WHO warns Global Fund on malaria policy

Andrew Jack | 14 May 2006

One of the world's leading international health bodies is pursuing a policy that could cause further resistance to malaria drugs, the World Health Organisation said on Sunday.

Kochi Arata, head of the WHO's malaria programme, told the Financial Times that the current policy of the Global Fund to Fight Aids, Tuberculosis and Malaria risked causing drug resistance.

He was referring to a compliance list of drugs circulated by the Global Fund, the world's leading funder of treatments for infectious disease, that contains advice on the malaria drug artemesinin. Artemisinin has proved effective in treating the worst cases of malaria, including those that have developed resistance to all other drugs.

However, health experts fear that the use of the drug as a "monotherapy" - without a second drug - will foster resistance, leaving no alternative medicine to treat the resistant parasite. 

The Global Fund's compliance list cites a number of such monotherapies, of which it believes manufacturing is of good quality, and is used as a guide for countries purchasing malaria drugs.

The WHO earlier this year launched an appeal to end monotherapy, calling on manufacturers to stop producing artemisinin alone, and on countries to ban its use. So far, 13 of the 40 manufacturers of artemisinin therapy it has identified have agreed to cease production.

Mr Arata said he was concerned that the others might seek to exploit the gap created by the Global Fund's compliance list and boost their own monotherapy sales.

While a number of countries have also agreed to withdraw marketing authorisation from monotherapies to ban their use, 49 have not.

Mr Arata said he was most worried about China, which both uses and produces large amounts of artemisinin. However, he also criticised what he called the "unsatisfactory" response of the Global Fund to the WHO's demands that it change its compliance list.

Contacted yesterday, the Global Fund said its policy was to follow whatever advice the WHO gave to countries that it funded.

It argues that its list is not compulsory and reflects WHO guidelines.

But the WHO argues that the list results in misuse and confusion, provides unnecessary endorsement for drugs and is used for marketing purposes by monotherapy manufacturers.