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Gains to control and eliminate malaria will be jeopardised by growing drug resistance in western Cambodia unless the global health community initiates a speedy, scientifically sound and coordinated response, says Nicholas J. White.

The emergence of resistance to artemisinin — a drug used to combat infections with the malaria parasite Plasmodium falciparum — mirrors the emergence of resistance to a different drug, chloroquine, which arose in the same part of Cambodia 50 years ago. It then spread quickly to Africa killing millions of children.

The only way to ensure that artemisinin-resistant malaria does not reach the rest of the tropical world might be to eliminate P. falciparum malaria at its source, at least temporarily, argues White. The affected part of Cambodia is geographically separated from other malarial areas, so this should prove possible, he says.

White pinpoints three questions to consider in deciding a course of action. Is enough being done to counter the threat, has artemisinin-resistant malaria spread already and is a truly radical approach to disease control justified?

If artemisinin resistance spreads widely, current strategies against malaria will be made redundant, he says.

The world has shown a limited ability to respond rapidly and effectively to global threats from infectious diseases. A 'passive model' of response — where individual countries make funding proposals to the Global Fund to Fight Aids, Tuberculosis and Malaria, for example — seems too "hit-and-miss", says White. He suggests that affected countries are involved in finding a solution, that the WHO takes a strong lead to tackle the problem and that high-level political backing for this effort is essential.

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