It wasn’t long ago when people were saying that combination treatments with Artemisinin would be the future for eradicating the deadly parasite from the African continent.
As a matter of fact, the use of Artemisinin combination therapy (ACT) and insecticide treated bed nets is given credit for saving over 700,000 lives in Africa from 2000 to 2010.
Then ACT resistance was seen on the Cambodia-Thailand border. A 2008 study in the New England Journal of Medicine demonstrated the drug was losing its potency in the region and a fear that it may spread worldwide has grown.
Artemisinin, the antimalarial drug is extracted from the plant Artemisia annua (wormwood).
Artemisinin combination therapy is where a patient takes both a fast-acting and a slow-acting drug to kill the malaria parasite. Before the parasite would be killed in 24 to 36 hours; it is now taking up to 120 hours to kill the parasite.
If the resistance was to spread, there are no new drugs to take the place of ACT.
It is suspected that the artemisinin resistance appeared in the Cambodia-Thailand area because of a long history of rampant and indiscriminate artemisinin monotherapy and counterfeit drugs.
There is some precedent in the Thai-Cambodia border region as far as antimalarial resistance. This is where chloroquine resistance was first seen also.
The World Health Organization (WHO) in response to this serious issue has released a new action plan. According to Dr. Margaret Chan, WHO Director-General:
“The usefulness of our most potent weapon in treating malaria is now under threat. The new plan takes advantage of an unprecedented opportunity in the history of malaria control - to stop the emergence of drug resistance at its source and prevent further international spread."
In an effort to prevent malaria rates from soaring again, The Global Plan for Artemisinin Resistance Containment was developed by the WHO Global Malaria Programme with funding from the Bill and Melinda Gates Foundation and expertise from the Roll Back Malaria Partnership.
The plan consists of the following 5 steps to contain and prevent artemisinin resistance:
- Stop the spread of resistant parasites. A fully funded and implemented malaria control agenda would address many of the needs for the containment and prevention of artemisinin resistance. Additional funding will be needed to stop the spread of resistant parasites in areas where there is evidence of artemisinin resistance. The global plan estimates that it will cost an additional US$10-20 per person in areas of confirmed resistance along the Cambodia-Thailand border and US$8-10 per person in the at-risk locations within the Greater Mekong area.
- Increase monitoring and surveillance for artemisinin resistance. WHO estimated in 2010 that only 31 of the 75 countries that should be conducting routine testing of the efficacy of artemisinin-based combination therapies actually did so. There is a risk of artemisinin resistance emerging silently in areas without ongoing surveillance.
- Improve access to malaria diagnostic testing and use artemisinin-based combination therapies only to combat malaria. These therapies are frequently used to treat causes of fever other than malaria, which can increase the risk of resistance. To reduce the number of patients who do not have malaria taking the therapies, WHO recommends diagnostic testing of all suspected malaria cases before treatment.
- Invest in artemisinin resistance-related research. There is an urgent need to develop more rapid techniques for detecting resistant parasites, and to develop new classes of antimalarial medicines to eventually replace the artemisinin-based combination therapies.
- Motivate action and mobilize resources. The success of the global plan will depend on a well coordinated and adequately funded response from many stakeholders at global, regional and national levels.
The plan is being implemented to prevent what happened years ago with the spread of chloroquine resistance worldwide. According to Professor Awa Marie Coll-Seck, executive director of the Roll Back Malaria Partnership:
"Despite clear evidence that chloroquine resistance was progressively spreading from Southeast Asia to sub-Saharan Africa, no global containment strategy was prepared or adopted. As a result, malaria mortality was increasing worldwide, with hundreds of thousands of additional deaths occurring every year, particularly in sub-Saharan Africa."
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