Leadership is a wonderful thing, but it is truly found when it is tested, and on that count malaria leadership has failed.

It is time for a thorough investigation of drug theft at the Global Fund to ensure that drugs are being used by those intended, rather than encouraging illegal parallel distribution systems, in both recipient nations and nations where products are diverted.

US government foreign assistance health programs are currently focused on combating HIV/AIDS, tuberculosis, and malaria, which account for several million deaths each year across Africa. The United States should prioritize sustaining the hard-won gains in disease control, which requires focusing on programs with proven track records of success and addressing failures within those programs.

Requiring African countries to use international competitive bidding processes for certain drug purchases has caused more harm than good.

A significant portion of antimalarial drugs in Africa have been illegally diverted from the public sector, where they were intended to be dispensed free of charge in public health facilities, to the private sector.

The Global Fund is to be commended for its transparency, but it has failed to act on the information it has gleaned, and continues to allow its funds to be used by governmental distribution systems known to be corrupt.

There are always costs of both action and inaction; however, before a costly scheme is funded, better evidence of its effectiveness should be established.

The global system for public health donations has a crippling accountability problem.