It's depressing to hear well-paid multilateral agency employees and consultants pontificating on their latest studies -- about how to spend money on aid programs -- while untreated babies are dying of malaria. And last week, the various parties to the World Health Organisation's Roll Back Malaria initiative met at UNICEF's offices in New York, and did just that.
Saying that Roll Back Malaria (RBM) is a failure is an understatement. In the first four years of a program designed to halve rates within 12 years, malaria rates rose by 10%. Estimates since the end of 2002 show a further increase in the frequency of cases. All the agencies party to RBM must share the blame, but the US Agency for International Development is probably most culpable since it isn't buying any drugs at all to combat malaria. Some agencies (such as the Global Fund and UNICEF) are still buying chloroquine, which has such a high failure rate that to continue buying it for use in Africa borders on negligence. But at least they are buying some drugs.
USAID is fixated with insecticide-impregnated bed nets for preventing mosquito bites, to the exclusion of almost any other initiative, including those with far superior proven success in preventing the disease, or in treating those who succumb to it. Nor, it seems, is USAID prepared to defend its position. Africa Fighting Malaria (AFM), a health advocacy organization I direct, recently filed a Freedom of Information Act request to ascertain USAID's policy on Artemisinin Combination Therapies (ACTs). These are new drugs, based on an ancient Chinese cure, which, when used in combination have very low resistance rates. ACTs should replace chloroquine as the drug of choice. The FOIA request was to find out what USAID thought of these new drugs, and whether they would start purchasing them.
USAID gave AFM some information about its policy towards ACTs, which is rhetorically positive. But it withheld fifteen key documents that would probably have exposed its inertia and true hostility to ACTs. Its excuse: the release of the documents might have created "public confusion." Given that it was a FOIA request, it seems ironic and bizarre that it would argue that release might cause public confusion. The public has the right to know why USAID won't buy ACTs even though it says they work better than any other drugs (and even if confusion was created as a result). AFM has appealed, so far with no response from USAID. Litigation will soon be the only recourse that remains.
The obvious inference is that USAID has something to hide in these documents. Their public records indicate what might be found. USAID has spent at least $495,000 on studies into the financing of ACTs, but in the past two years has spent precisely $0 on any drugs, let alone ACTs. As usual with multilateral agencies, its consultants are being well rewarded while the children of Africa receive no drugs at all.
Given USAID's inaction, it is remarkable that it handed out a document at last week's meeting, which discusses RBM (presumably through purchases from other agencies) buying $30 to $60 million worth of ACTs in 2004. Yet one has to ask from where this money and these drugs will materialise. RBM and all its partners have made no commitment to any drug company to purchase these drugs.
Even assuming the money is found, the typically bureaucratic RBM campaign appears to ignore financial realities. Most firms barely break even producing ACTs. Novartis, which produces the most successful ACT, Coartem, was audited last year and it loses money selling this drug. How can USAID in particular, and RBM in general, expect the drugs to magically materialize, or for Novartis to expand its production facilities 500% as estimated demand indicates they should, at the drop of a hat?
The Global Fund for AIDS, Tuberculosis and Malaria has come under heavy criticism, not least from this writer, for its failure to purchase more ACTs in 2002 and 2003. But unlike UNICEF, USAID and most other agencies at least the Global Fund spent several million dollars buying these most effective drugs.
Not content with demanding that other agencies buy drugs, USAID even suggested establishing another drug distribution facilitation agency at last week's meeting. The point of this is mystifying when the Global Fund was established to do this job. Even more mystifying was that it was almost unanimously supported by the 40+ staff and consultants in attendance, even though the agencies, function, delivery system, financing mechanism, (in fact any detail of its operation) had not been described. In what amounts to classic Orwellian obfuscation and misdirection, the RBM (led by USAID) seeks to cover its failure to reduce malaria deaths by establishing another "mechanism." The reality is that the RBM, and USAID in particular, is just a talking shop with little effective action. The US Congress put pressure on the Global Fund recently and it is changing for the better. Its time it pressured its own USAID to ensure the children of Africa receive drugs that actually work.
Roger Bate is a visiting fellow at the American Enterprise Institute and a Director of health advocacy group, Africa Fighting Malaria