MANILA, 24 October 2013 –The World Health Organization (WHO) has warned that the emergence of drug-resistant malaria in the Greater Mekong Subregion (GMS) is a worrying challenge to malaria control and elimination efforts and must be tackled urgently.
Resistance to the front-line anti-malarial drug artemisinin was first confirmed on the Cambodia–Thailand border in 2008 and has now also been detected in Myanmar and
“The emergence of artemisinin resistance could undo the enormous progress made towards malaria control and elimination—and potentially pose a serious global health threat,” says WHO Regional Director for the Western Pacific, Dr Shin Young-soo. “Key development partners strongly support our efforts. However, we still face a funding gap of at least US$ 450 million over the next three years. The Global Fund to Fight AIDS, Tuberculosis and Malaria has pledged US$ 100 million and a regional proposal has just been submitted.”
Artemisinin-based combination therapies (ACTs) are the first-line treatment for uncomplicated Plasmodium falciparum malaria in most endemic countries and are partially responsible for the remarkable recent success in reducing the global malaria burden.
“We are taking the situation very seriously,” says Dr Shin. “If resistance to artemisinin emerges elsewhere, the consequences for global health could be grave.”
Malaria is endemic in 10 of the 37 countries and areas in the Western Pacific Region—Cambodia, China, the Lao People’s Democratic Republic, Malaysia, Papua New Guinea, the Philippines, the Republic of Korea, Solomon Islands, Vanuatu and Viet Nam.
WHO, together with major development partners, carried out an assessment of the response to artemisinin resistance in the Greater Mekong Subregion in 2011–2012. The resultant report became the basis of the Emergency Response to Artemisinin Resistance in the Greater Mekong Subregion: Regional Framework for Action 2013–2015, which was launched on World Malaria Day 2013. This is an ambitious programme designed to provide the six countries and areas of the subregion with strategic direction to take on and beat resistance. It will be multipronged and will operate across borders.
WHO’s Regional Committee for the Western Pacific is currently meeting in Manila to urge Member States to capitalize on unprecedented political commitment to vigorously implement the emergency response, which includes the establishment of a WHO regional hub in Phnom Penh, Cambodia, to support and coordinate containment efforts, with financial support from the Bill & Melinda Gates Foundation and the Australian Agency for International Development (AusAID).
Dr Shin says: “With the framework and the hub, we now have the pieces in place to provide the countries of the Greater Mekong Subregion with the support they need to take on artemisinin resistance. The task is to contain resistance and then to eventually eliminate malaria from the Region.”
Artemisinin resistance exemplifies the multisectoral dimension of a public health emergency, affecting such groups as people living in remote border areas and mobile and migrant populations. “Health services cannot meet this challenge alone,” says Dr Shin. “Non-health sectors need to be involved in this effort, working across borders where necessary.”
In this context,the WHO regional offices for South-East Asia and the Western Pacific recently convened a high-level Biregional Meeting on Healthy Borders in the Greater Mekong Subregion, in Bangkok, Thailand.
The meeting analysed the complexities of this multisectoral problem, focusing on weaknesses in health systems, inequitable access to health care for the most vulnerable population groups in border areas, the impact of development projects on health and the need for consolidated action between various relevant sectors beyond health, such as trade, labour, immigration and agriculture.