WHO raises alarm on resistance to malaria drug
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The World Health Organisation (WHO) is calling on nations in the Mekong region to take urgent action to combat growing resistance to artemisinin - the frontline drug in the treatment of malaria.
It also urged health agencies to invest more in malaria control to ensure that recent achievements in fighting the disease are not rolled back.
“The [impact] of malaria is associated with economic and development activities like mining, forestry, plantation, farming, and constructions of roads and dams. This is why controlling malaria should be the collective responsibility of various sectors,” said Dr Samlee Plianbangchang, the WHO’s director for Southeast Asia.
Artemisinin, also known as qinghaosu, is a traditional Chinese herbal drug that has been used for more than 1,500 years, primarily to treat fevers. Artemisinin and its derivatives are the most effective antimalarial drugs known and are active against malaria parasite strains that are resistant to other common antimalarials.
Some malaria patients treated with an artemisininbased monotherapy discontinue treatment prematurely following the rapid disappearance of symptoms, and this can lead to the development of resistance on the part of the malariacausing parasite Plasmodium falciparum.
The emerging resistance to artemisinin derivatives has been a global public health concern for several years. Health experts say there is a limited window of opportunity to contain resistant parasites before they spread around the world.
Artemisininbased combination therapies, known as ACTs, are recommended by the WHO as the first line treatment for uncomplicated malaria, and the scaleup successes in the fights against malaria. No other antimalarial medicines are available at present with the same level of efficacy and tolerability.
A recent study, “Emergence of artemisininresistant malaria on the western border of Thailand: a longitudinal study” by Prof Francois Nosten and colleagues published in the journal Lancet on April 5 found evidence of the existence of artemisininresistant Plasmodium falciparum in parts of western Thailand.
The findings deepened the concern that WHO and other partners have about emerging artemisinin resistance along the ThaiMyanmar border.
The study prompted WHO to call on the global malaria community and donor organisations to urgently scale up efforts to prevent and contain artemisinin resistance in both Thailand and Myanmar, and to intensify ongoing efforts in the Greater Mekong subregion.
The four countries most affected by the emergence of artemisinin resistance are Thailand, Cambodia, Vietnam and Myanmar. Myanmar has by far the greatest malaria burden. Over 40 million people, or an estimated 69 per cent of the population, reside in malariaendemic areas, and 24 million live in hightransmission areas.
In 2010, Myanmar reported 650,000 malaria cases and 788 malariarelated fatalities in the public sector. Given its extensive migrant population, the widespread use of oral artemisininbased monotherapies, and its geographical proximity to India, Myanmar is critical to the success of efforts to prevent the emergence of artemisinin resistance globally, according to the WHO.
The WHO maintains that there is no cause for alarm about the efficacy of ACTs in Myanmar or in other countries of the Greater Mekong subregion. Even though ACTs may take longer to cure patients in settings with artemisinin resistance, they remain the most effective treatment for uncomplicated malaria, provided the partner medicine in the combination is effective.
“Our success is fragile; we did not reach universal coverage. We did not implement ACTs in the places that we want to archive and we did not use the rapid diagnostic test,” said Dr Pascal Ringwald, the medical officer in charge of antimalarial programmes at the WHO.
“We need political awareness and commitment across the Mekong region to contain artemisinin resistance,” he said.
