For most African countries, malaria has become an overwhelming public health problem, leading some governments to consider using DDT for malaria control in the midst of a heightened debate about its advantages and disadvantages. This report seeks to document the nature of the DDT debate in East and Southern Africa by describing current DDT policy plus malaria and insecticide control specialists’ views on alternatives to DDT use, examining the factors that influence malaria control policy formation and assessing specialists’ knowledge about the human health impacts of DDT. To obtain this information, malaria and insecticide control specialists were interviewed in Ethiopia, Uganda, Kenya, and South Africa and malaria control policy documents from each country were reviewed. Results indicate that DDT use for indoor residual spraying (IRS) continues to be viewed as a viable malaria control option, although most specialists are receptive to alternative control measures. Additionally, decentralization has had a profound impact on malaria control in East Africa and the POPs Treaty is used simultaneously as a rationale for a reintroduction of DDT and its continued prohibition in public health. Finally, research necessary to make informed decisions on malaria control policy is lacking in East Africa, and there is a need to educate malaria and insecticide control specialists on the human health impacts of insecticides used for vector control, including DDT.