Researchers find widespread drug resistance and fear it may spread from Southeast Asia into India and beyond
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Mae La refugee camp, north of Mae Sot in Thailand, and home to tens of thousands of Burmese refugees from a region where drug resistant malaria is re-emerging (Photo: Simon Roughneen)
YANGON – Southeast Asia is a potential flashpoint in the global fight to control malaria, with the widespread emergence of malarial parasites resistant to the front-line treatment artemisinin.
Now researchers fear hundreds of millions of people are at risk in South Asia after drug-resistant malaria was found just 25 kilometres from the Indian border in northwestern Myanmar.
“Emergence of artemisinin resistance in Southeast Asia poses a serious threat to the global control of Plasmodium falciparum malaria,” reads a new research report published in renowned medical journal The Lancet.
Falciparum is the deadliest of the various known strains of malaria, responsible for almost all of about 600,000 deaths worldwide every year.
Researchers from Oxford University and Thailand’s Mahidol University teamed up with Myanmar counterparts from the Defence Services Medical Research Unit and found incidences of resistance at 55 malaria treatment centres across Myanmar, including close to the Indian border at Homalin in Sagaing Region.
The findings, from research conducted in 2013 and 2014, come after previous work by other researchers showed drug-resistant malaria taking hold in Myanmar’s eastern border regions, close to China, Laos and Thailand, as well as in Cambodia.
In recent times, Myanmar’s re-emergence from the doldrums of military rule has seen the country pitched as a strategic bridge between China, India and the rest of Southeast Asia. But the emergence of drug-resistant malaria in Myanmar’s remote, impoverished borderlands has endowed the country with another, less welcome significance.
Myanmar has the only land border to the Indian sub-continent from Southeast Asia in within the malarial climate zone and is this is the only possible land bridge for resistance to spread.
Professor Mike Turner, Head of Infection & Immunobiology at the Wellcome Trust, which funded the work in Myanmar, warned that “we are facing the imminent threat of resistance spreading into India, with thousands of lives at risk.”
The study recommended urgent changes in treatment regimes to halt the spread of potentially artemisinin-resistant parasites.
Artemisinin is derived from the Chinese qing hao plant, also known as Artemisia annua or sweet wormwood. Herbal treatments for malaria derived from it have long been used in China, and the plant has a 2000-year-old history as a medicine source.
But the utility of the Chinese-derived treatment looks to be coming to an end – echoing what happened in the 1960s, when malaria-carrying parasites in Thailand became impervious to chloroquine, then the main treatment.
That resistance eventually spread around the globe – through the same land bridge – at a time of rapidly growing populations. Hundreds of millions of lives were lost.
Dr Woodrow told The Edge Review that because artemisinin has been used in southeast Asia for several decades, the region has become“the specific origin of artemisinin resistance.”
A repeat scenario could be on the cards, as around half the world’s population, spread across 97 countries, is at risk of malaria, which remains a major killer despite the effectiveness to date of artemisinin.
It is fast-acting, and is always recommended to be taken in combination with another more slow-acting anti-malarial drug to ensure that all parasites are destroyed.
The World Health Organization (WHO) estimates that 198 million people caught malaria in 2013, of whom an estimated 584,000 died, mostly African children. In context, fewer than 10,000 deaths have been confirmed from last year’s much-feared Ebola outbreak in western Africa.
Malaria mortality rates have fallen by 47 per cent globally in the past 15 years – progress to a large extent down to the efficacy of artemisinin – but the WHO warns that any impairment of current treatments could have catastrophic consequences.
“If resistance to artemisinins develops and spreads to other large geographical areas, the public health consequences could be dire,” said the UN agency.
Professor Philippe Guerin, Director of the Worldwide Antimalarial Resistance Network (WWARN), said the latest findings from Myanmar highlight “that the pace at which artemisinin resistance is spreading or emerging is alarming.”
