In the right hands?

New Delhi, April 25: An international team of health experts has accused the World Bank of funding obsolete treatment for a potentially deadly form of malaria in India and wasting lives and money through ineffective medicines.

The health experts, based in Europe, North America and Africa, have also said the World Bank used “false claims and statistics” to exaggerate the performance of its malaria control projects in Brazil and India.

The World Bank has denied the allegations. “These claims are utterly false and sensational,” said Suprotik Basu, a public health official with the World Bank in Washington DC. “The government of India formulates its malaria control strategy, and the bank funds both chloroquine and combination therapies.”

In a viewpoint in The Lancet, a medical journal, the health experts said the World Bank “wasted money and lives on ineffective medicines” by funding the purchase of the drug chloroquine in India, knowing it might be used on patients with chloroquine- resistant malaria.

Malaria caused by chloroquine-resistant plasmodium falciparum parasite has been spreading across India. Patients infected with this parasite when given chloroquine can develop severe disease or even die.

In 2003, the World Health Organisation recommended combination therapies, including a drug called artemisinin, for such malaria.

Yet in 2004, the bank approved purchases of over 100 million tablets of chloroquine for India “making it probable that millions of patients with plasmodium falciparum received such treatments inappropriately”, public health specialist Amir Attaran at the Institute of Population Health at the University of Ottawa, Canada, and his colleagues said.

“Had a doctor behaved as the bank did, ignoring expert guidance... and unethically supplying ineffective treatments for a potentially fatal disease, the person would be condemned and possibly sued for medical malpractice,” they said.

“It’s disgusting,” Attaran told The Telegraph in a telephone interview. “Children with falciparum malaria would have died because they got medicines that wouldn’t work.”

A top Indian malaria expert said national malaria control programme officials were also responsible for continuing with the chloroquine therapy when plasmodium falciparum was spreading.

“India should have switched over to combination therapy which is the correct way of dealing with plasmodium falciparum,” Vinod Prakash Sharma, former director of the Malaria Research Centre in New Delhi, said.

“Both the bank and the Indian government are equally to blame,” Attaran said. “It’s tragic, because India has the money that Africa doesn’t have, and India has drug industries that could produce combination therapy,” he said.

Responding in the same issue of The Lancet, bank officials said India has adopted a strategy to tailor drugs to match different malaria parasites in different parts of the country. Artemisinin therapy is given in areas with falciparum.

Chloroquine is cheaper than artemisinin and India stood to get “good value for money” by spending scarce resources wisely, they said. Chloroquine is still effective against plasmodium vivax, which accounts for one out of two malaria cases in India.

Attaran and his colleagues have also said the decline in the number of malaria cases in Brazil and India claimed by the World Bank is not supported by government figures from the two countries.

World Bank documents say malaria declined by 93 per cent in Maharashtra, 80 per cent in Gujarat and 40 per cent in Rajasthan between 1997 and 2002. These numbers are “highly inconsistent” with government figures, Attaran and his co-authors said.

The bank officials said malaria cases declined in bank-funded project districts much faster than in India as a whole.