Bold measures to accelerate malaria elimination

Abstract

In the Greater Mekong subregion, intense drug pressure and indiscriminate use of poor-quality antimalarial drugs has led to the emergence of antimalarial resistance to all widely used drugs, including the artemisinin derivatives. 1 Hamilton WL Amato R van der Pluijm RW et al. Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology study. Lancet Infect Dis. 2019; 19: 943-951 Summary Full Text Full Text PDF PubMed Scopus (112) Google Scholar The malaria community remains divided as to the magnitude of this threat. Malaria cases in the Greater Mekong subregion continue to fall, giving some authorities confidence that current activities will achieve elimination targets within the next few years. Counter-arguments highlight the potential for parasites to evolve under prolonged, intense drug pressure, possibly resulting in widespread resistance to all available antimalarial drugs and the prospect of resurgent, untreatable malaria. Paradoxically, the solution might be promoting wider use of antimalarial drugs, to expedite parasite elimination before resistance evolves further. Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria: a cluster-randomised trialIn this low-transmission setting, the substantial reduction in P falciparum prevalence resulting from support of community case management was accelerated by MDA. In addition to supporting community health worker case management and LLIN distribution, malaria elimination programmes should consider using MDA to reduce P falciparum prevalence rapidly in foci of higher transmission. Full-Text PDF