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The WHO has launched a worldwide ‘call to action’ to governments, agencies, researchers and non-governmental organisations over the malaria parasite’s growing resistance to the most potent weapon against it — the drug, artemisinin.
If recently discovered resistance spreads, said the WHO, the formidable successes of anti-malaria campaigns in recent years will be threatened. Artemisinin lies at the heart of malaria treatment worldwide and has no obvious successor.
"The consequences of widespread resistance to artemisinins would be catastrophic," WHO director-general Margaret Chan told a press conference held after the launch of the ‘Global plan for artemisinin resistance containment’ yesterday (12 January).
"We need to maintain this medicine. What is at stake it is not just the goals on malaria but, frankly, the whole related Millennium Development Goals", said Robert Newman, director of the WHO Global Malaria Programme.
Resistance to artemisinin was identified in the Plasmodium falciparum parasite on the Cambodia–Thailand border in studies conducted between 2001 and 2009. It is now reported in other areas of the Greater Mekong Subregion and some fear that the resistance will spread to Africa, where most malaria deaths occur.
GPARC calls for increased surveillance of resistance and improved access to diagnostics and treatment with artemisinin combination therapies (ACTs), and for more research on topics ranging from new methods for containing resistance to mathematical modelling of its spread.
"We don’t have all the knowledge and tools we need," said Newman, adding that finding a quick way of testing for resistance should be a priority.
"We need a molecular marker for drug resistance that will allow us to know much earlier where this problem may be emerging."
"The research community must be engaged in the development of new classes of antimalarial medicines that would not fall into the same trap of resistance that we have with ACTs," he added.
But it will not be easy to pin down the parasite’s genes responsible for resistance, according to Pascal Ringwald, coordinator of the drug resistance and containment unit of the WHO Global Malaria Programme.
"It took 30 years to find the gene related to chloroquine resistance," he told SciDev.Net. "There are thousands of mutant genes in the parasite and the problem is to find which mutation could be related to artemisinin resistance."
"Now we have better molecular tools," he said. "I don’t think it’s going to take another 30 years, but it is very difficult and also very expensive."
Call for action also aims to bring in new funds to bridge the estimated US$175 million funding gap for the project. So far, the UK’s Department for International Development (DFID) has agreed to fund a project to improve surveillance and map the extent of resistance.