According to the World Health Organisation’s World Malaria Report, there were ‘216 million episodes of malaria in 2010’ of which 81% were in Africa and another 13% were in South East Asia. A massive 655,000 deaths occurred in 2010, just over 90% of which were in Africa. Until recently, however, it was believed that the fight against malaria was slowly being won, particularly in the European, American and Western Pacific regions. Overall ‘the estimated incidence of malaria has fallen by 17% globally between 2000 and 2010.’
There is now increased concern that the parasites causing malaria are finding new ways to attack its victims. According to an article published in The Lancet on April 5 2012, a new virulent strain of malaria has developed that is resistant to current medical treatment. Although originally discovered in Western Cambodia, this strain of malaria has now also been confirmed in Thailand and Myanmar. It is resistant to Artemisia annua (more commonly known as sweet wormwood), which is currently the best-known treatment for malaria.
According to the Lancet article, researchers studied 3202 malaria patients along the north-western border of Thailand between 2001 and 2010. The findings proved that ‘artemisinin-resistant falciparum malaria’ is on the increase along the Thailand-Myanmar border and that within 2-6 years, it will have reached the proportions already seen in Cambodia. Over the nine years of the study, it was found that artemisinin drugs were less and less effective at clearing the malaria parasites from the bloodstream of patients.
As Professor Francois Nosten explained to the BBC, this is a very serious development; one that could mean the re-emergence of malaria in some parts of the world. There is concern that this strain of malaria could spill over into African countries, where malaria already kills thousands of people, and turn into an epidemic.
Artemisinin is rarely used on its own, but is part of a cocktail of drugs used to combat malaria. However, it is believed to be responsible for the fall in deaths from malaria and there are currently no viable alternatives. As the BBC article goes on to say, this is similar to the situation that occurred in the 1970s when resistance to chloroquine developed, something that resulted in a huge increase in the number of malaria cases and resulting deaths.
One of the aims of the study was to find out the reasons for the genetic changes in the malaria parasite. That has not been finally confirmed. As one of the researchers reported: “This study narrows the search to a region of the parasite genome containing around 10 genes. We haven`t yet found the precise changes involved, but we are getting close.”
In the meantime, the WHO is urging all countries to contribute towards financing malaria containment, particularly in those countries with limited public health frameworks and where resistance to artemesinin has already been discovered. Only then will there be any hope of meeting the Roll Back Malaria goals set in 2011, which are to: “(i) reduce global malaria deaths to near zero by end-2015; (ii) reduce global malaria cases by 75% from 2000 levels by end-2015; and (iii) eliminate malaria by end-2015 in 10 new countries since 2008, including in the WHO European Region.”