The World Bank is failing miserably on malaria, like it failed on HIV/AIDS before it. Although it has a US$20 billion budget that, deployed intelligently, could lower sickness and accelerate economic growth, actually the World Bank is making a mess of its reputation and costing patients' their lives on medical and epidemiological judgments that are hideously unsound. With 12 academic colleagues we overcame stringent peer-review at the world's top medical journal, The Lancet, to publish the following.
Six years ago, the Bank made a promise to Africa's heads of state that it would expedite $300-500 million to control malaria on their home continent. It was a landmark promise, but one that today the Bank admits it never honored. Some years and millions of lost lives later, the Bank is keen to get past that failure, and has launched another malaria plan, entailing $250-500 million (i.e. less money) of its own budget.
But the Bank's past record suggests that its new commitment should not be welcomed. The Bank has played fast and loose with science, which is directly traceable to actions that, lamentably, are killing people.
Our research in The Lancet found that the Bank used falsified epidemiological statistics in Brazil, claiming to have reduced malaria cases deeply from a project lasting from 1989 to 1996, but what the Bank claims to be its success in achieving a deep reduction of malaria cases in the final year of its Brazil project (1996) is actually caused by the Bank stopping to count malaria cases after August of year (and normally of course, one counts the whole year, all 12 months). The partial-year counting is admitted in a 1997 document in the Bank’s archives, but inexplicably, it was hushed up when the Bank later published a peer-reviewed paper for a scientific journal, trumpeting its success.
So far, the Bank has stood by its lie about its activities in Brazil, and has refused to withdraw the paper its staff authored and which contain the false statistics.
Tragically the Bank’s mishandling of scientific issues has serious consequences--consequences that kill patients. The Bank vocally supports an obsolete malaria medicine, called chloroquine, including in parts of the world where the clinical evidence shows that it fails to treat patients with the life-threatening species of malaria. This is the case in India, where until last year, and possibly still, patients are receiving chloroquine treatments the Bank financed. But chloroquine resistant malaria of the fatal sort is rampant in India, and the Indian government's policy is to make no distinction between who does and who does not have that kind of malaria--the policy is chloroquine for everyone. For a patient with the resistant and potentially fatal sort of the disease, chloroquine is little if at all better than aspirin, or a jellybean. Using the wrong treatment means that the patient is apt to get sicker and die, especially if that patient is a child.
The World Health Organization has mandated globally since 2003 that chloroquine must never be used in settings where the treatment failure rate in fatal species of malaria exceeds 10% or 15%. The Lancet authors and others have told the Bank that its ongoing defence of chloroquine in India is none other than medical malpractice--an accusation heightened by the fact that the Bank's own publications show that chloroquine fails in up to 95.9% of Indian patients. Why the Bank approved contracts of $1.8 million to buy chloroquine in India when it knew of the dangers, and knew of the World Health Organization's international guidance, is baffling and a tragic waste of both money and children's lives.
What is needed is a sober reevaluation of whether the Bank is institutionally suited to disease control. Our view of the evidence is that the Bank lacks medical expertise and so should exit that role. The Bank seems to have forgotten its laudable and true strength in the infrastructural aspects of health, such as to finance the building of laboratories, clinics and medical schools, and to top up the salaries of doctors, nurses and scientists to stem their mass emigration out of poor African countries. The Bank should cede the disease control "turf" to organizations such as the WHO and the Global Fund to fight AIDS, Tuberculosis and Malaria, but redouble its necessary efforts on the infrastructural components of health care. Such a division of responsibility is more in line with the Bank's core competence, and the core competences of WHO and the Global Fund also. Both money and lives would be saved.
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