Scientists accuse international agencies of approving useless
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By EMMA ROSS
AP Medical Writer
LONDON (AP) The World Health Organization and other aid
agencies are undermining the battle against malaria by funding
cheaper and less-effective drugs, contributing to tens of
thousands of deaths of children in Africa, researchers asserted.
The scientists, writing in The Lancet medical journal, accused
WHO and the Global Fund for AIDS, Tuberculosis and Malaria of
promoting programs that use the wrong drugs because they are
a tenth the cost of better medicines.
Both agencies defended their positions, saying they cannot
dictate countries' drug policies and that many are changing to
the new drugs.
At least 1 million people, most of them children, die every year
from malaria. One reason propelling the deadly mosquito-borne
epidemic is that the bug has become immune to the
conventional drugs, chloroquine and
Newer drugs, known as artemisinin-class combination therapy,
or ACT, are considered the best treatment in areas where
resistance has become widespread.
In the Lancet, health scholar Amir Attaran from the
London-based Royal Institute of International Affairs and
colleagues from Africa, Asia and Europe cited many examples
where the old drugs were funded for countries with
Many malaria programs are financed by the Global Fund for
AIDS, Malaria and Tuberculosis, set up in 2002 to channel
money into fighting the three diseases in the developing world.
"Most African countries reluctantly cling to chloroquine,
sulfadoxine-pyrimethamine, or the insignificantly better
combination of (them) because ACT is 10 times more
expensive, and therefore unaffordable to them," the scientists
say in the Lancet paper.
"When those same countries seek financial aid from the Global
Fund to purchase ACT, they are forcefully pressured out of it by
governments such as the U.S.A.," the scientists said.
The U.S. Department of Health and Human Services said in a
statement that it "has never pressured any nation to use the
drugs cited in the article as less effective, in place of the more
expensive ACT drugs."
The experts cited Kenya, where drug-resistant malaria is
widespread. The Global Fund rejected an application to fund a
$102 million malaria program based on the new drugs, but later
approved one using two older drugs that cost $33 million.
Vinand Nantulya, senior adviser to the executive director of the
Global Fund, said Kenya's original application was rejected
because its strategy was not clear enough.
However, Attaran said the Global Fund had also agreed to
finance a combination of the two old drugs in Uganda and
Ethiopia, a pairing WHO describes as "not recommended."
Attaran and his colleagues said the funding of the wrong drugs
is "indefensible." The practice "at least wastes precious
international aid money and at most kills patients who have
The scientists estimate tens of thousands of children die every
year as a direct result of getting the wrong drugs.
WHO spokesman Iain Simpson said the agency's approval of
Global Fund proposals does not constitute a full technical
review. He said WHO officials might have signed off on
something that is in line with a country's drug policy, even if the
policy is outdated.
"It's not up to us to advise the Global Fund on how to spend their
money," or to dictate a country's policy on malaria treatment,
Simpson said. "It is up to us to assist countries in making sure
that they have the right drug policy and we believe that we're
doing that. A number of countries have changed their drug policy
over the last couple of years and we would advise others to do
But Attaran rejected that explanation.
"When countries request the wrong medicines, WHO signs off
on those applications and that's the bottom line," he said. "They
are saying they are happy to support the wrong medicine."
The Global Fund said it plans, together with WHO, to submit a
rebuttal to the Lancet article.
Nantulya of the Global Fund acknowledged some countries use
old drugs that should be using the new ones.
"At the time they made their proposals, the countries' drug
policies were based on what they could afford. They didn't know
the data on resistance," he said.
Proposals that involve the old drugs do get rejected, he added,
citing Nigeria as an example.
In addition, money is not tied to specific drugs and countries can
switch to the new drugs during a program without having to
reapply to the Global Fund, he said.
Nantulya said the Global Fund is now advising countries to shift
to the new drugs. "We don't think there is a crisis, because
countries that want to change are changing," he said.