The World Bank and the government differ on malarial death toll

Jean-Louis Sarbib, a World Bank official, claimed that “new commitments of about $500 million for malaria control in Africa and South Asia were expected in 2006?08.” And being the World Bank, the figures were taken at face value. One snag: there was more to this saga. An international team of public health professionals and malaria experts has accused the World Bank of cheating on a pledge to combat malaria. They have claimed in an article in the journal The Lancet that the bank faked figures, boosting the success of its malaria projects, and reneged on a pledge to invest $300-500 million in Africa.

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, D.C.

The bank said that it reduced deaths from malaria in Gujarat by 58 per cent, Maharashtra by 98 per cent and Rajasthan by 79 per cent in 2002-2003. The figures from India’s Directorate of National Vector Borne Disease Control Programme showed that deaths from malaria rose in all three states in 2002-2003. Bank officials, however, claimed that the malaria cases declined in bank-funded project districts much faster than in India as a whole.

But detractors accuse the bank of supplying the anti-malarial drug chloroquine at a cost of $1.8 million and say the drug is unsuitable for use against malarial cases in India and against WHO guidelines. Malaria caused by the choloroquine-resistant Plasmodium falciparum parasite has been spreading across India and patients infected with this parasite when given chloroquine can develop severe disease or even die. Yet in 2004, the bank approved purchases of over 100 million tablets of chloroquine for India “making it probable that millions of patients received such treatments”, Amir Attaran, one of the authors of The Lancet article, said.

In a rebuttal, the bank said, “The government of India formulates its malaria control strategy and we fund both chloroquine and combination therapies.” It added that India had a strategy to tailor drugs to match different malaria parasites in different parts of the country. Choloroquine is cheaper and “India stood to gain by getting good value for money” by spending scarce resources wisely. If the bank did fudge data, as its critics claim, it can only be described as astonishing. Whatever the case, the bank would do well to hand over the $1 billion earmarked for anti-malaria projects to a separate body. Also, it should restrict itself to just funding.