Abstract
The emergence in 2009 of Plasmodium falciparum parasites resistant to the primary therapies currently in use (artemisinin-based combination therapy, ACT) in Southeast Asia threatens to set back decades of global progress in malaria control and elimination. Progress to date through multiple sets of initiatives and partners to contain or eliminate these parasites has been hampered due to a wide range of organizational, financial, and health systems-level challenges. In this commentary, a set of seven specific and concrete actions are proposed to directly address these issues and to accelerate P. falciparum elimination within the Greater Mekong Subregion to avert a wider public health crisis. These actions are specifically needed to elevate the situation and response mechanisms to those of a true emergency; to address systems-level challenges with personnel limitations and stock-outs of key commodities; and to restructure the response mechanisms to be well-aligned with the required outcomes. Consideration of these issues is especially pressing with planning meetings for renewal of the Regional Artemisinin-resistance Initiative (RAI) framework slated for late 2016 and into 2017, but these suggestions are also relevant for malaria programmes globally.
Highlights
The problem The emergence in 2009 of Plasmodium falciparum parasites resistant to the primary therapies currently in use in Southeast Asia threatens to set back decades of global progress in malaria control and elimination
If the current stringent criteria necessary to declare a Public Health Emergency of International Concern (PHEIC) are not met by the MDRP. falciparum threat, we suggest an alternative categorization should be created to elevate such ‘slow-motion’ emergencies to the proper level of global attention: perhaps a ‘Category II PHEIC’? The elevation of multi-drug resistant (MDR)-P. falciparum to a PHEIC, or creation of an additional PHEIC classification to cover situations such as AR, will require member states to actively work with WHO in lobbying for these changes
The sole responsibility of these positions would be to support the national and provincial level national malaria control programmes (NMCPs) management on practical aspects of malaria elimination- the size and scope of necessary response to MDR-P. falciparum is such that NMCPs leaders need far greater support
Summary
The emergence in 2009 of Plasmodium falciparum parasites resistant to the primary therapies currently in use (artemisinin-based combination therapy, ACT) in Southeast Asia threatens to set back decades of global progress in malaria control and elimination. Declare a Public Health Emergency of International Concern (PHEIC) Establish a command-and-control structure Eliminate stock-outs of ACT medicines and RDTs at peripheral sites Consider realistic time-limited incentives for elimination fieldwork Provide dedicated leadership support to national malaria programmes Massively strengthen face-to-face support to peripheral levels Track operational progress via indicators that capture essential field activities parasites within the region [7].
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