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Who Decisions Imperil Africa

Business Day (Johannesburg)
ANALYSIS
October 11, 2004
Posted to the web October 11, 2004

By Roger Bate
Johannesburg
AID care packages for the starving and malaria-ravaged children of Sudan's
wretched Darfur region "contain antimalarial medicines that will not work",
Republican senator Sam Brownback said at a US hearing on malaria last week. It
is astonishing that these drugs, mainly supplied by the United Nations
Children's Fund (Unicef), are being included in packages when they indirectly
kill children every week. Lives could easily be saved by switching to readily
available alternative therapies.
It is doubly disgraceful when Unicef , the World Health Organisation (WHO), the
US Agency for International Development (USAid), and other agencies were
criticised in January, in the medical journal The Lancet, for erroneously
supplying this same medicine, chloroquine, in numerous African countries.
Chloroquine has been the mainstay of anti-malaria programmes for the past 50
years, and is still useful in many countries. But in some, such as Ethiopia and
Sudan, failure rates due to drug resistance reach as high as 88%, so
alternatives should be used instead.
Agencies' laziness, inertia, lack of attention to the scientific literature and
inability to persuade African nations of the need to change drug regimes means
the continued purchase of these failing drugs in Africa. More than $41m, much
of it funded by US taxpayers, was spent buying these drugs for African
countries in 2003. It is not yet known how much has been spent in Darfur on
useless drugs, but the amount will not be trivial.
These recent disasters were not the first time the WHO wasted millions of
dollars on ineffective malaria interventions. In May 1995, the WHO purchased
the malaria vaccine, SPf66, only to find out a year later that the incidence of
malaria in the Thailand and Gambia refugee camps, where the WHO had conducted
its medicine trials, had risen, proving the vaccine ineffective.
Regardless of such errors, the WHO launched, with great fanfare, the Roll Back
Malaria campaign in 1998, pledging to halve malaria cases by the year 2010 and
demanding hundreds of millions of dollars to achieve success. Now at the
halfway mark, we find that malaria cases are in fact on the rise, and that
deaths have increased.
While all the agencies deserve blame for the recent egregious errors, the WHO
is the prime culprit. The WHO sets international health policy, behind which
all aid agencies naturally coalesce . And while there is little doubt that the
folks at the Geneva-based WHO mean well, their recent policies and
interventions look worrisome. In the past few years, the US has provided about
a quarter of the funding for the WHO. It has to be asked whether the money is
well-spent.
In addition to the malaria drug debacle, the WHO had to embarrassingly recall
five drugs used to treat the world's biggest scourge, HIV/ AIDS. Without
waiting for full safety and efficacy testing of antiretroviral drugs made by
two Indian generic manufacturers, Cipla and Ranbaxy, the WHO approved the
medicines for widespread use in 2001. With the WHO stamp of approval, nations
started buying the cheaper copy drugs . It's too soon to know what harm has
been caused, because the WHO did not carefully monitor the use of these drugs,
but what is certain is that the drugs should never have left Bombay.
Unfortunately, they made their way to Africa.
Compounding its earlier mistake, and apparently more concerned for its own
reputation than the children dying from AIDS, the WHO didn't widely announce
the recall to the media. Only some weeks after its policy U-turn, when the New
York Times published a story on the recall, was it widely known. Indeed,
according to experts in the field, some of those who needed to know the
information found out through media channels and not from the WHO.
The WHO now finds itself in a ridiculous position: it has continued to promote
the potentially harmful AIDS drugs because the risk of interrupting treatment
is more dangerous than providing medicines whose bioequivalence is not proven.
In addition to the mistakes on malaria and AIDS, there have been dubious
decisions taken on measles, obesity, substitute milk products and tobacco
control, to name but a few. It is time for the US congress to investigate how
the money the US donates to the WHO is spent. If there is not an immediate
overhaul of WHO policies, the US should withhold support, redirecting tax
dollars to agencies with a better chance of success. More than a few hundred
million dollars is being wasted; the lives of Africa's children, in particular,
hang in the balance.
Bate is a visiting fellow of the American Enterprise Institute and a Director
of Africa Fighting Malaria.

   

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