Time to contain artemisinin resistance

Abstract

The theme of this year’s World Malaria Day (April 25) is elimination: invest in the future and defeat malaria. Good progress has been made towards controlling malaria and reducing disease incidence. Since 2000, mortality rates from malaria have fallen by 42% worldwide and by 49% in Africa. This success can be attributed, in part, to the use of artemisinin-based combination therapy in malaria-endemic countries. But does resistance to artemisinins in the Greater Mekong Subregion threaten a global health catastrophe? Despite several meetings, plans, and increased funding, including US$100 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria for the Regional Artemisinin Resistance Initiative, containment of artemisinin resistance has failed. The WHO regional hub to direct containment activities, identified as urgent in 2007, was only established in Phnom Penh in April, 2013. The global response to this potentially devastating threat has been slow and uncoordinated. Chloroquine resistance was first reported in 1957, on the Cambodia–Thailand border. It emerged independently in South America in 1959, and was reported 15 years later in Africa, where it spread rapidly, resulting in millions of deaths. Resistance to artemisinins has now been identified in at least six areas of the Mekong, and reports suggest not only spread but also new foci of emergence. Delayed parasite clearance has been reported in Suriname, Nigeria, and Kenya, and there is mounting evidence of treatment failure in Cambodia. As discussed by Nick White in a Comment in this week’s issue, the discovery of a molecular marker for artemisinin resistance in Plasmodium falciparum might offer a window of opportunity for improved surveillance. This year’s World Malaria Day should refocus commitment to address the danger of artemisinin resistance with effective mobilisation of resources in the field, research, and above all leadership. For the World Malaria Report 2013 see http://www.who.int/malaria/publications/world_malaria_report_2013/report/en/For more on artemisinin resistance see http://www.who.int/malaria/media/artemisinin_resistance_qa/en/ For the World Malaria Report 2013 see http://www.who.int/malaria/publications/world_malaria_report_2013/report/en/ For more on artemisinin resistance see http://www.who.int/malaria/media/artemisinin_resistance_qa/en/ Malaria: a molecular marker of artemisinin resistanceGlobal malaria morbidity and mortality are falling.1 Elimination of malaria is back on the table. Things are looking good—or are they? The two main developments that have achieved these advances—insecticides to repel or kill mosquitoes, and drugs to prevent and treat malaria—are both falling to resistance. Artemisinin, the cornerstone of antimalarial therapeutics, is the latest casualty. The artemisinin derivatives are remarkable antimalarials; they are very safe and well tolerated, and are rapidly effective. Full-Text PDF