New Delhi: In a hard-hitting viewpoint published in the online edition of the medical journal Lancet to mark Africa Malaria Day (April 25), Canadian health experts have accused the World Bank of giving false financial and statistical figures about its malaria programme worldwide, in particular in Africa, and having wasted money on ineffective medicines in malaria treatment in India.

The authors, Amir Attaran and his colleagues, have claimed that, since 2000, the Bank had concealed the amount of its actual expenditure on malaria; reneged on its commitment of $300-500 million for malaria control in Africa; downsized its staff of malaria experts from seven to zero shortly after promising to do more for the disease; published false epidemiological statistics to exaggerate the performance of its malaria projects and funded clinically ineffective treatment against the advice of WHO for a potentially fatal plasmodium falciparum malaria in India.

According to the Lancet report, in April 2005, when the Bank launched its Global Strategy and Booster Programme, it had reported that India had achieved dramatic reduction in Gujarat (58 per cent) Maharashtra (98 per cent) and Rajasthan (79 per cent) through the Bank-supported Malaria Control Project, and that too in just one year from 2002 to 2003.

Doubting that such reductions were possible in such a short time, the authors cross-checked the data with the data of the Indian Government's National Vector-Borne Diseases Control Programme (NVBDCP) and found that the data were at complete variance with the Bank's claims. "According to NVBDCP," the authors point out, "far from malaria cases declining in the three States, the numbers actually rose sharply in all of them."

To understand the discrepancies, when the authors sought the India project status report, the Bank apparently refused. "We cannot [therefore] discern the cause of the Bank's many statistical errors, and particularly whether these errors arise from unintentional mistakes or from intentional data falsification. We note that most of the statistical errors exaggerate the performance of the Bank's projects."

The authors' investigations also found that on six occasions in 2004 in which the Bank approved the purchases of chloroquine in its projects knowing full well that the drug would be used in chloroquine-resistant P. falciparum malaria. The chloroquine purchases were worth $1.8 million and exceeded 100 million tablets.

Chloroquine resistance

In doing so, the authors point out, the Bank disregarded medical realities and WHO guidelines. Epidemiological studies, they point out, have shown that rising chloroquine resistance is associated with an increase of two to 11 times in malaria deaths, particularly in children. According to WHO policy since 2003, chloroquine should not be used when the treatment failure rate exceeded 15 per cent. "The quantities make it probable that millions of patients with P. falciparum malaria received such treatments inappropriately. Both money and lives are wasted by these decisions," say the authors.

World Bank's Jean-Louis Sarbib and colleagues have, however, rejected these charges in an accompanying article. According to them, in India the Bank focussed on co-financing a country-led strategy that tailored drug treatment policies to match the distribution of different malaria parasites in the country. This approach was "more effective."

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