The World Bank, a leader in the global effort to control malaria,
has been accused of deception and medical malpractice by a group of
public health doctors for failing to carry out its funding promises and
wrongly claiming its programmes have been successful at cutting the
death toll from the disease.
The serious charges are levelled by Amir Attaran, a professor
at the Institute of Population Health and faculty of law of Ottawa
University, and colleagues from around the world. Writing in an online
publication for the Lancet medical journal, they say the World Bank is
unfit to lead global efforts to control the disease, which kills around
1 million people a year - most of them small children.
They argue that the World Bank has not delivered the
$300m-$500m (£168m-£280m) funding it promised to Africa when it
launched the ambitious global Roll Back Malaria campaign in 1998, which
was intended to halve malaria deaths this decade. They add that it has
not been open about the amounts it is spending on malaria and that it
has wasted money and endangered lives by allowing countries to buy
malarial drugs that no longer work.
In a response, also published online, the Bank acknowledges
that it should have done more in the past but says its current
programmes are well-funded, well-staffed and delivering results.
Professor Attaran and colleagues say the new plan "is
inadequate to reverse the Bank's troubling history of neglect for
malaria". The Bank at first refused to disclose how much it had spent
on malaria in each country, say the authors, but eventually published
accounts in April 2005 showing that in the previous five years it had
committed $100m-$150m to malaria programmes. It had also spent
non-earmarked funds on malaria it says are "difficult to quantify",
says the article.
"The most disturbing fact, however, is that the Bank actually
does not know, and at best guesses, how much money it spends or loans
for malaria," say the authors. "No commercial high-street bank could
keep such imprecise accounts for its clients without running a serious
risk of civil or criminal illegality."
In 1998 the Bank had seven staff dedicated to malaria. By 2002
it had none. "Without even a single worker, the malaria programme could
do little ... we cannot know what lay behind the downsizing of the
Bank's malaria team and whether the reduction in staff is explained by
careless management or an intention to renege on the funds pledged to
Africa. Regardless, funds stalled just as Africa's malaria cases rose
sharply, destroying several million children's lives and deepening the
poverty the Bank had promised to ameliorate," they write.
The Bank says malaria cases in Brazil dropped by 60% between
1989 and 1996 as a result of its programmes there. Prof Attaran and
colleagues say the figure was 23%. The Bank claimed malaria deaths in
three Indian states, Gujarat, Maharashtra and Rajasthan, dropped by
58%, 98% and 79% between 2002 and 2003. The authors obtained statistics
from India's directorate of national vector-borne diseases control
programme. In that year, "far from malaria cases declining in the three
states the Bank names, actually the numbers rose sharply in all of
them", they write.
The Bank, they conclude, "remains unfit for any operational
role whatsoever in malaria control". They call for its role to be
passed to other agencies, principally the Global Fund to fight Aids,
Tuberculosis and Malaria.
Jean-Louis Sarbib and colleagues, for the World Bank, say it
is difficult to be specific about the sums spent on malaria, some of
which will have gone to improve healthcare systems, the training of
staff and the provision of drugs for a variety of diseases, not just
one. They reject accusations the Bank has funded chloroquine for areas
of India where it no longer works because of resistance that has built
up in the parasite which causes the disease.
Mr Sarbib and colleagues say the World Bank is dedicated to
fighting malaria. "Paul Wolfowitz has put the full weight of his
leadership behind the Bank's renewed commitment to malaria," they say.
But the Lancet points out that "malaria was absent from
Wolfowitz's policy speech on April 11 ... instead, he emphasised
reducing corruption in recipient governments by increasing the Bank's
department of integrity staff from 53 to 65". If the Bank is serious
about results, the journal says, it needs to focus on the Abuja 2000
target of halving mortality by 2010.
· Malaria is caused by a parasite passed by an infected
female Anopheles mosquito. There are four species of parasite, of which
the two most common are Plasmodium falciparum and Plasmodium vivax.
· Symptoms include extreme exhaustion with high fever, sweating, shaking chills and anaemia.
· Patients need treatment within 24 hours to avoid risk of severe disease, which has a high fatality rate.
· Resistance to commonly used drugs has grown rapidly. The new hope is the artmisinin compounds, derived from a Chinese herb.