Two of the world's most powerful medical organisations have been accused of medical malpractice for allegedly promoting useless medicines that have led to the deaths of hundreds of thousands of children.
The World Health Organisation (WHO) and the United Nations Global Fund, which was set up to buy medicines for poor countries, have allocated millions of dollars to malaria medicines that are no longer effective against the disease, a group of specialists said.
They claim negligence by the two organisations has contributed to a rising death rate from malaria, which has doubled in a decade in some parts of Africa because of growing resistance to older drugs.
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The WHO launched its Roll Back Malaria programme in 1998, with a target to halve the number of deaths by 2010, but six years into the 12-year programme, deaths have risen from between 600 000 and 800 000 to more than one million annually. Of these, 90 percent are children under five.
| 'How can it be right for a global medical organisation?' |
In some areas the death rate has risen by as much as 50 percent, simply because victims have not had the right medicines. Hundreds of thousands of children have died needlessly and this has gone virtually unnoticed in the West.
Amir Attaran, of the Royal Institute of International Affairs in London, who made the accusation of malpractice in The Lancet with 12 malaria specialists from Britain, the United States, Africa and the Far East, said, "I am angry... It is really negligent for these organisations to have made no progress towards the target in six years. Why should anyone connected with the programme still have their job?"
In 2003 the Global Fund, acting on advice from the WHO, spent $41,4 million (R290-million) on the outdated anti-malarials, chloroquine and sulfadoxine-pyrimethamine, which have been rendered useless by growing drug resistance, but only $18,3-million (R128-million) on artemesinin-based therapies, which are effective.
For 40 years chloroquine was the standard treatment.
Patients swallowed a couple of pills at the onset of fever and within 48 hours they were better. It was safe, effective and cheap.
But, over recent decades, a drug-resistant strain of malaria, Plasmodium falciparum, has been growing in Africa and now accounts for well over 90% of cases. Surveys in East Africa show almost two-thirds of patients given chloroquine and nearly half of those on its successor, sulfadoxine-pyrimethamine, have died. The only effective therapies are those based on artemesinin, a drug derived from a weed that grows wild in Africa and the Far East.
Sub-Saharan Africa is the area worst affected by malaria, accounting for 80 percent of the world's cases. A child under five in Malawi can expect to get malaria three or four times a year, while an adult will go down with the fever at least once a year. Nine out of 10 of those who die are children.
Yet, countries in this region have proved reluctant to buy the new artemesinin drugs, because they are more expensive at $1 to $2 (R7 to R14) a dose, 10 times more than chloroquine and sulfadoxine-pyrimethamine.
One dollar is not a lot to save a life, but because of the vast numbers affected - 600 million people in Africa - countries have been afraid to pay for the new drugs, even with full financial support from the UN Global Fund. They fear that somewhere down the line they may be left to foot the bill themselves. As a result, patients treated with outdated drugs in Africa outnumber those given the artemesinin drugs by more than 10 to one.
But Attaran, a lawyer and malaria expert, said: "If a hospital consultant were to provide medicines which 80 percent of the time were ineffective, would that not be malpractice? And if it is wrong for an individual doctor to behave in that way, how can it be right for a global medical organisation?"
Bill Watkins, co-author of the Lancet paper and research fellow at the University of Liverpool, is a former director of the Wellcome Research Unit in Nairobi, Kenya. He said: "I spent 30 years working on malaria in Africa and we have been getting more and more frustrated at the lack of progress. The figures speak for themselves. Vast sums are being spent on chloroquine, which should not be used anywhere in Africa."
Other scientists have supported the specialists. Nicholas White from Mahidol University, Bangkok, with colleagues from Sweden and Kenya, says in The Lancet, "Provision of ineffective drugs for a life-threatening disease is indefensible... We in the developed world bear the responsibility for this humanitarian disaster."
Allan Schapira, co-ordinator of the policy team for the WHO Roll Back Malaria programme, admitted mistakes had been made.
"The principal charge that people have had insufficient access to the right drugs is correct. The impediment has been the anxiety of policy-makers in the affected countries over moving to more expensive treatments. The Global Fund says they have the money, but the policy-makers worry that it may be withdrawn in a couple of years."
He added: "I would concede we should have come out more strongly with our guidance. We should have spoken with a louder voice. We were aware there was a lamentable use of funds for better drugs. Too many countries applied for chloroquine and we should have said more strongly they can't go on with this."
Schapira said, however, the financial consequences for the global community were serious. WHO's estimate is that spending on anti-malarials will have to rise from the present $50-million (R350-million) to $1-billion (R7-billion).
To make matters worse, Aids distracts attention from an even deadlier epidemic. In Malawi, malaria still claims more lives each year than Aids, but it attracts a fraction of the attention.
Coachloads of overseas visitors come to view the Aids drugs projects run by Médicins Sans Fronti?res outside Blantyre, which hand out free antiretrovirals to people with HIV, but few are interested in malaria.
Malaria is old and Aids is new. Malaria has never captured the public imagination as Aids has done, even though children are its chief victims. Most important, malaria is not a disease that bothers the West - except for those fortunate enough to holiday in the tropics.
Yet the scale on which malaria kills is breathtaking. About 40 percent of the world's population is at risk, in the tropics and sub-tropics.
The WHO, which advises countries which drugs to buy, and the Global Fund, which provides the cash, have both argued that it takes time to persuade countries to change their treatment policies. - The Independent
- This article was originally published on page 9 of Sunday Tribune on April 25, 2004
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