Failing drugs and super bugs: the elimination race
The Fight The paradox of malaria: the rarer it becomes, the harder it is to fight. In the Mekong, drug-resistant strains threaten progress.
The fight against malaria is one of the biggest success stories of the 21st century. The number of deaths caused by malaria globally declined 48 percent between 2000 and 2015, averting an estimated 6.4 million deaths, seeing more and more countries closer to malaria elimination than ever before. Malaria experts warn, however, that drug and insecticide resistance poses a serious problem.
Despite only one malaria death in 2016, Cambodia are down to a just a single effective treatment.
In the Greater Mekong, the Global Fund is supporting a programme known as the Regional Artemisinin-resistance Initiative. RAI is a collaboration of funders, multilateral agencies, technical partners, scientific researchers, communities and governments to pursue the goal of malaria elimination in Myanmar, Thailand, Cambodia, Laos and Viet Nam.
Despite a downward trend for malaria, antimalarial drug resistance is getting worse quickly, with resistance to both artemisinin and its partner drugs – the standard for malaria treatment – seen in all five countries. As countries whittle down areas and populations affected by malaria, only the strongest parasites hold out. Failing to eliminate malaria quickly could allow these difficult-to-treat, resistant strains to cause a resurgence.
Cambodia illustrates the problem: while there was only one malaria death nationwide in 2016, the country is down to a single effective treatment regimen – the other drugs are no longer effective there.
A network of local organisations work to reach remote populations, such as rubber plantation workers.
Unwittingly, humans have helped the parasite develop resistance. A combination of drugs, including artemisinin, when taken correctly are effective at curing malaria. However, in some places, people take substandard drugs, or fail to make it to clinics for diagnosis, take a single drug on its own or complete the entire course of drugs: all of which drive drug resistance.
These are precisely the kinds of obstacles to elimination the Global Fund partnership is working to address through RAI. Together we are working to close gaps in supply chains so the right drugs are in the right places at the right time. A network of local organisations work to reach highly mobile and remote populations, such as rubber plantation workers, and ethnic minorities who historically have been under served by health systems. Improved surveillance data means that when an outbreak flairs up, an appropriate response can be deployed.
The regional implementation of these strategies is key. In the Mekong, several distinct drug-resistant parasites are occurring at the same time. That is why RAI focuses on elimination, which requires regional coordination and cooperation.
The Global Fund supports the work of the Regional Artemisinin-resistance Initiative in the Greater Mekong.
The window of opportunity is limited and urgent action is needed. The Global Fund partnership will invest more than $242 million through RAI over the next three years to help make a big strike. If we don’t eliminate malaria in the Mekong – and the drug-resistant strains along with it – there’s a risk that artemisinin resistance will spread to other countries, and then the fight will become a lot harder to win.
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