Malaria - the left hand doesn't know what the right hand is doing!

The World Health Organisation (WHO) is quite rightly patting itself on the back because it has persuaded as many as 13 drug companies to abandon the marketing and promotion of monotherapy in the treatment of Malaria.

The WHO favours the use of the 95% effective Artemisinin Combination Therapies (ACTs), but meanwhile another of the world's leading international health bodies is apparently pursuing a policy that encourages further resistance to malaria drugs.

According to Kochi Arata, head of the WHO's malaria programme, the current policy of the Global Fund to Fight Aids, Tuberculosis and Malaria risks causing drug resistance.

Arata was speaking with reference to the compliance list of drugs circulated by the Global Fund, the world's leading funder of treatments for infectious disease, which contains advice on the malaria monotherapy drug artemisinin.

In the past Artemisinin has proved to be effective in treating the worst cases of malaria, including those that have developed resistance to all other drugs, but many health experts fervently believe that the continued use of the drug as a "monotherapy" without a second drug, will only serve to create a resistance, thereby leaving no alternative medicine to treat a resistant parasite.

On the Global Fund's compliance list of therapies a number of good quality monotherapies are recommended, and the list is used as a guide for countries purchasing malaria drugs.

At the outset of the year the WHO launched an appeal to end monotherapy, calling on manufacturers to stop producing Artemisinin alone, and advising countries to ban its use.

To date 13 of the 40 manufacturers of artemisinin therapy identified have agreed to cease production and to focus on the production and marketing of Artemisinin Combination Therapies.

Mr Arata has expressed concern that some drug companies see a window of opportunity to exploit the gap created by the Global Fund's compliance list and boost their own monotherapy sales.

Although a number of countries have agreed to withdraw marketing authorisation from monotherapies in an attempt to discourage their use, 49 have not.

Mr Arata is apparently particularly concerned about China, which both uses and produces large amounts of artemisinin and he is critical of what he regards as the "unsatisfactory" response of the Global Fund to the WHO's demands that it change its compliance list.

The Global Fund insists its policy follows advice derived from the WHO and argues that its list is not compulsory.

The WHO however suggests the list results in misuse and confusion, provides unnecessary endorsement for drugs and is used for marketing by monotherapy manufacturers.