LONDON — 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 sulfadoxine-pyrimethamine. 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 drug-resistant malaria.
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 malaria."
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 so."
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.