It's time for Britain to get tough over malaria funding

Roger Bate | 07 Mar 2004
Daily Telegraph (UK)

Although both agencies reject the experts' analysis as "wrong", neither has denied any of these core facts, which are unassailable. The consequences of this mismanagement are so dire that The Lancet, not given to broadsides on the UN, published the experts' paper in a matter of weeks - warp speed for the academic world - and circulated a press release to draw attention to it.

Though the WHO and the Global Fund have protested vigorously in public health circles, on each occasion they have appeared more concerned with saving their reputations than with saving lives. Sounding like the consummate flat-earther, the WHO's top man in Ethiopia told the press that no scientific proof of drug resistance exists.

It is probably no coincidence that, according to Medecins Sans Frontieres, Ethiopia now has Africa's largest malaria epidemic.

These facts are hard to face for those who think the UN can do no wrong, but if their concern for patients in poor countries is genuine, the realities must not be ignored. About 7pc of the Global Fund's budget (over £65m) originates from the UK, and 60pc of its grants flow to Africa.

That means that, when the world's top experts condemn its decisions as medical malpractice, both British money and African lives are being wasted.

In 1998, the WHO launched a flagship campaign to "Roll Back Malaria". The goal they set was to halve the number of malaria deaths by 2010. The pledge was made at the highest levels, since it was the top priority for the WHO's former boss, Dr Gro Harlem Brundtland.

So in 2004, at the halfway mark to halving malaria deaths, what has happened? Malaria has indeed "rolled back" with a vengeance. Rather than declining by 50pc as the UN promised, or even 5pc, malaria deaths have risen. In the WHO's words, there is a "background of increasing malaria burden", though of course the WHO avoids saying how much.

If the UN ever sincerely meant to Roll Back Malaria, it surely would have done at least two things differently. First, it would have used every defensive weapon against malaria in the arsenal, including spraying homes with DDT. This is highly effective, and very little escapes into the food chain.

Second, the WHO would have followed scientists' advice to field ACT much sooner and before drug resistance reached cataclysmic levels. But the UN did neither of these things and achieved nothing.

All this leads to a fascinating question: if the WHO fumbled it so badly with Roll Back Malaria, which was their poster child campaign of 1998, why should they be trusted in the pole position of the latest global campaign, to treat three million Aids patients by 2005?

The problem seems to be scientific incompetence: to solve it, an independent panel of malaria scientists must be put in charge of deciding what medicines and insecticides are paid for, so that international aid follows the same kind of peer-reviewed quality control that the scientific establishment already uses.

In South Africa, where scientists run the national malaria programme, their very unpopular decision to use both DDT and ACT reduced malaria cases by 91pc in only three years.

Left to their own, the WHO and Global Fund will never do this. The British government should therefore force them: either replace the fund's useless internal scientific review, which made all the errors with malaria medicines and so wasted UK money, or withdraw our funding in the future.

This would be the worst nightmare of the Global Fund, and the best gift for malaria patients. That is why it has to be done.

  • Dr Bate is a fellow of the American Enterprise Institute and the Institute of Economic Affairs and a director of health advocacy group Africa Fighting Malaria.