On World Malaria Day, the World Health Organization
has launched an emergency program in Phnom Penh to tackle a worrying regional trend - a strain of malaria that is proving resistant to the most important anti-malarial drug.
Six years ago, health researchers were worried after a strain of malaria in western Cambodia began to show resistance to the world’s key malaria treatment - Artemisinin-based Combination Therapy, known as ACT.
In response, the Cambodian government and its health partners, including the World Health Organization, put in place a program to prevent the resistant strain (falciparum malaria) from spreading within Cambodia and beyond its borders.
That program appears to have contained the resistant strain. But Thailand, Burma and Vietnam have reported pockets of artemisinin-resistant malaria strains.
The WHO malaria specialist in Phnom Penh, Stephen Bjorge, said it is likely the strains in those countries arose independently of Cambodia’s - which means the containment efforts have worked.
But because artemisinin is the standard treatment, it is important the resistant strains in all of these areas are contained and then eradicated. That is the purpose of a three-year, $400-million program the World Health Organization announced Thursday.
“The risks are significant - not only are they significant for the region in terms of having a reversal of the gains that have been made against malaria, but they are actually significant globally," said Robert Newman, director of the WHO’s Global Malaria Program. "If history is any guide, if we were not to contain this problem then it is very likely to spread elsewhere. Especially risky is to sub-Saharan Africa, where the greatest burden still exists. And, if we were to lose the efficacy of the ACTs today, this really would be a public health catastrophe in Africa.”
The WHO-led program is being funded by the Global Fund, the Bill & Melinda Gates Foundation and by the Australian government’s development arm called AusAID.
It will cover six countries: the four where resistance has already been found, as well as two more considered to be “at risk” from the resistant strain: Laos and an area of southern China.
Newman said some of the lessons learned from Cambodia’s efforts are being used.
“This is not starting from zero," he explained. "It is building on the experience initially on the Cambodia-Thailand border where those countries gained a lot of experience in how to reach the populations that are actually most difficult to reach - migrant and mobile populations, how to use village health care workers, how to more aggressively remove substandard medicines from the market.”
The program will distribute insecticide-treated bed nets; monitor fake drugs; ensure people have access to reliable testing and treatment; and track the disease. Migrant communities and people living in border regions will be key targets of the program.
has provided $5 million of funding for the program.
“Well, our initial funding is fixed, but the reality is Australia is part of this region," said AusAID’s principal health advisor Ben David. "We are part of the Asia-Pacific and we see this as a critical investment to protect the poor in the region from malaria, but also to protect the interests of countries because if this problem gets out of control and we see malaria drug resistance spread in the region and beyond, then we are in to face a big set of problems.”
David says, last year, malaria killed 42,000 people in the Asia-Pacific region and more than half a million worldwide, most of them children in Africa.
Recent years have seen good progress in tackling malaria, but the WHO warns that could be undone should the resistant strains escape the current pockets in the countries of the Greater Mekong sub-region.
David believes governments will do their part to prevent the spread.
“It has actually got significant economic implications, if this problem of resistance continues. So, we really need to make the economic case to governments to continue to invest in this problem,” he added.
The chloroquine-resistant malaria strain has caused millions of deaths globally since it emerged 60 years ago from the forests of western Cambodia.
The World Health Organization warns the world cannot afford a similar repeat outbreak by allowing the new strain or strains of artemisinin-resistant malaria to escape the region.