WHO's to Blame?

Roger Bate | 30 Apr 2004
National Review Online
The multilateral health agencies are at it again. Facing exposure for failing to combat a health problem — in this case, malaria — their only reaction is to try to pin it on someone else. When African kids die every minute from terrible diseases (like malaria), it is shameful that groups spend precious taxpayer resources deflecting blame.

The champion responsibility-dodger is the World Health Organization. In the past two weeks the WHO and its affiliates have had to listen to scads of commentators in the New York Times, the Wall Street Journal, the Washington Post, and other papers complain that malaria rates are increasing when the WHO promised six years ago to halve them. The consensus is that the failure of existing therapies like chloroquine — and the lack of use of insecticides like DDT — are the cause. In less than a week, the WHO has masterminded its policy response: Blame the usual suspects.

In doing so, the WHO employs the vast network of NGOs and campaign groups that they directly or indirectly support. For example, the WHO's Roll Back Malaria initiative (among other groups) told the BBC on Monday that "governments, donor agencies, and pharmaceutical firms must take action now to prevent a shortfall in malaria treatments, next year."

According to the BBC, "Campaigners fear targets for eradicating the disease set by governments and health agencies at a summit in Nigeria four years ago may not be met." Furthermore, the WHO is apparently advocating a new plant-based treatment — Artemisinin-based combination therapy, or ACT — which it describes as "highly effective." The WHO has called on governments and pharmaceutical companies to place large orders to guarantee supply of the treatment. "Increased demand is the main factor that will drive down prices," said Dr. Fatoumata Nafo-Traore, director of Roll Back Malaria.

What cheek! First, campaigners funded by WHO are unlikely to blame WHO for the failure, so perhaps the BBC should have chosen a different — perhaps an objective — source for comment. Second, the BBC's use of "advocating" is seriously misplaced. The WHO has sat on its hands and equivocated about whether to use the new ACT drugs for the past three years, all the while supplying failing drugs to African kids. Third, and most bizarrely, WHO is demanding that pharmaceutical companies buy their own drugs so they can distribute them to needy people requiring treatment. Since when have drug companies been responsible for drug procurement? Dr. Nafo-Traore is correct that increased demand will lower prices, but surely that demand has to come from the WHO, which has a decent budget for buying drugs, not from companies whose role is pharmaceutical development.

At least one Geneva-based group, the Medicines for Malaria Venture, has come out swinging, attacking some of the WHO campaigners' claims (in particular, the group Massive Effort's). Chris Hentschel, the director of MMV — a public-private partnership dedicated to developing new medicines — commented on a Massive Effort press release:

It is misleading to say, "Pharmaceutical companies have yet to find a cheap, safe ACT generic that donors will support," as if they are the main party accountable for the historic public under-investment in the creation of the desired "public goods." It is parenthetically rather odd to direct these comments to the research-based industry as if it controls the production of generics. In fact, these comments are particularly off-target since the only ACT that's manufactured to an international registration standard, and on the WHO essential drugs list, is Coartem, sold to WHO at cost-of-goods by Novartis — note that this program arguably represents a loss to Novartis because of the opportunity cost to the company.

Activists have even tried to blame the high cost of ACTs on patents and the lack of generics. Dr. Hentschel's expert comments are again instructive:

We agree that the price of ACTs, even at cost, are high relative to the simple drugs introduced in the '50s and '60s, but this has nothing to do with them being a generic or branded drugs. ACTs are relatively costly because they are difficult to produce and scale up. It's not, as stated, because "too few companies are producing ACT drugs." The inherent drawback of using a plant extract is that you have to wait an entire season in order to harvest the plant and then 99 percent of the plant has to be discarded — as potentially toxic organic-laden waste if not done properly. The extraction process is long, difficult, and potentially dangerous. ACT's are only semi-stable, so formulation is difficult if one wishes to achieve an acceptable shelf life.

The solution to this dilemma will be the production of synthetic artemisinin, something only MMV and the pharmaceutical companies will be able to deliver. As Dr. Hentschel concludes: "The research-based pharma industry is today a vital part of the solution to the 'innovation gap' that developed over decades; slinging bricks at them now does no one any favors."

One of the other claims made by RBM in Nigeria was that, by next year, 60 percent of children across Africa should be sleeping under safe mosquito nets. Unfortunately, like so many U.N. goals, it was ridiculously ambitious — the number of bed nets required would have been 160 million (there are at most six million being used in Africa today). One waits with baited breath for the RBM statement claiming that net-producing companies have failed to distribute them for free in Africa, and that hence they (and we) are failing to control malaria.

The WHO and RBM campaign always had an uphill battle, but by following the wrong policies and then blaming others for their failure, they deserve the opprobrium they are now reaping.

Dr. Roger Bate is a visiting fellow at the American Enterprise Institute and a director of the health-advocacy group Africa Fighting Malaria.