BMJ  2004;328:183 (24 January), doi:10.1136/bmj.328.7433.183-a

News

Researchers accuse WHO and Global Fund of malpractice

BMJ

An international group of 13 malaria researchers has accused WHO and the Global Fund of medical malpractice for supporting the use of ineffective malaria treatments. This practice, says the group, at the very least "wastes international aid money, and at most, kills patients who have malaria."

Writing in the Lancet ( 2004;363: 237-40)[CrossRef][ISI][Medline], the group says that in many African countries the agencies support the use of chloroquine and sulfadoxinepyrimethamine, which fail in up to 80% of cases, instead of highly effective artemisinin based combination treatments.

The group calculates that the Global Fund's purchase of ineffective drugs causes tens of thousands of children to die each year. This situation, it says, is ethically and legally tantamount to medical malpractice, analogous to a doctor who "knowingly furnished treatments that failed perhaps 80% of the time, while withholding the alternatives as `too expensive.'"

The group says the fund's technical review panel is doing poorly at reviewing countries' malaria proposals ( BMJ 2003;327: 1188[Free Full Text]) and that WHO must urgently define global guidelines for malaria treatment.

WHO denies that new guidelines are needed. Dr Allan Schapira, who leads the Roll Back Malaria initiative, said: "We gave clear recommendations [to use artemisinin based combination treatments] in 2001, which we sent to all four corners of the globe, in many languages."

It is not up to WHO or the Global Fund, he said, to dictate which treatments countries should use. Instead, national malaria control programmes must set their own policy. Six countries in Africa are already using artemisinin based combination treatments as first line treatment, he said, and it will take time and a "change in mindset" for other countries to move towards using these drugs.

On the charge of medical malpractice, he said that this accusation was "disgusting when you consider the efforts that our staff are putting in."

Dr Vinand Nantulya of the Global Fund explained that the fund's financing mechanism is flexible, which means that a country can switch to using artemisinin based combination treatments even if it originally requested support for purchasing less effective drugs.

But Professor Paul Garner, lead author of a meta-analysis showing that adding artemisinin to standard treatments substantially reduces treatment failure ( Lancet 2004;363: 9-17[CrossRef][ISI][Medline]), believes the fund is not spending enough on combination treatments. "The [Lancet] authors are spot-on with their criticism of the Global Fund. As a UK taxpayer, I am horrified that a UN organisation can waste money on interventions known to be ineffective."

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