Urgent action is needed to address the rising malarial treatment resistance in eastern Africa, a recent Policy Forum has warned.
Artemisinin-based combination therapies (ACTs), first recommended by the World Health Organisation in 2006, have been the cornerstone of malaria treatment and control for over a decade, and have played a crucial role in reducing the global burden of malaria.
However, a new threat has emerged in the fight against this deadly disease with Artemisinin-Resistance (Art-R) in malaria-causing Plasmodium falciparum parasites.
This resistance has compromised the efficacy of ACTs, posing a significant threat to public health in the region, the forum lead Dr Mehul Dhorda at the University of Oxford, Mahidol Oxford Tropical Medicine Research Unit (Moru) said in a paper titled “Artemisinin-Resistant Malaria in Africa Demands Urgent Action”, published in Science last week.
The authors argue that a multipronged approach, similar to the one successfully implemented in the Greater Mekong Subregion in Asia, is necessary to prevent a surge in malaria-related sickness and death in Eastern Africa.
The success in containing Art-R in Asia offers a valuable blueprint for addressing this issue in Africa. “Success in containing ART-R in the Greater Mekong Subregion in Asia, where Art-R was first reported in 2008, suggests that a multipronged approach is needed in East Africa to reduce and interrupt malaria transmission permanently,” write Dhorda.
In response to the spread of Art-R in Southeast Asia, the Global Fund to Fight Aids, Tuberculosis and Malaria launched the Regional Artemisinin-resistance Initiative to work with national malaria control programmes, focused on enhanced surveillance, rapid diagnosis, and mass drug administration in malaria hotspots.
These efforts led to a significant decline in malaria throughout the region, despite the prevalence of ART-R.
Now, as ART-R increases across East Africa, Dhorda and the team suggest that similar investment and strategies are needed to prevent a public health crisis.
One recommended approach is the use of triple ACTs (TACTs), which combine an artemisinin derivative with two partner drugs. These TACTs have proven effective in Asia and could be crucial in combating ART-R in Africa.
In addition to TACTs, the authors emphasize the importance of enhanced community health worker networks, rapid diagnostic testing, and antimalarial treatments.
Malaria vaccination and vector control measures, such as insecticide-treated bed nets and indoor residual spraying, are also essential components of a comprehensive strategy to reduce transmission. Regular monitoring of drug resistance is critical to adapting and updating treatment protocols as needed.
Furthermore, the authors call for the implementation of new strategies using recently approved novel malaria vaccines to address the growing threat in Africa. They highlight the importance of continued funding from international organizations, specifically the GFATM and the US government’s President’s Malaria Initiative, which played a crucial role in containing ART-R in Asia.
“A similarly visionary approach is now needed to protect the populations at risk in Africa,” write Dhorda and colleagues. The call to action is clear: without urgent and coordinated efforts, the rising antimalarial resistance in Africa could undermine decades of progress in the fight against malaria, leading to increased sickness and death in vulnerable populations.
