TCS Daily

Is the WHO Becoming the World 'Harm' Organization?

By Nick Schulz - August 9, 2004 12:00 AM

The acronym "WHO" stands for the World Health Organization. With its recent track record, however, the Geneva-based global health body is running the risk of becoming the World Harm Organization.

If that sounds unduly harsh, consider a series of developments that have badly jeopardized global health.

Last week WHO removed several AIDS drugs from its list of "prequalified" AIDS treatments. That's the list of drugs WHO encourages global health care providers to select from when treating HIV/AIDS victims in poor countries, mostly in Africa. The recently de-listed drugs, made by the Indian firm Ranbaxy, are knockoff anti-retrovirals (ARVs). Western pharmaceutical companies developed the original ARVs, the drugs that halts HIV in its tracks and transform the disease from a death sentence into a chronic, manageable illness. Ranbaxy, as well as some other Indian firms, pirate the intellectual property (IP) of American and European companies to make copies (sometimes mistakenly referred to in the press as "generics") of these drugs. After first approving these copy drugs for use, WHO delisted the Indian drugs because it could not guarantee their bioequivalence.

According to a WHO press release, the "medicines may or may not offer the same therapeutic benefits as the originals on which they are based." That means poor AIDS victims have been duped into taking drugs of unknown efficacy. What's worse, WHO has no protocol or procedure for notifying the patients who may have been taking these drugs.

This is not the first time WHO has mishandled AIDS drug selection. Back in June, two ARVs produced by another Indian copycat firm, Cipla, were delisted from the WHO's prequalification list.

These developments are troubling on two levels, as getting HIV/AIDS treatment right is a question not just of morality but of self-interest. This kind of shoddy treatment can exacerbate the AIDS virus, creating mutant strains of an infectious disease that can't be checked by current treatments.

And it's not just in the realm of HIV/AIDS that WHO is bungling health matters. The British medical journal The Lancet recently published an article accusing the WHO of "medical malpractice" in its program to fight malaria. WHO has continued supporting the procurement of two drugs that are no longer effective in malaria control even though a newer and more effective option exists. Moreover, WHO also continues refusing to support the use of DDT spraying to control the mosquitoes that spread malaria, despite DDT being safe and effective when used properly.

How can an institution staffed with intelligent, hard-working men and women make so many gross errors that jeopardize the people it is charged with helping? Politics is the primary answer.

For example, activist groups have opposed DDT spraying since the publication of Rachel Carson's "Silent Spring" galvanized the global environmental movement in the 1960s against the use of industrial chemicals. At the time, DDT was used in large quantities to control agricultural pests and mosquitoes. Carson alleged that DDT spraying was harming bird populations such as raptors.

But Carson's charge was also two generations ago. We've learned a lot since then, including just how effective DDT is in curbing malaria and how overwrought concerns over DDT have been. As Ronald Bailey, the science correspondent for Reason magazine put it in an article explaining the history of the DDT scare, "Banning DDT saved thousands of raptors over the past 30 years, but outright bans and misguided fears about the pesticide cost the lives of millions of people who died of insect-borne diseases like malaria." Despite this, many green groups and aid agencies, including WHO, continue opposing the use of controlled, limited DDT spraying.

As for WHO's advocacy of questionable drugs, ideological hostility to the IP system plays a big role. WHO seems beholden to activist gripes -- coming from groups like the Clinton Foundation, Oxfam and Doctors Without Borders -- that IP patents keep the prices of essential medicines unjustifiably high for treating the poor in developing countries.

Research from Amir Attaran of the Royal Institute for International Affairs in London published in the journal Health Affairs; a study from Carol Adelman and Jeremiah Norris of the Hudson Institute; and a recent American Enterprise Institute health policy outlook (Bate, Tren 2004) all demonstrate the activists' complaints about patents are mostly nonsense. Regardless, WHO should insist on gold-standard treatments that work, whether they are patented or not.

Last week's WHO delisting has prompted some countries to take action. According to South Africa's Business Day, that country's Medicines Control Council is launching an investigation into the drugs made by Ranbaxy that are registered in South Africa. The United States needs to act, too. It provides up to 25 percent of the WHO's budget. Congress and the Bush administration need to take firm steps to address a politicized WHO's troubling mistakes. They can start by insisting that the agency put science and best health practices ahead of politics.

Nick Schulz is editor of He recently reported on the VX International AIDS Conference in Bangkok.


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