Bangkok — Millions of lives could be put at risk unless urgent action is taken to curb the spread of drug-resistant malaria in Africa, according to a new paper published in the journal Science.

The paper says the parasite that causes malaria is showing signs of resistance to artemisinin, the main drug used to fight the disease, in several east African countries.

“Mutations indicating artemisinin-resistance have been found in more than 10% of malaria infected individuals in Ethiopia, Eritrea, Rwanda, Uganda, and Tanzania,” according to the report.

Artemisinin Combination Therapies, or ACTs, have been the cornerstone of malaria treatment in recent years — but there are worrying signs that they are becoming less effective, says report co-author Lorenz von Seidlein of the Mahidol Oxford Tropical Medicine Research Unit in Bangkok.

“We have increasing reports from eastern Africa saying that they have documented resistance against the first line treatments against malaria,” he says. “The first line treatments are artemisinin combination therapy – that has been used for the last 20 years and has worked excellently well. And it’s now not working quite as well as it used to do.”

It’s estimated that over one thousand children die every day from malaria in Africa. The World Health Organization estimates that the global death toll from malaria in 2022 — the most recent figures available — was 608,000.

Past lessons

Before artemisinin therapies were developed, chloroquine was the medicine most used to treat malaria. The report authors say that in the 1990s and early 2000s, signs that the malaria parasite was developing resistance to chloroquine were widely ignored.

“When chloroquine resistance slowly sneaked into Africa there was a whole wave of childhood mortality followed by it. So really, a large number of children — probably in the millions — died because chloroquine didn’t work as well as it used to do. And now we see these first signs that something similar is happening with the ACTs. And that is of course very worrying,” von Seidlein says.

Urgent action

The report authors urge policymakers and global funding bodies to act now to prevent artemisinin resistance taking hold.

Their recommendations include combining artemisinin drugs with other medicines.

“Combining an artemisinin derivative drug with two partner drugs in triple artemisinin combination therapies [TACTs] is the simplest, most affordable, readily implementable, and sustainable approach to counter artemisinin resistance,” the report says.

The authors also call for the rollout of new, more effective insecticides and mosquito nets; better training of community health workers; the rapid deployment of new malaria vaccines; and better monitoring of parasite mutations.

Southeast Asia

Many of these methods were used to halt the spread of artemisinin resistance in south-east Asia since 2014, notes von Seidlein.

“Ultimately, there was an understanding that this could be a major health emergency globally and so there were a lot of investments from funders for the from high-income countries towards these countries in the Greater Mekong sub-region to stop the spread of artemisinin resistant parasites,” he says.

The report says that sense of urgency must now be applied to tackling artemisinin resistance in Africa.

“We ask funders, specifically the Global Fund to Fight AIDS, Tuberculosis and Malaria [GFATM] and the U.S. Government’s President’s Malaria Initiative, to be visionary and to step up funding for malaria control and elimination programs to contain the spread of artemisinin resistance in Africa — as they have done effectively in Southeast Asia since 2014,” says report co-author Ntuli Kapologwe, the director of preventive services at Tanzania’s Ministry of Health.
…