by Jeremy Laurance
April 11 2004
Two of the world's most powerful medical organisations have been accused
of medical malpractice for knowingly promoting useless drugs 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 drugs for poor countries, have allocated
millions of dollars to malaria medicines that are no longer effective
against the disease, a group of specialists say.
They claim negligence by the two organisations 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.
Attaran, a lawyer and malaria expert, said:
"If a hospital consultant were to provide medicines to patients
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, was 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, and colleagues from Sweden and Kenya, say
in The Lancet that deaths in eastern and southern Africa have doubled in
the past decade.
"Provision of ineffective drugs for a life-threatening disease is
indefensible. We have failed to roll back malaria and we in the
developed world bear the responsibility for this humanitarian
disaster."
The WHO said that changing countries' approach to malaria treatment was
"a process, not an event". But 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
policymakers in the affected countries over moving to more expensive
treatments.
"The Global Fund says they have the money but the policymakers
worry that it may be withdrawn in a couple of years.
"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 the financial consequences for the global community were
serious. The WHO's estimate is that spending on anti-malarials will have
to rise from the present $50-million a year to $1-billion.
Aids distracts attention from an even deadlier epidemic. In Malawi,
malaria still claims more lives each year than Aids, but attracts a
fraction of the attention. Coachloads of overseas visitors come to view
the Aids drugs projects run by Médicins Sans Frontieres outside
Blantyre, which hand out free anti-retrovirals 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 - whereas
Aids threatens us all.
Yet the scale on which the parasite, transmitted by the mosquito, kills
is breathtaking. It causes 300 million cases a year and more than one
million deaths. About 40 percent of the world's population is at risk,
in the tropics and sub-tropics.
Six years ago the WHO set a target to halve the number of deaths by
2010, but instead the toll has risen by at least a quarter, and in some
areas by as much as 50 percent, because victims have not had the right
drugs. Hundreds of thousands of children have died needlessly, virtually
unnoticed in the West.
Sub-Saharan Africa is the worst-affected region, 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 ten of those who die are
children.
For 40 years chloroquine was the standard treatment. Patients swallowed
a couple of pills at the onset of the fever and within 48 hours they
would be 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
percent of cases.
Surveys in East Africa show that almost two-thirds of patients given
chloroquine and nearly half of those on its successor,
sulfadoxine-pyrimethamine, have died.
After six years of the WHO programme, malaria deaths have soared.
Thousands more children will die unless the life-saving artemesinin
drugs reach the people who need them. - Foreign Service
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