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Global Action on Malaria Resistance Urgent, WHO

The WHO has launched a worldwide ‘call to action’ to governments, agencies, researchers and non-governmental organisations over the malaria parasite’s growing resistance to the most potent weapon against it — the drug, artemisinin.

If recently discovered resistance spreads, said the WHO, the formidable successes of anti-malaria campaigns in recent years will be threatened. Artemisinin lies at the heart of malaria treatment worldwide and has no obvious successor.

“The consequences of widespread resistance to artemisinins would be catastrophic,” WHO director-general Margaret Chan told a press conference held after the launch of the ‘Global plan for artemisinin resistance containment’ yesterday (12 January).

“We need to maintain this medicine. What is at stake it is not just the goals on malaria but, frankly, the whole related Millennium Development Goals”, said Robert Newman, director of the WHO Global Malaria Programme.

Resistance to artemisinin was identified in the Plasmodium falciparum parasite on the Cambodia–Thailand border in studies conducted between 2001 and 2009. It is now reported in other areas of the Greater Mekong Subregion and some fear that the resistance will spread to Africa, where most malaria deaths occur.

GPARC calls for increased surveillance of resistance and improved access to diagnostics and treatment with artemisinin combination therapies (ACTs), and for more research on topics ranging from new methods for containing resistance to mathematical modelling of its spread.

“We don’t have all the knowledge and tools we need,” said Newman, adding that finding a quick way of testing for resistance should be a priority.

“We need a molecular marker for drug resistance that will allow us to know much earlier where this problem may be emerging.”

“The research community must be engaged in the development of new classes of antimalarial medicines that would not fall into the same trap of resistance that we have with ACTs,” he added.

But it will not be easy to pin down the parasite’s genes responsible for resistance, according to Pascal Ringwald, coordinator of the drug resistance and containment unit of the WHO Global Malaria Programme.

“It took 30 years to find the gene related to chloroquine resistance,” he told SciDev.Net. “There are thousands of mutant genes in the parasite and the problem is to find which mutation could be related to artemisinin resistance.”

“Now we have better molecular tools,” he said. “I don’t think it’s going to take another 30 years, but it is very difficult and also very expensive.”

Call for action also aims to bring in new funds to bridge the estimated US$175 million funding gap for the project. So far, the UK’s Department for International Development (DFID) has agreed to fund a project to improve surveillance and map the extent of resistance.

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Eradicating malaria in Sub-saharan Africa, Yes We Can

Distribution of Malaria (US CDC)
Malaria is a killer. About half a million people die annually from malaria, mostly children in sub-Saharan-Africa. In fact a child dies of malaria every 30 seconds.
Even though malaria has not yet received the attention it needs on the global stage, today wealthy foundations, companies, and some governments across the world are making malaria a priority. It was hoped that this momentum would continue for a while but, as we reported here last week, a series of papers published in a respected scientific journal, the Lancet, may put pressure on the breaks.
The team of researchers cast a gloomy cloud over any hope of eradicating malaria, at least in our lifetime. I need to admit that I have not yet read all the papers but their conclusion is clear: governments, donor agencies and foundations should now focus more on minimizing the prevalence of malaria and not on eradicating malaria. It is very easy to see how this could sap away the energy of organization like Malaria no More, the Bill and Melinda Gates Foundation and other organizations toiling to see the day when there will be no more malaria.
Anyone who doubts mankind’s ability to eradicate malaria may need to be reminded that the progress on malaria eradication in the US and Canada happened over a ‘relatively short time span’. In fact, it was not until the late 1890’s that scientists even learnt that the disease is caused by a parasite and that it is a mosquito that transmits the parasite from person to person. The assumption in those days was that malaria was caused by some ‘environmental dirt’. The word malaria actually comes from the Italian “mala aria”, meaning “bad air” because it was generally believed that malaria was caused by breathing in bad or foul air and vapors emanating from swamps marshy lands and latrines.
 
It is important to remember that, 70 to 80 years ago, Americans traveling to the eastern Tennessee valleys had the same fear they now have when traveling to Togo or Ivory Coast because of malaria. The story changed with the creation of the U.S. Tennessee Valley Authority (TVA) in 1933 which established an organized malaria control program. At the time, malaria affected 30 percent of the population in the region where the TVA was incorporated. After implementing aggressive research and control operations, the disease was essentially eradicated in the TVA region by 1947.
The U.S. Centers for Disease Control (CDC) in Atlanta CDC was founded in 1946 to help control malaria. Within a few years of the campaign, malaria had been completely eradicated in the US.
The US did not win the battle over malaria overnight. Efforts to control malaria became national focus as far back as the early 20th century during the occupation American military in Cuba and the construction of the Panama Canal. It is recorded that malaria (and yellow fever) caused significant number of deaths among the workers of the canal. This triggered an aggressive program of malaria control which in 10 years had already made remarkable progress.
It is for these reasons that I have some concerns over the conclusions of the international team of researchers. Scientific possibility and budgetary recommendations perhaps should not be jammed together, especially when there is a huge regional disparity in the consequences of such recommendations.
Malaria can be defeated, albeit, not overnight. The funding available for anti-malaria campaigns, and research and development is tiny compared to the challenges. When the US announces a $10 billion annual budget for Africa it may appear too generous unless you know what we’re talking about. It is not Mali nor Zambia, but a continent of nearly 1 billion people.
We need to encourage non-governmental organizations, foundations and governments to keep on fighting. Efforts to minimize the prevalence of malaria should be encouraged but this cannot be an open-ended laissez faire attitude with no responsibility. There should be an aggressive program to eradicate the disease as it was done in the US and Canada.
Yes We Can
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