Malaria rates declined in last 15 years, but now we are at a negative tipping point
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This year's World Malaria Day theme, "Zero Malaria Starts With Me" re-energizes the fight to eliminate malaria which, despite being preventable and treatable, still kills over half a million people every year. While incredible progress has been made in the past 15 years (with over 7 million malaria deaths averted and about 40% reduction in malaria globally), the fight against the disease is now inching towards a tipping point - progress has slowed down in some parts of the world and reversed in a few.
Is drug resistance a threat?
A major challenge confronting malaria elimination is the emergence of drug-resistant malaria in the Greater Mekong Subregion (GMS), including countries like Thailand, Cambodia, Myanmar, Laos and Vietnam. Thailand's Minister of Public Health, Professor Piyasakol Sakolsatayadorn said to CNS (Citizen News Service): "Drug-resistant malaria is a threat to Thailand and the Greater Mekong Subregion (GMS). This area is the epicentre of drug-resistant malaria. Drug-resistant malaria can become a global health threat if we cannot manage and eliminate drug-resistant malaria in Thailand and the GMS."
Historically, the GMS region has long been an epicentre of antimalarial drug resistance. In fact, 40-45 years ago, chloroquine resistance had spread throughout the world from this region. So, there are fears about risk of re-emergence of malaria because of anti-artemisinin resistance.
"If drug resistance from Greater Mekong Subregion (GMS) spreads beyond this region, it will have a devastating impact on countries with high burden of malaria" cautioned Alistair Shaw, Senior Program Officer, Raks Thai Foundation.
But science at best is inconclusive, if the spread of drug resistance is a risk. "It is mostly the asymptomatic patients that carry gametocytes and transmit Plasmodium Falciparum. In Thailand, less than 5% patients have gametocytes that can transmit to next mosquito cycle. There is no strong evidence so far if a person who has drug-resistant malaria can transmit it to the mosquito and mosquito carrying that phenotype, transmits it to another person," says Professor Jetsumon Sattabongkot Prachumsri, who is the Director of Mahidol Vivax Research Unit (MVRU), Faculty of Tropical Medicine, Mahidol University in Thailand.
Agrees Dr Tim France, a noted global health expert, who also leads Inis Communication: "At present you can say largely that there is more that we do not understand about malarial drug resistance and we do know we are at a very active learning period. But at the end of the day whether drug resistance is spreading or occurring de novo, the conclusions and essential actions remain the same."
Governments promised to end malaria
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