World Bank accused of lying over funding to fight malaria

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The world's largest foreign aid organisation is accused today of deception and medical malpractice that has contributed to the unnecessary deaths of hundreds of thousands of children from malaria.

The World Bank, which has a $20bn (£11.2bn) budget and a mission to reduce poverty, is alleged to have published misleading financial claims and false statistical accounts and wasted money on ineffective medicines for treating the disease, which kills more than a million people a year, 90 per cent of them children.

More than half a billion people suffer from malaria and incidence of the disease is getting worse. Eight years ago the World Bank, with the World Health Organisation and the UN Global Fund, launched the Roll Back Malaria programme to halve malaria deaths by 2010. Instead, the toll has risen by at least a quarter and in some areas by 50 per cent. The WHO estimates 3,000 children die from it each day.

Today, 13 malaria specialists from around the world accuse the World Bank of reneging on its promise to spend at least $300m on malaria control in Africa. They say much of its spending from 2000 to 2005 has been concealed, but the available figures suggest it has spent less than half the amount pledged.

They allege the Bank has cut its malaria staff from seven to zero, exaggerated the success of its projects and is continuing to fund "clinically obsolete treatments". They demand an independent inquiry into the mistakes made and say the World Bank should wind down its malaria projects and allocate $1bn to other organisations with greater expertise, such as the UN Global Fund for Aids, Tuberculosis and Malaria.

Writing in the online edition of The Lancet, the authors, led by Professor Amir Attaran, a lawyer and malaria specialist from Ottawa University, say they made repeated attempts to raise their concerns with the Bank but were refused a meeting. "We therefore introduce our recommendations here, for concerned citizens to contact their elected representatives and urge the necessary changes on the Bank," they write.

Professor Attaran is a malaria activist and has challenged the global medical establishment over its failure to make progress. He is backed by specialists from Britain, the US, and Africa.

The World Bank rejected the allegations as unfounded in a response published simultaneously by The Lancet.

Although it is largely preventable with mosquito nets and insecticides, malaria is one of the biggest killers of under fives.

At a meeting in Abuja, Nigeria, in 2000, at which 53 African heads pledged to halve deaths from malaria by 2010, the World Bank made an "unprecedented" pledge to spend $300m- $500m to fight the disease in Africa. But its most recent accounts published in April 2005, show that from 2000 to 2005, the Bank committed "about $100 - 150 million in earmarked funds for malaria control" worldwide, plus an unspecified amount in non-earmarked funds.

"No one knows how much money the Bank actually disbursed, but even if it disbursed every dollar that it earmarked, the total is still very much less than the $300m-500m for Africa alone," the authors write.

In India, the authors allege that on five occasions in 2004, the Bank approved chloroquine for treating malaria, despite knowing it was ineffective against resistant forms (caused by the plasmodium falciparum parasite).

"Had a doctor or pharmacist behaved as the Bank did, [they] would be condemned and possibly sued for medical malpractice," they write.

In its response, Jean-Louis Sarbib and colleagues from the World Bank accept that in the early years of the programme the Bank's "overall efforts in malaria control were understaffed and underfunded". But they reject charges that it concealed funds or reneged on promises. They argue that it is often more effective to provide financial support to countries for development at a national level which can make it difficult to trace "how much input went from a specific donor to a specific activity".

They say a "one size fits all" approach to treatment is inappropriate in a country such as India, where over half of all cases of malaria are sensitive to chloroquine, which is 10 to 20 times cheaper than alternative drugs. "India stood to get good value for money by spending scarce resources wisely in accordance with local realities," they write.

They conclude: "Our approach is driven by results. We are committed to learning from our shortcomings and to sustaining our efforts."