nigeria resulting from the completion of the large-scale drainage scheme initiated 1322 in 1942 to protect Service personnel and taken over by the Government in 1946 and run by the Lagos Town Council, since 1948. Four thousand two hundred acres have been reclaimed and the channels dug have extended to 130 miles. The value of this scheme is incalculable, both as regards the general health of the local inhabitants and as a guide for the future.

Extensive control operations are being undertaken in Freetown and here the main attack is by larvicidal methods. A major scheme is being planned for the reclamation of 30 square miles of swamp breeding ground surrounding Bathurst in the Gambia. In Kenya the Insect-Borne Diseases Division has successfully applied modern methods of residual spraying to houses in rural areas in the highlands.

With regard to research, in Uganda two experiments are being carried out under the guidance of the Colonial Insecticides Committee on the control of malaria by spraying. One, which has been conducted for four years. resulted in a reduction in the incidence of malaria by 50 per cent. Much research has been completed, and is in prospect, in Nigeria where the malaria service is organised within the framework of the medical department. At Ilaro, in Southern Nigeria, we have a typical example of a congested community in a hyper-endemic malaria zone where a residual spraying campaign is in progress. In this area some 1,500 houses have already been treated. As a result, a vast amount of information has been obtained, and it is hoped to extend this project to other areas.

Another difficulty has been that antimalarial drugs did not have the same conspicuous success in Africa as they had in other parts of the world, and this has necessitated a great deal of research. Such was our concern, that members of the Ministry of Health Malaria Laboratory flew out to West Africa and brought back African strains. As a result of research locally and in this country, a method of thoroughly efficacious treatment has been worked out. We are doing all we can to drive on with the treatment of malaria.

With regard to the question of cooperation with the World Health Organisation, it is to be remembered that this organisation is still barely two years old, and its operational programme is not yet, by a long way, fully extended. Colonial Governments are aware of the 1323 many types of assistance provided by this specialised agency of the United Nations, and we confidently expect there will be a steady increase in the number of requests to the organisation for their services. Indeed, co-operation between Colonial Governments and this organisation will become closer when the latter sets up its regional office in Africa.

We do realise that the World Health Organisation can make a tremendous contribution to the fight against malaria. Indeed, for some months one of the Organisation's experts. Professor Cambournac, has been touring Africa examining the problem in consultation with territorial medical departments. During his tour he has discussed arrangements for the international conference on malaria which is to be held in East Africa in November and December this year, under the joint auspices of the World Health Organisation and the Commission for Technical Co-operation in Africa South of the Sahara…an inter-governmental body on which France, Belgium, Portugal, Southern Rhodesia, the Union of South Africa, and the United Kingdom, are represented.

Foremost experts on African malaria, including members of the World Health 1324 Organisation's expert committee, will be invited to the conference. The problem of malaria in Africa will be exhaustively studied, and it is hoped as a result to have carefully-drawn-up plans for the future for the intensification of the attack on this horrible disease on a continent-wide basis.