The Emerging Risk of Drug-resistant Malaria

Recently, the global fight against malaria has experienced impressive victories. The number of deaths caused by malaria declined by 48 percent between 2000 and 2014 with an estimated 438,000 deaths worldwide from the disease in 2015. To put the magnitude of the improvement in perspective, tuberculosis still claimed the lives of 1.5 million people globally in 2014. Thanks to global malaria funding initiatives such as the Global Fund, Department of State’s Lower Mekong Initiative and the President’s Malaria Initiative, treatment is increasingly accessible and communities are becoming more educated on prevention tactics. Among such amazing victories, however, a new enemy is emerging.

Drug-resistant strains of malaria are quickly taking hold in an area of Southeast Asia known as the Greater Mekong Subregion (GMS). Currently, Myanmar, Thailand, Vietnam, Laos and Cambodia have all reported cases of artemisinin-resistant malaria. Artemisinin based combination therapies (ACT) are the first-line drugs used to treat malaria due to their high efficacy in quickly reducing parasite concentration in the bloodstream. Parasitic resistance to this widely used and effective drug could have potentially devastating consequences for the global fight to eradicate malaria

In April 2013, the WHO launched an emergency response to artemisinin resistance in the GMS. While the current drug-resistant strains are isolated to that region, there is risk of the strains spreading to India or Africa, increasing the impact of this resistance exponentially. The affected countries border many densely populated areas, providing a great number of potential hosts for drug-resistant strains. On top of the challenges of the epidemic itself, inability to access treatment or to complete the full scope of treatment contributes to the potential consequences of drug-resistant malaria.

The Global Fund started the Regional Artemisinin-resistance Initiative (RAI) in order to combat this emerging issue. With an allocation of $100 million for the 2014-2016 period, the intiative provides “an unprecedented level of funding for a single regional grant.” The grant is being used to create sustainable health systems within the affected countries to ensure full treatment courses for patients, as well as a smooth transition to sustainable domestic programming.

No single grant or organization can solve the problem of drug-resistant malaria. Continued international support is required to prevent drug resistance from continuing to appear. Health systems must be put in place to ensure correct use of drugs to prevent the development of resistance. Furthermore, malaria prevention must be prioritized to discourage the natural evolution of resistance among pathogens. While the RAI is a good start to combatting these issues, it is paramount for wealthy nations like the United States to continue to invest into global health to prevent disease resurgence.

As put by Global Fund Executive Director Mark Dybul in his op-ed on drug-resistant malaria, “Our ability to succeed will ultimately depend on the resilience of our partnerships.” Steady investment in research and treatment for artemisinin resistant strains of malaria is the key component to combatting this issue. If we continue to build strong partnerships to facilitate the path from funding to treatment to prevention, this newly emerging problem can be stopped.