Resistance to treatments threatens to undo our progress
Treatment Q&A with Professor Philippe Guérin, discussing the most pressing challenges in today's fight against malaria.
1. What is the most pressing challenge or challenges in fighting malaria in 2017?
"Malaria is a complex problem and there is no silver bullet. We know the solution will be multi-dimensional and will result from partnership and collaboration. Resistance to malaria drug treatments is a major challenge that threatens to destroy the gains we have made in fighting the disease in recent years.
"Artemisinin used in combination with other medicines is currently the cornerstone of malaria treatment, and it has significantly helped to reduce the number of deaths in recent decades. Still, malaria kills approximately half a million people every year, most of them children under the age of five in Africa. Unfortunately, artemisinin resistance has been identified in Cambodia, Thailand, Vietnam, Laos, South China and Myanmar. Elimination efforts are under way in this region in order to contain resistance but the task has proven to be difficult and challenging. Other forms of resistance especially to the partner drugs of artemisinin derivatives have also been reported elsewhere in endemic countries.
"Since there are no non-artemisinin based drugs to be registered in the near future, it is vital that we maintain the efficacy of artemisinin combination therapies until new alternative medicines are developed and made available at an affordable cost."
Photo credits: see below
2. What can scientists do to address the growing problem of resistance to antimalarial medicines?
"The scientific community can track the emergence and spread of antimalarial resistance and improve the efficacy of current and future drug treatments, for example, by studying the underlying factors facilitating the emergence of resistance. We know that efficacy of antimalarial medicines for specific groups, such as very young children, pregnant women and patients with co-morbidities should be optimized. Other potential drivers of resistance such as poor quality medicines must be urgently addressed. It is a big task but an essential one if we wish to achieve malaria elimination.
"One major challenge to tracking resistance is getting information. Although there are clinical trials and surveys happening around the world, the data are difficult to gather and consolidate to guide policy. Pooling and sharing data from different trials allows scientists to make more comprehensive assessments of key questions relating to drug efficacy."
Photo credits: see below
3. What are some of the challenges associated with sharing data?
"Individual clinical trials often collect information in different formats. Therefore, we must find ways to standardise heterogeneous data to allow for better analyses of large combined datasets. We are pleased with how far we have come in the fight against malaria, but there are many challenges ahead. Containing resistance and maintaining the efficacy of our current treatments requires a concerted effort from everyone involved in malaria research, policy-making and drug development, so that we can work together towards malaria elimination."
Photo credits: Copyright, Pearl Gan in association with Oxford University Clinical Research Unit, Vietnam; Eijkman Oxford University Clinical Research Unit, Jakarta; and The Wellcome Trust. www.asiamalariaimages.com
Professor Philippe Guérin
Guérin is Professor of Epidemiology and Global Health and Director of the Infectious Diseases Data Observatory (IDDO), a collection of data platforms encompassing the WorldWide Antimalarial Resistance Network.
Prior to joining WWARN at the University of Oxford, Professor Guérin conducted extensive research in Africa and Asia, and held positions at Médecins Sans Frontières, the Norwegian Institute of Public Health, and Épicentre, Paris.