New drug resistance threatens to deal blow to malaria control efforts worldwide

The World Health Organization (WHO) has expressed its concern over the emergence along the Thai-Cambodia border of malaria parasites that are resistant to a previously highly effective drug. WHO fears that the Plasmodium parasites' growing resistance to the drug artemisinin "could seriously undermine the success of global malaria control efforts".

Artemisinin is a compound obtained from the plant Artemisia annua, a common type of wormwood native to temperate Asia. Only recently has malaria treatment been shifted from traditional, but progressively failing drugs to artemisinin-based combination therapies (ACTs). ACTs combine highly effective artemisinin with another effective anti-malarial medicine in order to prevent the development of resistances to artemisinin. According to WHO, this shift has been a breakthrough, as ACTs have proven to be successful in 90% of cases if administered appropriately.

However, the efforts to prevent artemisinin resistances are undermined by the use of single-drug therapies, especially mono-therapies of artemisinin and its derivatives. The use of only one drug will make it easier for the parasites to adapt and hence become resistant to it. The threat is all the greater since 'there are no effective alternatives to artemisinin for the treatment of malaria either on the market or nearing the end of the drug development process,' WHO states.

"If we do not put a stop to the drug-resistant malaria situation that has been documented in the Thai-Cambodia border, it could spread rapidly to neighbouring countries and threaten our efforts to control this deadly disease," says Dr Hiroki Nakatani, Assistant Director-General of WHO.

For this reason, WHO's treatment policy suggests the use of ACTs in all cases of uncomplicated falciparum malaria, which is one of the most common and most deadly forms of the disease. Plasmodium falciparum is responsible for about three quarters of cases and 90% of deaths.

The European Union, too, backs the ACTs approach: In the guise of Artepal, a project of the European Agency for Development and Health (AEDES), the European Commission's cooperation office for EU external aid programmes, EuropeAid, has been funding the promotion of ACTs.

In addition, Artepal aims to further the transfer of technology so as to reinforce local anti-malaria drug production capacity, mostly in Africa and Asia. At the same time, it helps to sustain national policies in the fight against the disease and, in the long run, Artepal wants to improve access to high-quality ACTs and reduce prices.

Half of the world's population is at risk of malaria, particularly those living in lower-income countries. More than one million people die of the disease every year.

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