A group of public health experts has called for an independent investigation into the World Bank’s publication of “false epidemiological statistics”, approval of “obsolete treatments” for a deadly strain of malaria, and failure to uphold its pledges for funding malaria control. They have called for the Bank to get out of health programme work. The charges, authored by Amir Attaran from the University of Ottawa, and the Bank’s response appeared in the 25 April online issue of the British medical journal The Lancet.
Attaran and his colleagues assert that the Bank falsified statistics on its anti-malarial programmes in Brazil and India, hugely overstating their effectiveness. The Bank has conceded as much in the case of Brazil, correcting the original data on its website. In India, the Bank argues that the discrepancy between its numbers and that of the Indian government is caused by the Bank limiting its figures to those districts “with the highest burden of malaria” in which it funded projects. In communication with the Bretton Woods Project, Attaran has countered that “no data were given by the Bank for this claim, and if it is true, then several Bank districts underperformed the surrounding districts”.
the job to fix malaria must no longer be based at the Bank
Most troubling are charges that the Bank approved the purchase of chloroquine, knowing it was ineffective for treating the deadly strain of malaria (falciparum) commonly found in India. In his response, Jean-Louis Sarbib, senior vice-president of the Bank’s Human Development Network, defended the decision. He said that chloroquine is still generally an effective treatment for vivax, a non-deadly strain which causes 52 per cent of the country’s malaria. Chloroquine is cheaper than other drugs and “India stood to get good value for money by spending scarce resources in accordance with local realities”, said Sarbib. However, Dr. Nick White, professor of tropical medicine at Oxford and Mahidol Universities, and chair of the World Health Organisation committee that sets global guidelines for malaria treatment, disagrees with the Bank: “In much of malaria-affected India, both malaria species [vivax and falciparum] are present. … It is clearly wrong to support ineffective treatments for life threatening infections.”
In 2000 the Bank pledged to make available $300 to $500 million to fight malaria in Africa. After claims in 2001 that it had already made available $450 million, the Bank was forced to backtrack in 2002, admitting that the real figure was only $200 million, and that the number of countries where it supported anti-malarial programmes had been cut from 46 to 25. The number of malaria specialists at the Bank during this period fell from seven to zero.
Sarbib has conceded that efforts by the Bank in malaria control during this period “were understaffed and underfunded”. He believes that the Bank turned a corner with the 2005 Global Strategy and Booster Program. The number of staff members working on malaria has grown from none to more than 40 in the past year. Sixty-two million dollars in new spending has recently been approved, with expected new commitments in Africa and South Asia to reach more than $500 million in 2006 – 2008. This figure however conflicts with Bank responses to questions from Attaran’s team, when it said it would commit up to $500 million, (shifting the rest of the financial burden onto unspecified “partners”). The Bank has provided no data on country programmes to substantiate the new figure, with critics suggesting it may evaporate like the commitments made in 2000. As a result of their findings, Attaran believes that “the job to fix malaria must no longer be based at the Bank”. His team thinks that the institution’s “performance lags far behind the more agile Global Fund for AIDS, Tuberculosis and Malaria (GFATM)”, its “technical expertise is insufficient”, and it is “institutionally unsuited to deliver excellence on malaria”. This conclusion, says Attaran, is backed up by the Bank-commissioned review of the comparative advantages of the Bank and the GFATM. It argued that “the lead responsibility for health systems should be with the Bank, and for prevention and treatment with the Global Fund.”
The options, says Attaran, are for the Bank “either to spend years plodding to rebuild competence in malaria – years in which over a million people will die – or to honour its past and future funding commitments by handing that money to more expert institutions that are swifter to act.”