[afro-nets] My oped on NRO on World Bank Funding for Malaria

[Philip Coticelli <pcoticelli@gmail.com>]

My oped on NRO on World Bank Funding for Malaria
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http://www.nationalreview.com/comment/coticelli_schwab200604270701.asp

April 27, 2006, 7:01 a.m.
Sickening Incompetence

The World Bank needs to clean up its act when it comes to pre-
venting malaria.

By Philip Coticelli & Justin Schwab*

The World Bank is publishing inaccurate data to save face rather
than face up to its failure to control malaria. Worse still, it
is promoting ineffective treatments in India, resulting in the
death of an unknown number of children. The Bank is incapable of
disease control work and it should leave the field to more com-
petent agencies.

In the 20th century, malaria all but vanished from the developed
world. Chloroquine and DDT helped eradicate the disease in North
America and Europe, and brought it to a nadir worldwide. In Af-
rica and parts of South Asia and South America, however, the ef-
fort was thwarted by lack of basic infrastructure. Today, sub-
Saharan Africa is home to 90 percent of reported cases.

More money and attention are devoted to the disease than ever
before. We can readily produce drugs, bed nets, and pesticides.
So why does malaria remain among the world's deadliest diseases?
We have been waging a cheap, sloppy war against malaria, without
using all available weapons.

Six years ago, the World Health Organization (WHO) met with the
World Bank, USAID, and African heads of state at the Abuja Sum-
mit to Roll Back Malaria. Although the attendees committed to
halve malaria cases by 2010, it was not a sincere commitment,
since they failed to establish baseline figures for the disease
­ one cannot halve an unknown amount.

While figures are speculative, WHO admitted in its World Malaria
Report 2005 that the rate of infection in Africa is likely equal
to or higher than that in 2000. But this has not stopped agen-
cies from claiming progress.

A new study in THE LANCET disproves these claims. Dr. Amir Atta-
ran et al. charge that the Bank concealed its real expenditures
on malaria; reneged on commitments of $300-500 million; cut its
staff of malaria experts from seven to zero; published inaccu-
rate data to exaggerate the effects of its programs in India and
Brazil; and purchased chloroquine against WHO recommendations
and in spite of high rates of parasitic resistance to the drug.

Suprotik Basu of the Bank's malaria-program staff responded to
these accusations swiftly, telling Reuters, "Any insinuation
that the bank's support for malaria control in Africa or world-
wide has been responsible for the deaths of children is mislead-
ing and grotesquely incorrect."

THE LANCET authors asked the world's top expert for an opinion:
Dr. Nick White, professor of Tropical Medicine of Oxford and Ma-
hidol Universities, and chairman of the WHO committee that sets
that organization's guidelines for malaria treatment.

Professor White was so horrified by the Bank's false justifica-
tion, he wrote to them saying:

"Chloroquine resistance in Plasmodium falciparum has fuelled the
resurgence of malaria in India over the past two decades. In
much of malaria affected India, both malaria species [vivax and
falciparum] are present. I cannot find evidence in the public
domain that supports your contention that chloroquine still
works well for falciparum malaria in areas where the World Bank
has supported chloroquine deployment. Do you have this evidence?
It is the cornerstone of your defense. It is clearly wrong to
support ineffective treatments for life threatening infections."

Professor White ­ and India's children ­ awaits the Bank's re-
sponse.

Like other donors, the Bank has relied too much on bed nets and
too little on indoor residual spraying (IRS) with insecticides.
Bed nets appear convenient since one can pretend that distribu-
tion equates with use. For example, the U.S. Agency for Interna-
tional Development (USAID) passed out the equivalent of one net
per home in Togo and Zambia and claimed 90 percent coverage
against malaria. It relegated to a footnote the fact that only
56 percent of those nets were being used (and that amount does
not mean they were used properly all night).

After much congressional pressure USAID is now promoting IRS ­
and allegedly with DDT, a chemical that has long been stigma-
tized. Contrary to popular belief, DDT has not been shown to
cause human cancer. In addition to ridding the developed world
of malaria in the mid-20th century, DDT has been used recently
in Africa to great effect.

DDT use has been restricted by donors taking a passive stance,
requiring countries to pursue every alternative before using
DDT. Some donors are more overt in their opposition. Last year,
the EU threatened Uganda with trade sanctions
http://www.fightingdiseases.org/main/articles.php?articles_id=415
if it purchased DDT for public health programs.

Africa Fighting Malaria http://www.fightingmalaria.org/ , a
health advocacy group we work with, is lobbying USAID and the
World Bank to spend more on anti-malarial drugs, nets, and in-
secticide and less on technical advice and conferences. They
hope to see DDT de-stigmatized and used more widely by African
countries. Signatory supporters of their work include Nobel Lau-
reates Archbishop Tutu, F.W. de Klerk, Norman Borlaug, Roy In-
nis, and Patrick Moore (co-founder of Greenpeace).

AFM's campaign has contributed to recent shake-ups in malaria
control at USAID, but it is unclear if their message will reach
the World Bank and the greater Western public, which has long
been told that DDT is unacceptably dangerous.

Dr. Attaran et al. argue the Bank should end its haphazard man-
agement and donate the money to the Global Fund to Fight AIDS,
TB and Malaria http://www.theglobalfund.org/en/. In contrast to
the Bank, the Fund disburses money quickly, and is already the
largest single donor for malaria control. The Bank disbursed a
mere $150 million over the past five years, while the Global
Fund disbursed $151 million in under 7 months. The Fund operates
more transparently than the Bank, publishing and updating re-
cords on its website. It is committed to using all available
means to control malaria. Along with bed nets and effective
drugs for worldwide use, the Fund is buying DDT for targeted use
in South Africa, Swaziland, Mozambique, and Zambia. We agree
that the Bank's money would be better spent by the Fund ­ where
it will promote the image of DDT not as a killer but as a life-
saver.

--
* Philip Coticelli is a consultant for Africa Fighting Malaria
(http://www.fightingmalaria.org/) and works at the National In-
stitute of Neurological Disorders and Stroke.

Justin Schwab is a graduate student at the University of Cali-
fornia (Berkeley). They received no remuneration of any kind
from the chemical or pharmaceutical industries for this article.