When the European and Developing Countries Clinical Trials Programme (EDCTP) was formed in 2003, some public health experts worried that the pan-European scheme would conflict with national research programs. Others wondered whether its emphasis on AIDS, malaria and tuberculosis would cause other diseases to be neglected.

Four years later, with the program's fourth executive director set to take office, those fears seem naively optimistic.

I simply have no idea what they're doing. Mario Raviglione, World Health Organization

With a €600 million budget, the EDCTP is the largest European sponsor of developing-world drug trials. But it has thus far funded only eight trials. Staff turnover, grant squabbles and communications breakdowns have plagued the program, and its potential remains largely unfulfilled.

“The EDCTP is certainly in big trouble,” says Mario Raviglione, director of the World Health Organization's Stop TB partnership.

Although €87 million was reserved for future grant calls, just €24 million has been awarded so far. Complaints over the program's first round of grants led in September 2004 to the ouster of its then-executive director, Piero Olliaro. The next call for grants was released only in early 2006. By October, Odile Leroy, the third director in as many years, had stepped down to head the European Malaria Vaccine Initiative.

The board in January approved Charles Mgone, the Tanzanian-born head of the program's African office as its next director.

The high staff turnover and organizational bureaucracy has left some would-be partners, including Raviglione, unsure of whom to contact on important matters. No one from the program has ever contacted Stop TB, Raviglione adds. “I simply have no idea what they're doing, and when I ask around, not many people know what's going on over there,” he says.

Cynthia Naus, the program's operations manager, says staff have worked with the WHO on non-tuberculosis projects. The director of the WHO's Tropical Diseases Program is also an observer on the main strategizing group, she adds.

“The EDCTP has had a slow start, but it was also an organization that was literally built from scratch,” Naus says. “We do realize the urgency.”