Abstract
Resistance to artemisinin casts a shadow on the fight against malaria. The importance of illegal gold miners and of malaria in isolated regions of French Guiana constitutes a threat that endangers the fight against malaria in the Amazon. The hurdles of French laws and the remoteness of the territory from France make it impossible for the system to adapt to the problem of total inaccessibility of an important part of the malaria problem. Transmission is high in these areas and gold miners self-medicate with erratic regimens of artemisinin combinations, thus creating perfect conditions for the emergence of resistance. What needs to be done is being done, but within the limits of national law, with some results. However, facing the same difficult problem, Suriname shows more flexibility and is doing much better than French Guiana despite having lower resources. Local authorities in French Guiana cannot overrule the laws that block appropriate malaria care from reaching a third of malaria-exposed persons. Thus the health authorities in France should take immediate calibrated legislative and financial measures to avoid a predictable disaster.
Highlights
Encouraged by the last decade’s funding efforts and significant successes, malaria elimination has become a serious goal. In the past, such efforts have stumbled on the rise of resistance to anti-malarials and insecticides that affected the sustainability of the progresses made
In the late 1950s, shortly after WHO embarked on the malaria eradication programme, resistance of Plasmodium falciparum to chloroquine emerged on the Thai-Cambodia border and spread throughout Asia and Africa within decades
Facing the same problem as French Guiana, neighbouring Suriname has implemented an integrated comprehensive programme funded by the global fund that has been followed by remarkable success, with the objective of malaria elimination in sight
Summary
Encouraged by the last decade’s funding efforts and significant successes, malaria elimination has become a serious goal. The hopes of controlling and eliminating malaria are threatened by resistance against artemisinin derivatives, which has emerged and is spreading in Southeast Asia [1,2,3].
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