Health
Rising resistance to malaria treatment is a ticking time bomb
Urgent action is needed to address rising resistance to malaria treatment in East Africa, a recent policy forum warned.
First recommended by the World Health Organization in 2006, artemisinin-based combination therapy (ACT) has been the cornerstone of malaria treatment and control for over a decade and has played a key role in reducing the global burden of malaria.
However, artemisinin resistance (Art-R) in the malaria-causing parasite Plasmodium falciparum has posed a new threat in the fight against this deadly disease.
This resistance undermines the efficacy of ACTs and poses a major threat to public health in the region, forum leader Dr Mehul Dorda from the Tropical Medicine Research Unit (Moru) at Mahidol, University of Oxford, said in a paper published in Science last week titled “Urgent action needed for artemisinin-resistant malaria in Africa”.
The authors argue that preventing a sharp increase in malaria-related illness and death in East Africa requires a multifaceted approach, similar to that which has been successful in Asia's Greater Mekong Subregion.
read: Changes in malaria parasites make first-line treatment difficult
The successful containment of ART-R in Asia provides a valuable blueprint for tackling the problem in Africa. “The successful containment of ART-R in Asia's Greater Mekong Subregion, where ART-R was first reported in 2008, suggests that a multi-pronged approach is needed to permanently reduce and halt malaria transmission in East Africa,” Dolda wrote.
In response to the spread of artemisinin resistance in Southeast Asia, the Global Fund to Fight AIDS, Tuberculosis and Malaria launched the Regional Artemisinin Resistance Initiative to work with national malaria control programs, focusing on strengthening surveillance, rapid diagnosis and mass drug administration in malaria-endemic areas.
These efforts have led to significant reductions in malaria across the region, despite widespread ART-R.
Now, with ART-R on the rise across East Africa, Dorda and team recommend that similar investments and strategies are needed to prevent a public health crisis.
One recommended approach is the use of triple ACTs (TACTs), which combine an artemisinin derivative with two partner drugs. These TACTs have proven effective in Asia and could be crucial for ART-R responses in Africa.
In addition to TACT, the authors highlight the importance of strengthened local health worker networks, rapid diagnostic testing, and antimalarial treatment.
Malaria vaccination and vector control measures, such as insecticide-treated bed nets and indoor residual spraying, are also essential components of an overall strategy to reduce transmission. Regular monitoring for drug resistance is essential to adapt and update treatment protocols if necessary.
Furthermore, the authors call for the implementation of new strategies using recently approved new malaria vaccines to address the growing threat in Africa. The authors emphasize the importance of continued funding from international organizations, particularly the GFATM and the US government's President's Malaria Initiative, which played a key role in containing ART-R in Asia.
“Similar visionary approaches are needed now to protect at-risk populations in Africa,” Dorda et al. write. The call to action is clear: without urgent and coordinated efforts, growing antimalarial drug resistance in Africa risks undermining decades of progress in the fight against malaria and increasing illness and death among vulnerable people.
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