y that names ACT as the gold standard of treatment, WHO signs its approval when GFATM funds cheap but ineffective chloroquine or sulfadoxine-pyrimethamine to treat P falciparum malaria.' According to data presented by the authors, GFATM is spending more money to purchase chloroquine and sulfadoxine-pyrimethamine in Africa than ACT.

Amir Attaran and colleagues conclude this is "indefensible", and accuse WHO and GFATM of conduct ethically and legally tantamount to "medical malpractice" in supplying inappropriate drugs to Africans with malaria. They write: "For WHO and GFATM to provide chloroquine and sulfadoxine-pyrimethamine treatmentsat least wastes precious international aid money, and at most, kills patients who have malaria. If one takes the measured increase in childhood malaria mortality that follows P falciparum drug resistance (two-fold to 11-fold) and extrapolates it to populations in which GFATM is funding chloroquine or sulfadoxine-pyrimethamine despite resistanceat least tens of thousands of children die every year as a direct result."

The authors offer several recommendations for improvement that to date have been ignored by WHO and GFATM. They warn that "a risk exists that if WHO and GFATM do not act with celerity, the reputations of both will be tainted to a degree that rich governments lose confidence and cease funding them". Amir Attaran comments: "The fact both agencies are violating their own policies, with knowledge that this will cause the 1998 promise to Roll Back Malaria to be broken, appears highly relevant to their new promise to treat 3 million AIDS patients by 2005.

'"/>

Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
15-Jan-2004

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