World Health Agencies Alert for Dangerous Malaria Strain

Concern about inadequate malaria protections and control gave rise to a major street protest in Kolkata, India, in October 2012.
Concern about inadequate malaria protections and control gave rise to a major street protest in Kolkata, India, in October 2012.

By Charlene Porter
IIP Staff Writer
Washington,
April 29, 2013

Health authorities in Southeast Asia have detected a strain of the malaria-causing parasite that is resistant to the best medicines available to treat the disease. The urgency for action to contain that strain of the disease from spreading is being felt as far away as Geneva, Washington and Atlanta.

In Geneva and Phnom Penh, Cambodia, the World Health Organization (WHO) announced the launch of an emergency response to scale up measures to combat what could become a serious global health threat.

The most effective treatment known today is artemisinin-based combination therapy (ACTs). Resistance to artemisinins — the core component of the combination — has now been identified in Cambodia, Myanmar, Thailand and Vietnam.

Health authorities in Southeast Asia have attempted to contain the resistant strains, but the WHO announcement April 24 declared a need for urgent action to fully eliminate the resistant strains. The action is especially important to preserve ACTs as an effective treatment for the estimated 220 million cases occurring in about 100 countries where malaria is found.

“The consequences of widespread resistance to artemisinins would be catastrophic,” said Dr. Robert Newman, director of WHO’s Global Malaria Programme. “We must act now to protect Southeast Asia today and sub-Saharan Africa tomorrow.”

Artemisinin is derived from an herb native to China. It was developed as an effective treatment for malaria in 1965 after the disease-causing parasite carried by mosquitoes became immune to the most frequently used drug of the time, chloroquine. ACTs are now used in a cocktail of drugs as a means to decrease the risk of resistance.

While research for alternate malaria treatments is underway, ACTs remain the “last, best drug we have available,” said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC).

The action plan the WHO is launching in affected countries will urge governments to pull poor-quality antimalarial drugs from circulation. The use of such drugs can reduce the effectiveness of ACTs, yet they remain in circulation in some regions lacking strict pharmaceutical regulation.

The WHO plan also calls for a thorough assessment of what has been done to contain resistant strains so far and identify what else is necessary.

Frieden’s remarks about the importance of artemisinin came as he testified April 23 before the House Foreign Affairs Subcommittee on Global Health.

The subcommittee convened the hearing with a special focus on drug-resistant diseases as a threat to developing countries and to the United States as well. Frieden told the committee that 12 million Americans travel each year to countries where malaria is a health threat.

“If these resistant strains spread, the risk to people in this country will be substantial, in addition to the number of deaths and the amount of suffering and economic hardship that will cause around the world,” said Frieden.

The CDC head said his agency is “quite concerned” about the ACT-resistant strains of malaria, telling the committee that 30 percent of the cases being diagnosed among the people living on the Cambodia-Thailand border are caused by this dangerous strain.

Frieden said stopping the dangerous malaria strain depends on “stopping the mosquito [and] treating effectively, diagnosing and treating well.” The CDC director also said that persistence is critical in malaria control, that is, maintaining mosquito-control efforts even after it seems the disease has declined.

Representative Christopher Smith, a Republican from New Jersey and chairman of the Global Health Subcommittee, pointed out that U.S. contributions to worldwide malaria control efforts have increased from $100 million per year in 2000 to $1.8 billion in 2012.

WHO estimates that 3.3 billion people worldwide are at risk of exposure to malaria every day. Malaria kills about 660,000 people each year, most of them small children in Africa.