New report on containing the emergence of drug resistance

The report summarises the excellent progress being made towards reducing malaria incidence, but highlights how this is under serious threat due to the ongoing emergence or spread of drug resistant parasites in Asia.

Resistance to the most effective treatments against falciparum malaria, artemisinin derivatives, first emerged on the Thai-Cambodia border in 2008[1]. Since then artemisinin resistance has emerged in other areas of the Mekong region. If resistance emerges or spreads beyond the Mekong region into Africa – as we’ve seen previously - millions of lives will be at risk. There is no other treatment in the drug development pipeline ready to replace artemisinins, as such it is critical that we retain the use of highly effective artemisinin combination therapies (ACTs).

The APPMG report recommends a number of measures to tackle artemisinin resistance and support the drive towards eliminating malaria. These include:

• Improve access to treatments
• Develop tools to improve quality and timeliness of data collection
• Improve surveillance
• Tackle poor quality, falsified or substandard medicines
• Enhance coverage and use of insecticide treated bed nets
• Develop approaches and tools to reduce the risk of mosquito bites.

Jeremy Lefroy, Chair of the APPMG and MP for Stafford comments, 'Drug resistance to Artemisinin Combination Therapies is a very serious problem, which is why the All Party Group has unusually issued a short special report on the subject. Tackling malaria in SE Asia has to be a global health priority both because of the threat to the people of the region and the dangerous consequences of the further spread of drug resistance, particularly in sub Saharan Africa.

WWARN supports three of the key areas highlighted: we work with researchers to improve the quality and timeliness of their clinical trial data collection, we provide evidence on the best treatment approaches for malaria patients through results gathered from large pooled data analyses, and we help to gather data on poor quality antimalarial medicines.

WWARN’s Study Groups work with multiple research partners to provide evidence to maintain the efficacy of life-saving (ACTs) and inform treatment and prevention strategies. For example, a recent Study Group analysis found that small children treated with dihydroartemisinin piperaquine (DP) were not receiving a high enough dose, putting children at risk of recurring malaria infections. Based on these findings, the World Health Organisation has updated the dosing recommendation for DP for small children.

To support government-led surveillance efforts, WWARN has developed a series of interactive mapping tools known as Molecular Surveyors (K13, dhfr & dhps, and pfmdr1 & pfcrt). These tools provide researchers and policy makers with a visual summary of data on the most important molecular markers of antimalarial resistance. WWARN’s External Quality Assurance team is also working directly with laboratories across the world to strengthen the analysis of antimalarial drug treatment regimens and enhance the quality of clinical trial research data outputs.

The drive to combat resistance would not be complete without our Medicine Quality team who provide expertise and collate information to increase our understanding of the prevalence and distribution of poor quality, substandard and falsified antimalarials. The Antimalarial Quality Surveyor, is a mapping tool that visualises summaries of published reports of antimalarial medicine quality, displaying their geographical distribution across regions and over time.

The APPMG report emphasises areas where sustained or additional financial investment and political advocacy efforts are needed, especially given that the Sustainable Development Goals (SDGs) do not include such a strong emphasis on malaria when compared to the Millennium Development Goals. It puts the spotlight on the Mekong region where continued investment will ensure that surveillance and containment efforts are sustained, and resistance levels closely monitored.

WWARN supports this call to maintain global investments in malaria, sustain government-led surveillance initiatives, and support the provision of valuable research evidence on drug resistance to inform future decision-making.

This report was dedicated to Sylvia Meek, Technical Director of the Malaria Consortium, who committed her enthusiasm and tireless efforts to tackling the threat of malaria and other neglected tropical diseases. Sylvia died on 11 May 2016.

Download a copy of the report.

References:

1. Wongsrichanalai C1, Meshnick SR et al.  Declining artesunate-mefloquine efficacy against falciparum malaria on the Cambodia-Thailand border. Emerg Infect Dis. 2008 May;14(5):716-9. doi: 10.3201/eid1405.071601.