As President Bush's speech writers begin working on his State of the Union address they should note a claim made today in the British medical journal, The Lancet, that medical malpractice is occurring in the supply of useless malaria drugs to Africa. The World Health Organisation and the Global Fund for AIDS, TB and Malaria (GFATM), are responsible for this deadly policy failure. AIDS activists and Democrats, who attack Mr. Bush for his miserly funding of these agencies for the treatment of AIDS should acknowledge that the Bush administration is right to retain control of the funds it delivers, since it is far from certain the Geneva-based multilateral health agencies can be trusted.
In 1998 the WHO said it would halve malaria deaths by 2010. Today, half way through the allotted time, malaria deaths are increasing globally. The WHO recently blamed energy policies and climate change for the increase but its own policy failures are responsible. Furthermore, the GFATM has been spending more money buying ineffective drugs to treat malaria patients in Africa than on effective drugs, claims The Lancet paper, authored by Dr. Amir Attaran, of the Royal Institute of International Affairs, and a Who's Who of the malaria medical fraternity. The authors accuse both the WHO and GFATM of medical malpractice and call for some wide ranging reforms.
Drugs to Combat Malaria
For many decades, malaria patients around the world could rely upon chloroquine to cure them of the parasitic disease. When this drug began to fail during the 1970s, sulphadoxine-pyrimethamine (SP) took its place, but that too, began to fail as the parasite developed resistance to it. The most effective drug at the moment, Artemesinin, is based on an ancient Chinese herbal remedy; an extract of the sweet wormwood plant. When used in combination with other drugs (Artemesinin Combination Therapies, ACT), it not only clears parasites from blood faster than other drugs, but also greatly reduces the chances that drug resistance will develop.
Like all new patented drugs, Artemesinin-based therapies are more expensive than both chloroquine and SP (both off patent), mostly because the process of extracting the active ingredient from the plant is very costly. The unit cost of chloroquine is around $0.13, SP is around $0.14 while ACTs cost anywhere between $1 and $3.
Cost should not be an insurmountable problem for African countries as the whole idea behind the GFATM was that it would provide funding for the expensive drugs that these countries could not afford. Yet, according to The Lancet study, in the two most recent funding rounds, GFATM has spent more on chloroquine and SP (a total of $38.5m) while ACTs only received $16.1m. Because of the price differences, this means that around 10 times more people are being treated with failing drugs than on the drugs that actually work.
For some countries, such as Senegal and Kenya where the treatment failure rates can be as high as 50%, the GFATM's funding decisions are deadly. Not only will people die because of the useless drugs, but the ongoing prescription of these medicines means that drug resistance will be exacerbated and spread to other areas.
Far from providing guidance on this matter, the WHO has been sanctioning the use of these ineffectual drugs. WHO country representatives in Uganda and Ethiopia reviewed GFATM funding proposals and supported them, despite the fact that The Lancet study points to "obvious errors of scientific and medical judgement." Perhaps it isn't surprising the WHO malaria policies are failing Africa. WHO International in Geneva refuses to support the use of insecticide spraying, which has been shown time and again to be one of the most effective ways of controlling mosquitoes, and therefore malaria. If WHO Geneva can be negligent when it comes to mosquito control, why shouldn't they be negligent when it comes to malaria treatment?
South Africa is in a fortunate position since the government can afford to fund its malaria control entirely from the national fiscus. This means that it has been able to maintain an excellent insecticide spraying programme as well as introduce ACTs in both KwaZulu Natal and Mpumalanga Provinces. The result is falling malaria rates, which are now near an all time low.
A Growing Scandal
The authors of The Lancet paper call for, among other things, clarity on malaria treatment guidelines from the WHO and a "green-light committee" made up of malaria experts who can critically assess funding proposals and ensure that effective drugs are delivered.
The growing scandal over funding for malaria control and treatment should be setting off alarm bells in Washington. The WHO and GFATM seem loathe to buy patented drugs, whether it is for malaria control or AIDS. But buying off-patent drugs that don't work is unacceptable.
President Bush has promised significant amounts of money for HIV/AIDS, some of which will to go to the GFATM. Yet. if the GFATM cannot get it right over malaria drugs, one wonders if they can sustain decent AIDS treatment. If drug resistance develops to the current range of AIDS drugs, as many experts have predicted, and the WHO doesn't change its policies, the results could be disastrous. In any event, thousands of people in Africa are dying needlessly from malaria because of negligent policies; African health ministers and President Bush should take the health bureaucrats in Geneva to task over this.
Mr Tren is a director of the South African health advocacy group Africa Fighting Malaria. Dr Bate is a visiting fellow at the American Enterprise Institute in Washington DC. Their paper on South Africa's control of malaria is published next month by the Cato Institute.