News about malaria rarely garners much interest outside the developing world. But in recent weeks, the World Health Organization (WHO) has had to publicly defend itself against scathing critique from international scholars, who claim the organization's malaria treatment policies in Africa are tantamount to “medical malpractice.”

The WHO recommends that countries use artemisinin-based combination therapy (ACT)—derived from sweet wormwood—the gold-standard treatment for malaria. ACT is 10 times as expensive as the widely used chloroquine, but in most countries, resistance to chloroquine has rendered it virtually ineffective.

Led by UK expert Amir Attaran, the scholars charge that the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria are funding Ethiopia, Kenya and other nations to treat millions with the conventional drugs, rather than with ACT. Although figures for child mortality in some regions have risen by as much as 11-fold, the scholars say, the organizations are providing insufficient training and assistance to those nations (Lancet 363, 237–240; 2004). Their criticisms echo earlier complaints from the group Medecins Sans Frontières.

The critique has put the WHO, which has recently spearheaded proactive initiatives to combat AIDS and other threats (Nat. Med. 10, 112; 2004), under international scrutiny.

“I don't think they're guilty of medical malpractice, but I do think they're guilty of incompetence,” says Roger Bate, a visiting fellow at the American Enterprise Institute and director of the advocacy group Africa Fighting Malaria. “They're concentrating on AIDS because it's not something you can duck, but they're dropping the ball on other important issues.”

Allan Schapira, coordinator of strategy and policy for the WHO's Roll Back Malaria, says the charges are “completely unfair.” He notes that as countries' grants are evaluated over the five-year cycle, they will have to prove that they are switching to ACT. The WHO is also developing schemes to increase countries' access to ACT and improve their drug procurement strategies.

Still, Schapira admits that resistance to adopting the new treatment remains—even among some WHO ground-level representatives. In some cases, he adds, health ministers acknowledge the need but remain hesitant, in part due to skepticism about international funding.

“We need to acknowledge that we should have been much more insistent and firm in this message than we have been,” Schapira says. “We have to say the same things we have said until now—but in a stronger voice.”