Containment of artemisinin resistance

Plasmodium falciparum resistance to artemisinin was first confirmed on the Cambodia-Thailand border in 2008 and is now present in four countries of the Greater Mekong Subregion: Cambodia, Myanmar, Thailand and Viet Nam. The spread of artemisinin resistance to other regions, or its independent emergence in other parts of the world, could trigger a major public health emergency. Urgent action is therefore required by endemic countries and development partners to prevent the situation from worsening.

In January 2011, WHO released the Global plan for artemisinin resistance containment (GPARC) calling on endemic countries and stakeholders to scale up containment activities in affected countries, and to implement a comprehensive plan in other endemic regions to prevent the emergence of resistance.

The Greater Mekong Subregion has long been the epicentre of antimalarial drug resistance. During the past decades, the spread of resistant parasites from this region to India and Africa led to a dramatic rise in the global malaria burden. Today, WHO recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria caused by P. falciparum. ACTs have been integral to the remarkable recent successes in global malaria control, and there is broad consensus that protecting the efficacy of ACTs is an urgent priority.

Containment efforts are now ongoing in all four countries with confirmed or suspected resistance. In areas where there is evidence of artemisinin resistance, an immediate, comprehensive response with a combination of malaria control and elimination interventions is needed to stop the spread of resistant parasites. Once resistance to artemisinin has been detected, it is more likely that resistance to partner drugs (the medicines used in combination with artemisinins as part of ACTs) will also develop, and vice versa. Consequently, parasite resistance to partner drugs is also an important concern and needs to be monitored.

Efforts to contain artemisinin resistance in the Greater Mekong Subregion have been effective where implemented, but programmes now need to be strengthened and expanded. This requires a rapid scale-up of core malaria prevention and control measures, considerable investments in monitoring drug efficacy, and an expansion of access to diagnostics and quality-assured, locally appropriate antimalarials. There is also a great need to take action to accelerate the removal of oral artemisinin-based monotherapies from markets, along with antimalarials that do not meet international quality standards, as has been called for by the World Health Assembly.

Thus far, artemisinin resistance has been identified mainly near international borders and in areas with a high number of migrants. While country-level activities are essential, strong cross-border and regional cooperation activities will also be needed to contain and eventually eliminate artemisinin resistance. In early 2013, WHO established a regional hub in Phnom Penh, Cambodia to coordinate the multi-partner effort to scale up containment efforts in the Greater Mekong Subregion.

Last update: 6 March 2013

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