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Malaria Drug Resistance in Cambodia Not a Surprise

   Joe DeCapua 06 July 2010

   Health  officials  in  Cambodia  have found a strain of malaria thatâs
   showing   resistance   to   the   main  anti-malaria  drug,  known  as
   artemisinin.

   Resistance  means  patients  can  take  longer  to  recover.   Health
   officials  and  medical  aid  groups  in  Africa â home to most of the
   worldâs  malaria  cases  â are keeping a close eye on the situation in
   Cambodia.

   One  of  the  groups battling the disease is Africa Fighting Malaria.Â
   Director Richard Tren says news of the drug resistance in Cambodia did
   not come as a surprise.

   âItâs  not  new  news.   This is something people have been concerned
   about   for   some  time.   In  that  part  of  Southeast  Asia,  the
   artemisinin-class  of  drugs  has been used for a long time.  Theyâve
   been  used  as  a  mono-therapy.   In  other words, they havenât been
   combined with other drugs,â he says.

   Long-term  use  of  a  single  drug  to  treat  malaria  leads to drug
   resistance, according to Tren.

   âThis  has  been  the history of malaria treatment.  The good part is
   that  the  authorities  are trying to do something about it.  This is
   not being ignored.â

   What can be done?

   One of the steps being taken is improving drug treatment policies.

   âTheyâre  making  sure that malaria treatment is done with combination
   therapies  so that youâre mixing the artemisinin drug with a different
   drug that has a different mode of action.  What happens then if there
   is  resistance  to  the  artemisinin,  the  other  drug will take that
   parasite out,â says Tren.

   But  drugs  alone  wonât  solve  the  malaria  problem,  no matter how
   effective.   Transmission  of  the  malaria  parasite must be sharply
   reduced.

   âIf there are fewer cases of malaria, Tren says, âreduced transmission
   means  that  the resistant gene of the malaria parasite canât be drive
   through   a   population.   Reducing  malaria  burden  and  improving
   treatment is the only way that we have to control this.â

   He  warns  though,  that  the  situation  in  Cambodia is very serious
   because  âthereâs no next class of drug of the artemisinin-based class
   of  drugs.   Theyâre  our last, best hope of malaria treatment and it
   will be many years before we get a new class of drug available.â

   Worse in Africa, but⦠

   Most of the one million malaria deaths each year occur in Africa.

   âThe  burden  of  malaria  in Africa is much higher.  There is a much
   more  deadly  strain of malaria.  The falciparum malaria that you get
   in  Africa  is  much more likely to kill.  And unfortunately, you see
   the problems that you do in Southeast Asia, where you have ongoing use
   of these mono-therapy drugs,â he says.

   Africa  Fighting  Malaria research found a high rate of âsub-standardâ
   and fake medicines being sold on the continent in private markets.

   âWe  have to be clear that no drug resistance has been found in Africa
   yet.   These  artemisinin drugs are still highly effective, but it is
   something we have to be very vigilant about,â he says.

   While  mono-therapy  is  found in Africa, official policies call for a
   different approach.

   âOfficially,  all governments are supposed to be using the combination
   therapies.   But  the  reality is in many African settings people buy
   their medicines from shops and kiosks and the mono-therapies are still
   being  used  far too much.  African leaders, African governments have
   committed  themselves to getting these mono-therapies off the market,â
   he says.

   The  more  mono-therapy  is  used  in  Africa, the greater the risk of
   artemisinin resistance.

   A vaccine

   A malaria vaccine would help but not solve the epidemic.

   âWeâre closer now than ever before,â Tren says, âwith a good candidate
   vaccine  that  is  being  supported by the Gates Foundation and by the
   drug company GSK (GlaxoSmithKline) and other partners.â

   But  he  warns  that  a malaria vaccine would not be as effective as a
   smallpox  vaccine, for example.  âThis will reduce the probability of
   dying  by  about  half, I think.  You know, this is not going to be a
   magic bullet,â he says.

   Effective   medicines  and  malaria  control  will  still  be  needed,
   including  insecticide  treated  bed nets and indoor spraying of homes
   with insecticides to control mosquitoes.

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