The Lancet Infectious Diseases Journal reports that the resistant strain, which has already been detected in Burma, Vietnam, Thailand, Laos and Cambodia and is on the verge of entering India, would likely pose a serious hazard to the chance of global control and eradication – especially if the drug-resistance spreads to or emerges independently in Africa.
‘Myanmar is considered the front line in the battle against artemisinin resistance as it forms a gateway for resistance to spread to the rest of the world,’ said Charles Woodrow of the Mahidol-Oxford tropical medicine research unit, who led the study at Oxford University.
Blood samples from 940 infected malaria patients at 55 malaria treatment centres across Burma showed that 371 (or 39 per cent) of those had mutations known as K13 (the ‘kelch gene’), which is a known signal of artemisinin drug resistance. Prevalence of the resistant parasites was more than 20 per cent in seven of the ten administrative regions of Myanmar areas.
In Homalin, Sagaing Region, only 15 miles from the Indian border, 47 per cent of those tested carried the mutations.
While no evidence of the resistance actually reaching India has been discovered, the team reports that there is little data available to make what it would consider to be an informed judgement.
As such, the report suggests that appropriate therapeutic regimens should be tested urgently and implemented comprehensively if this resistance is going to be stopped spreading to other regions. As part of a combination treatment, there is a chance that the other, slower-acting partner drug will initially keep the treatment effective in the short-term, but Dr Woodrow states that resistance to that drug is bound to develop over time, and so a more practical longer-term solution must be found.
Talking to the BBC, he stated: ‘If this were to spread into India, malaria will continue to affect rural populations there, but there may not be an immediate effect on cure-rate. But beyond the short term, there is very likely to be a problem, and there are very few [other] drugs on the table.’
Phillippe Guerin, director of the Worldwide Antimalarial Resistance Network, has described these findings of the pace at which this resistance is spreading as ‘alarming’, while Professor Mike Turner, the head of infection and immunobiology at the Wellcome Trust medical charity, has told the BBC that he believes ‘we are facing the imminent threat of resistance spreading into India, [putting] thousands of lives at risk’.
However, some hope has been offered within the report – thanks to scientific advances made in genetic analysis, researchers tracking artemisinin antimalarials are ‘in the unusual position of having molecular markers for resistance before resistance has spread globally. The more we understand about the current situation, the better prepared we are to adapt and implement strategies to overcome the spread of further drug resistance’.
This presents an opportunity like never before to best contain and hopefully prevent the outbreak of resistance spreading to other regions.
This is not the first time that malaria has gained a resistance to the drugs used to treat it. Chloroquine, the original cure, is estimated to have saved hundreds of millions of lives before 1957, when a resistant strain was discovered on the Cambodia–Thailand border and subsequently spread around the globe, reaching Africa in 1974. This development of resistance is believed to have caused millions of deaths.
That treatment was replaced by sulphadoxine/pyrimethamine (SP), but resistance to SP subsequently emerged in the late 1980s in western Cambodia before, again, eventually spreading to Africa. SP was then replaced by the current Artemisinin Combination Treatment (ACT). There had been hopes that this would be the treatment that would eventually allow for the total eradication of deaths from malaria, but there are now significant fears that it may be about to be rendered redundant – leading to potentially terrible consequences.