As malaria resistance continues to evolve, science must keep pace

Last week, a parasite small enough to hide out in the salivary glands of a mosquito served notice that it’s capable of undoing a multibillion-dollar global effort that, over the last 10 years, has dramatically reduced deaths from one of humanity’s most prolific killers.

The message arrived through a study in the Lancet Infectious Diseases medical journal reporting that malaria parasites resistant to the lifesaving drug artemisinin have spread across Southeast Asia much faster than expected and are now in regions of Myanmar close to its border with India.

That’s a potential problem for India, and a potential disaster for Africa, which accounts for 90 percent of the deaths from malaria each year — most of them young children. There is a sad history of drug-resistant malaria parasites emerging first in Southeast Asia and subsequently wreaking havoc in Africa. That was the pattern in the 1970s, when parasites resistant to the drug chloroquine spread to Africa and caused millions of deaths.

The news that drug-resistant parasites are once again on the march will prompt new efforts to slow their advance and add urgency to the search for alternatives to artemisinin, as it should. But there is really only one way to break out of malaria’s version of the boom-bust cycle: eliminate malaria from its remaining strongholds and eventually eradicate the parasite altogether.

Speaking late last year at the annual meeting of the American Society of Tropical Medicine and Hygiene, Bill Gates observed that while various malaria control strategies can be very effective, they are ultimately unsustainable in the face of a parasite that has proven it can consistently and reliably find a way to overcome them.

“We are in a race against evolutionary biology,” he said. “The only way to win that race is to eliminate our chief competitor — the malaria parasite.”

How can this be achieved? It can begin in Southeast Asia with efforts to prevent and contain the spread of drug-resistant malaria, which can buy time for development of new treatments and other interventions and also for reconsidering the best strategies for implementing them.

Already there is a discussion in the region of using a combination of new diagnostic techniques along with sophisticated mapping and modeling tools to launch mass treatment campaigns that would target not just sick individuals but also asymptomatic carriers. Scientists now understand that there are millions of these people carrying and transmitting malaria parasites, even if they are not showing signs of disease. Targeting parasites in both sick individuals and asymptomatic carriers could help create a firewall that would prevent or at least significantly delay artemisinin-resistant malaria from moving on to Africa.

This approach is an example of how fresh research and analysis probing things like transmission patterns can provide the type of data needed to wage a more aggressive, effective and efficient fight against malaria. Indeed, we need to make sure our strategies for addressing the complex challenges presented by this fight today are informed by current insights and not reliant on outdated research.

But we also need to develop a host of new malaria fighting tools — new drugs, diagnostics and insecticides, as well as vaccines that can prevent malaria infection and even break the cycle of malaria transmission between mosquitoes and humans.

Late last year, the World Health Organization released a new analysis showing that malaria deaths worldwide had dropped dramatically since 2000, with deaths in Africa declining by 54 percent. That’s an impressive achievement. But even with such progress, in 2013, malaria still killed more than half a million Africans, most of them young children.

To put that in perspective, consider that the total number of deaths from the Ebola outbreak currently stands at about 9,500. Four to five times more Africans will die from malaria in this month alone. While the threat of Ebola triggered an intensive global response, one senses that malaria today is not generating anywhere close to this level of urgency. But the progress of the last 10 to 20 years against malaria was made possible because many people brought a new level of energy to the effort. We cannot become complacent and assume such progress will continue.

As drug-resistant malaria parasites approach India’s doorstep, edging closer to the African continent where their toll will be greatest, we should once again be reminded that eradication is the only acceptable long-term goal.

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