Malaria in 2015 - emergence and emergency

In the last decade, remarkable achievements in malaria control have been made: globally, malaria mortality has been reduced by 47 per cent between 2000 and 2013, leading to an estimated 4.3 million deaths averted. A total of 64 countries are succeeding in reversing the curb of new cases, the incidence of malaria, and 55 countries are on track to meet the targets of reducing malaria case incidence rates by 75 per cent in 2015.

However, in the same period, resistance to the most commonly used insecticides and – above all – resistance to anti-malarial drugs, have emerged as the two major threats to these advances. 

Parasite resistance to artemisinine, one of the drugs used in combination therapy given to patients with malaria, is today confirmed in the five Great Mekong Sub-region countries, including Thailand. Thanks to the identification of a resistance gene, by scientists from the Pasteur Institute in Paris and in Cambodia, it is now possible to better trace resistance expansion. The resistance appeared at first in Southeast Asia, is now spreading out up to the borders with India, and might expand all over the world, as resistance to previous anti-malarial drugs did in the past, to reach Africa (where malaria leads to hundreds of thousands of deaths, especially among children), and then Latin America. For, when resistance expands, standard treatments become far less efficient.

In addition, growing resistance of malaria vectors, mosquitoes, to most-used insecticides must be acknowledged. This resistance has been identified, in variable degrees, in 64 malaria-endemic countries worldwide and it continues to rise in Africa, Southeast Asia and Latin America.

Thus, the response to malaria is now facing a double-challenge. And this is a matter of public health emergency. 

The World Health Organisation, the Global Fund against Aids, TB and Malaria (of which France is the second most important donor, with 360 millions euros yearly), the Bill & Melinda Gates Foundation, Australia and many other international and national partners, are offering and implementing appropriate responses. It is the case in Thailand as well as in its neighbouring countries, Lao PDR, Myanmar, Cambodia and Vietnam, where a regional programme on artemisinine resistance (Regional Artemisinine Initiative) is already in place, thanks to the financial support of The Global Fund. The objective is to allocate more funds to the fight against malaria on the ground, in each country, and to allow for trans-border programmes. Indeed, malaria ignores borders, which, as areas often covered by forest, are also areas of high-prevalence for malaria. 

Prevention efforts (including bed-nets distribution), care and treatment are now receiving better funding to envisage the elimination of the disease. 

France also provides support to scientific research on malaria in the region, an investment of nearly 1.5 million euros, for a programme focused on resistance to insecticides led by the Pasteur Institute in Lao PDR, in partnership with Kasetsart University in Bangkok and two French institutes, IRD and CIRAD; and for a programme studying the elimination of malaria being implemented in Thailand, Cambodia and Lao PDR by the Mahidol University and the Shoklo Unit in Mae Sot, under the supervision of Pr Francois Nosten. 

During a scientific symposium held in December in Bangkok, researchers on malaria confirmed the urgent call for a coordinated and efficient response to the disease. It would mean more research, more actions on the ground, supported by governments and implemented with input from the communities. There is no question that a mobilisation is urgently needed. In this respect, France remains more committed than ever.

 

Thierry Viteau is France’s ambassador in Thailand