Call for immediate action on artemisinin resistance

In a New England Journal of Medicine article published September 22, WWARN scientists join a rallying call for renewed focus on artemisinin resistance.  The authors warn that without immediate action, the real opportunity of malaria elimination in many countries will be lost. Of greater concern is the spectre of increased African childhood mortality, mirroring last century’s events when chloroquine failed as the result of drug-resistant parasites.

The introduction of ACTs and other malaria control measures had revived hopes that the disease could be eliminated. Success relies, in large part, on the continued availability of the highly-efficacious ACTs – a requirement now under threat with the emergence of artemisinin resistance in parts of Southeast Asia.

We have now developed reliable methods for estimating parasite clearance - a faster, more sensitive way to detect susceptibility to artemisinins,” comments Arjen Dondorp, Deputy Director of the Mahidol Oxford Tropical Medicine Research Unit in Bangkok, Thailand.  Arjen was one of the first scientists to describe artemisinin resistance in Western Cambodia. “We can use this tool to understand which factors influence the potential for transmission and disease burden.”

Chris Plowe, a Howard Hughes Medical Institute investigator and Professor of Medicine at the University of Maryland in Baltimore, USA, underlines the need for global collaborative efforts. “Despite considerable efforts, we have yet to identify specific candidate genes associated with delayed parasite clearance that could be used as surveillance tools to track and contain resistance. WWARN has been asked to lead an initiative to share appropriate samples with the wider scientific community in a bid to accelerate the pace of scientific discovery.” More details.

"Twice before, drug resistant malaria has originated along the Thailand/Cambodia border, and both times it spread to Africa," adds Chris, who studies malaria drug resistance in Africa and Asia, and who was the senior author on the paper. "When chloroquine resistance got to sub-Saharan Africa, massive increases in malaria-related hospitalisations and death were seen, and there is every reason to expect the same if artemisinin resistance follows the same pattern. If we - and by “we” I mean everybody –scientists, health officials, governments – don't get on top of this problem now, it could become a huge public health catastrophe."

Dondorp AM, Fairhurst RM, Slutsker L, MacArthur JR, Breman JG, Guerin PJ, Wellems TE, Ringwald P, Newman RD, Plowe CV. The threat of artemisinin-resistant malaria. N Engl J Med 2011 365: 1075-1077.