Trends by Martin Khor
Monday 9 April 2012
rise of Super Malaria
danger of drug resistance is coming uncomfortably close to home, as
scientists report the rapid spread of super malaria resistant to the
best drugs, and warn of the need to contain this resistance.
a fortnight after the World Health Organisation chief warned about
the possible end of modern medicine because of the resistance of disease-causing
micro-organisms to drugs, there was alarming news last week of the
rapid spread of a strain of malaria in Asia that is resistant to the
most effective drugs.
A new study published last week found resistance growing in a malaria
strain in the Thai-Myanmar border. It had earlier been found in Western
Cambodia. The study’s authors warn that the deadly form of malaria
could spread through Myanmar to other countries, unless swift action
Malaria is caused by parasites carried by mosquitoes, and killed 655,000
people worldwide in 2010.
It had earlier been treated with quinine then chloroquine. When malaria
developed resistance to chloroquine it was no longer effective and
the new effective drug ingredient was artemisinin (derived from the
sweet wormwood shrub), which is now mainly used in combination with
Resistance to artemisinin-based drugs is now causing alarm bells to
ring, because there are no other effective drugs, and no new anti-malaria
drug is expected to be in the market in the next several years.
Malaria that is resistant to artemisinin was first found in 2006 in
Cambodia. In Western Cambodia, 42% of malaria cases were found to
be resistant in 2007-2010. That’s a shockingly high percentage, and
if this kind of prevalent resistance spreads to other regions, there
will be a malaria emergency.
A team of British and Thai scientists studied 3,202 patients along
Thailand’s northwestern border with Myanmar from 2001 and 2010 and
measured the time it took them to clear malaria infections from their
blood after treatment. An article in The Lancet journal reported that
the number of slow-clearing infections rose from 0.6 per cent of cases
treated in 2001 to 20 per cent in 2010, indicating a rapid rise in
In that period, the average time taken to reduce the number of parasites
in the blood by half rose from 2.6 hours to 3.7 hours. The proportion
of slow-clearing infections rose from six to 200 out of every 1,000
cases, indicating resistance has reached 20% of cases.
to a report by Sky News, the lead researcher, Professor Francois Nosten,
director of the Shoklo Malaria Research Unit in Thailand, warned of
a “race against time” to halt the resistance trend.
“If the situation continues to deteriorate then it could mean that
the newest drugs that we have to treat malaria now which are the derivatives
of artemisinin, will be progressively inefficient, ineffective.”
Nosten said the consequences, as seen in the past, would be increasing
number of cases of malaria and more deaths.
He said the reason why the malaria strain has evolved resistance to
the new treatments is probably because they have been used a lot over
the last 20 years, as they were the only effective treatments.
“We can still treat the patient with these drugs and they get better
and they get cured, it just takes longer for them to clear the disease,”
“We have now seen the emergence of malaria resistant to our best drugs,
and these resistant parasites are not confined to western Cambodia.
This is very worrying indeed and suggests that we are in a race against
time to control malaria in these regions before drug resistance worsens
and develops and spreads further. The effect of that happening could
“Malaria already kills hundreds of thousands of people a year – if
our drugs become ineffective, this figure will rise dramatically.”
Another of the researchers, Prof. Nicholas White at the Faculty of
Tropical Medicine in Mahidol University in Bangkok, urged that support
be given to Myanmar to fight the spread of drug-resistant malaria
Support is needed to contain the resistance in this region, otherwise
it is going to spread to India and Africa, said White.
The spread of resistant malaria is but one more example of a critical
situation, one in which Margaret Chan, director general of the World
Health Organisation waned of an emerging era of the end of modern
There should be a worldwide campaign to identify the sources of this
problem and to contain drug resistance, including through the proper
prescription and use of drugs.