MALARIA: Signs of Drug Resistance Rattle Experts, Trigger Bold Plan

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http://www.sciencemag.org/cgi/content/full/322/5909/1776

Science 19 December 2008:
Vol. 322. no. 5909, p. 1776
DOI: 10.1126/science.322.5909.1776

News of the Week

MALARIA:
Signs of Drug Resistance Rattle Experts, Trigger Bold Plan

Martin Enserink

NEW ORLEANS, LOUISIANA--"A catastrophic scenario," one researcher calls it. "A global disaster," predicts another, contemplating what could happen if malaria parasites worldwide developed resistance against the new artemisinin-based combination therapies (ACTs) that have become the gold standard. Large parts of the world would have no drugs to fall back on, and malaria cases and deaths could soar, erasing hope that the world might be on the eve of a huge reduction in the disease. Yet resistance against ACTs is precisely what now seems to be developing in western Cambodia, along the Thai border, according to several studies presented here last week at the annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH).

The data have given new urgency to an audacious proposal hatched last year to eliminate malaria entirely from the areas where resistance seems to arise. Experts are gathering this week in Phnom Penh to discuss the plan's implementation, which will be coordinated by the World Health Organization (WHO). The Bill and Melinda Gates Foundation plans to bankroll the effort, says WHO malaria expert Pascal Ringwald.

Scientists still don't fully understand the extent and nature of the problem, stresses Nicholas White of Mahidol University in Bangkok, who has a study about it coming out soon. The main phenomenon researchers have documented so far is a delay in clearing the parasites from the blood of some patients on artemisinin drugs. Most researchers prefer to say that the parasite is now "tolerant" rather than resistant to the drug. Still, says White, the data are worrisome.

Cambodia's western border has long been the cradle of antimalarial drug resistance: Chloroquine, sulphadoxine-pyrimethamine, and mefloquine all met their match there before becoming useless elsewhere in the world. Scientists believe this may have to do with the misuse of drugs there and the widespread availability of underdose and counterfeit therapies. From Cambodia, gem miners and other migrants have carried resistant parasites to other Southeast Asian countries.

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