Experts Rip World Bank on Malaria Work

Danica Kirka | 25 Apr 2006
Washington Post
A group of public health experts accused the World Bank on Tuesday of faking medical data, approving useless treatments and reneging on promises to help fund the fight against malaria.

A dozen experts who signed the opinion piece in the online version of the British medical journal The Lancet charged that the bank falsified data to indicate progress against malaria and approved obsolete treatments for a potentially deadly form of the disease _ charges the institution hotly denies.

The article accuses the bank of not honoring a 2000 pledge of between $300 million and $500 million in loans to fight malaria in Africa. The piece says that, according to the bank's most recent accounting, it has spent between $100 million and $150 million, plus some unspecified funds that are "difficult to quantify."

"The bank failed to lend Africa the funds for malaria control that it said it would, and rather than admit this with candor, the bank concealed the fact by using untransparent and contradictory accounting," immunologist Amir Attaran, who also is a lawyer at the Institute of Population Health at Canada's University of Ottawa, wrote in the article.

The World Bank disputed many of the criticisms in the article, acknowledging that its malaria programs have been understaffed and underfunded but insisting that the bank has learned from its mistakes and moved to set things right

In a response published with Attaran's article, bank officials argued it was difficult if not impossible to put a specific figure on how much money the bank had directed to malaria control, since such efforts were often part of larger health programs. But the bank stressed it would try harder to direct more money to malaria-fighting efforts.

One of the charges by the experts was that the bank funded programs in India using chloroquine - a drug they claim is largely ineffective - instead of more costly and effective drugs.

The bank argued that a uniform national policy would have been inappropriate in India, a vast country where chloroquine is still effective in some regions.

The experts also charged that bank statistics were manipulated to make it seem as if its malaria programs were making progress.

"They tortured the data until it confessed the desired outcome," Attaran said. "They fabricated the data."

Bank officials defended their numbers, arguing that their figures had been subjected to rigorous review.

Officials insisted that the Attaran piece was "old news" and said that the bank will commit as much as $1 billion to the global fight against malaria worldwide with other partners in the next five years - with as much as half directed to Africa.

The bank also has dedicated more people to the issue, said Suprotik Basu, a public health specialist who deals with malaria in Africa. While last year the bank had no one dedicated to the disease - which was noted in the report - now at least 40 people are working on malaria-related projects.

"We've managed in a year's time to turn around a relatively large ship," Basu said. "The bank is beginning to live up to what it could do for malaria-fighting in Africa."

The opinion piece and the bank's counterpoint were published to coincide with Africa Malaria Day, which marks the sixth anniversary of an agreement by officials from 44 malaria-afflicted African countries to try to halve the global incidence of malaria by 2010.

Malaria - which is caused by a parasite carried by mosquitoes - kills more than 1 million people a year, many of them young children in Africa, even though it is both preventable and treatable. As much as 40 percent of the world's population is at risk, mostly in poor countries, the World Health Organization said.

Signers of Attaran's article include public health experts at the University of Oxford, the London School of Hygiene and Tropical Medicine and the Prince Leopold Institute of Tropical Medicine in Antwerp, Belgium