Mosquitoes carry malaria

Drug resistance to traditional, cheap, treatments is an increasing problem in the fight against the disease.

Writing in the Lancet, critics say the Global Fund, backed by the World Health Organisation (WHO), is wrongly funding these treatments.

But the WHO said it always advocated the newer, more effective, treatment.

Proposals may have many aspects to them which would all be lost if we refused them because countries wanted chloroquine Jon Liden, Global Fund

Malaria kills around a million people each year, most of whom are children.

The WHO launched a campaign in 1998 to halve deaths from malaria by 2010.

The fight against malaria has been undermined by resistance to conventional treatments such as chloroquine and sulfadoxine-pyrimethamine.

But research has shown artemisinin-class combination therapy (ACT) is much more effective in tackling the disease.

But it is around 10 times more expensive than chloroquine.

'Irresponsible'

The Global Fund for Aids, tuberculosis, and malaria was set up in 2002 by the G8 group of industrialised countries.

It has awarded grants totalling $2.1bn, between a quarter and a third of which has been spent on fighting malaria.

Countries apply to the fund, and a WHO representative has to back the bid.

Authors of the Lancet article, malaria specialists from around the world, say the Global Fund and the WHO should not approve funding for the less effective chloroquine treatment.

Dr Amir Attaran of the Royal Institute of International Affairs in London, speaking on behalf of the critics, told the BBC World Service's World Today programme: "The WHO and the Global Fund have approved treatments for malaria to be sent to Africa that simply don't work.

"There are better treatments which do work, and they have not provided these.

"In some instances, they have actively obstructed the provision of these."

He added: "The ACT treatment could cost as little as �1. But that �1 is being begrudged."

The researchers say such decisions are "indefensible", and accuse the WHO and GFATM of conduct ethically and legally tantamount to "medical malpractice" in supplying inappropriate drugs to Africans with malaria.

They are calling for definitive treatment guidelines to be published by the WHO to guide countries applying to the Global Fund.

'Open door'

But Ian Simpson of the WHO told BBC News Online: "We have been saying that ACT is the best way to treat malaria since 2001.

"The problem has been money. In the early stage of the fund, countries weren't convinced that it would provide sustainable funding for the more expensive treatment.

"Now there is a growing belief is a sustainable source, and countries are increasingly asking for funding for ACT."

Jon Liden of the Global Fund added: "The critics are pushing on a door that is already open.

"We are actively encouraging ACT proposals, but it would be hopeless to insist on them.

"The proposals may have many aspects to them which would all be lost if we refused them because countries wanted chloroquine."