The world risks losing its most potent treatment for malaria unless steps are quickly taken to prevent the development and spread of drug resistant parasites, according to a new action plan released today by WHO and Roll Back Malaria partnership (RBM).
The Global plan for artemisinin resistance containment outlines the necessary actions to contain and prevent resistance to artemisinins, which are the critical component of artemisinin-based combination therapies (ACTs), the most potent weapon in treating falciparum malaria, the deadliest form of the disease. Resistance to artemisinins has already emerged in areas on the Cambodia-Thailand border. Although ACTs are currently more than 90% efficacious around the world, quick action is essential. If these treatments fail, many countries will have nothing to fall back on.
Stop the emergence of drug resistance at its source
“The usefulness of our most potent weapon in treating malaria is now under threat,” said Dr Margaret Chan, WHO Director-General. “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. The consequences of widespread artemisinin resistance compel us to seize this opportunity.”
The global plan aims to contain and prevent artemisinin resistance through a five-step action plan:
1. Stop the spread of resistant parasites
A fully funded and implemented malaria control agenda, as outlined in the Global malaria action plan, would address many of the needs for the containment and prevention of artemisinin resistance. However, 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 (Cambodia-Thailand border) and US$ 8–10 per person in the at-risk areas of the Greater Mekong area.
2. 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 ACTs actually did so. There is a risk of artemisinin resistance emerging silently in areas without ongoing surveillance.
3. Improve access to malaria diagnostic testing and rational treatment with ACTs
These therapies are frequently used to treat causes of fever other than malaria. Unnecessary use of ACTs can increase the risk of resistance. In order to reduce the number of patients who do not have malaria taking the therapies, WHO recommends diagnostic testing of all suspected malaria cases prior to treatment.
4. 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 ACTs.
5. 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.
”Effective containment of artemisinin resistance will significantly improve our capability to sustain current control achievements at country level,” said Professor Awa Coll-Seck, Executive Director of the Roll Back Malaria Partnership. ”We now have a coordinated plan to stop the spread of resistant parasites, but we need additional funding to fully implement it,” Coll-Seck reminded the international donor community.
WHO estimates that the number of malaria cases has fallen by more than 50% in 43 countries over the past decade. A recent modeling analysis of malaria prevention in 34 African countries estimates that more than 730 000 lives were saved between 2000 and 2010; nearly three quarters of them since 2006, when the use of both insecticide treated mosquito nets and ACTs became more widespread. The loss of ACTs as an effective treatment would likely result in a significant increase in malaria-related deaths.
Tremendous progress against malaria
“We have made tremendous progress over the past decade in the fight against malaria,” noted Dr Robert Newman, Director of the WHO Global Malaria Programme. “If we are to sustain these gains and achieve the health-related Millennium Development Goals, then it is essential that we work together to overcome the threat of artemisinin resistance.”
The Global plan for artemisinin resistance containment was developed by the WHO Global Malaria Programme through consultation with over 100 malaria experts from across the Roll Back Malaria Partnership. Funding was provided by the Bill & Melinda Gates Foundation.