Global Public Health Disaster
Malaria drug-resistant superbugs threaten a global public health disaster unless urgent action is taken to fight their spread in Southeast Asia, authors of research have warned [Financial Times, 2nd February 2017].
Female Anopheles mosquito.
Mosquitoes Transmit Disease
Mosquitos are a vector for a number of diseases, Dengue fever, Chikungunya, West Nile Virus, Filariasis, Zika Virus and most notably Malaria. On average, malaria kills one child every minute and around one million people worldwide every year.
Malaria is transmitted to humans by the female Anopheles mosquito. Like all mosquitoes, anophelines go through four stages in their life cycle: egg, larva, pupa, and adult. The first three stages are aquatic and last 5-14 days.
The adult stage is when the female Anopheles mosquito acts as the agent that carries and transmits the malaria parasites in human populations. The parasite that the Anopheles mosquito transmits is called Plasmodium.
Plasmodium falciparum, malaria parasite inside a human blood cells.
Plasmodium falciparum is a unicellular protozoan parasite of humans and is the deadliest species of Plasmodium that cause malaria in humans. It is transmitted through the bite of a female Anopheles mosquito.
Greater Mekong Sub-region
Plasmodium falciparum is the species of malaria parasite that accounts for 55% of cases and most malaria deaths in the Greater Mekong Sub-region. The Greater Mekong Sub-region countries are Cambodia, the Yunnan Province and Guangxi Zhuang region of China, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam. These countries are bound together by the Mekong River and have a population of about 278 million people.
A Burmese health care worker tends to a baby in a medical clinic at Mae Kasa, Mae Sot, near the Thai-Burmese border. Babies are at a high risk of being infected with malaria because their immune system can’t fight off the parasite.
Epicentre of Drug-Resistant Malaria
Artemisinin has been the first choice drug for battling malaria for 20 years. In recent years though, health care workers in Thailand, Cambodia and Myanmar (Burma) are seeing signs that the malaria parasite is becoming resistant to artemisinin.
A doctor consults with Burmese medics about an 18 year old pregnant woman in a refugee camp north of Mae Sot, on the Thai-Burmese border. The young woman receives extra attention because health professionals are seeing increasing evidence of malaria resistant to Artemisinin coming out of the jungles of the Greater Mekong Sub-region.
Scientists who study malaria are concerned that history could repeat itself because chloroquine, an effective malaria treatment until the 1990s, first lost its effectiveness in Cambodia and Burma before spreading to Africa, which led to a spike in deaths there.
Electron micrograph of Plasmodium falciparum inside a human cell.
The deployment of anti-malarial drugs that kill the malarial parasite has been effective. However, the development of the most deadly species of malarial parasite, Plasmodium falciparum, has developed drug resistance to almost every anti-malarial drug currently in use. There is a real risk that multi-drug resistance will soon emerge in other parts of the Mekong Sub-region as well.
The Spread of Resistant Strains
The spread of resistant strains to other countries of the world could pose a major public health threat and jeopardize important recent gains in malaria control. It could be ‘untreatable’ in a few years (WHO).
Professor Sir Nicholas White, of Mahidol and Oxford universities, says:
“The spread and emergence of drug-resistant malaria parasites across Asia into Africa has occurred before. Last time it killed millions.”
The mutant malaria parasites were identified through microscopic examination of blood spot samples from patients with falciparum malaria in Cambodia, Myanmar (Burma), Thailand and Laos.
About 160,000 Burmese refugees live in refugee camps along the Thai side of the Burmese border.
Burmese refugee mother caring for her sick child at a medical clinic on the Thai-Burmese border.
In response to this serious threat, the World Health Organisation (WHO) has called for increased coordinated efforts to tackle this drug resistant malaria in Cambodia, Laos, Myanmar, Thailand and Vietnam. With guidance from WHO, all these countries have developed emergency malarial elimination plans. However, success requires urgent and coordinated action by a consortium or partners. In malaria endemic areas, people must have access to tools that both prevent and treat the disease.
High quality anti-malarial medicines are the cornerstone of effective malarial management.
High quality anti-malarial medicines are the ‘cornerstone’ of effective malaria management. Poor quality medicines not only contribute to drug resistance but also adversely affect the health and the life of the patients. People who are diagnosed with malaria should be promptly treated with effective anti-malarial medicines for their own health and to prevent ongoing transmission of the disease in the community.
Vector control is the primary way to prevent and reduce malaria transmission. If the coverage of vector control within a specific area is high enough, then a measure of protection will be effective across the community. For the protection of all people at risk of malaria, WHO recommends two forms of vector control. Mosquito nets treated with an insecticide and indoor residual spraying – are effective in a wide range of circumstances.
In most settings, WHO recommends ‘long-lasting insecticidal treated nets’ (LLIN) for all people at risk of malaria. The most cost effective way to achieve this is by providing LLINs free of charge to ensure that people at risk sleep under a LLIN every night.
The other powerful way to reduce malaria transmission is through ‘indoor residual spraying’ (IRS) with insecticides. Depending on the insecticide formulation used and the type of surface on which it is sprayed, indoor spraying is effective for 3-6 months. To protect a community for the entire malaria season, multiple spray rounds are needed.
World Health Organisation
The most biologically vulnerable are children under five years of age and pregnant women. Malaria is the leading cause of morbidity and mortality in Myanmar. The most virulent and drug resistant form of malaria is found along the Thai-Burmese border. Untreated, the disease is often fatal.
As of March 2017, WHO reported that along the Cambodian-Thai border the malaria parasite, Plasmodium falciparum, has become resistant to almost all available anti-malarial medicines.
WHO has called for urgent and aggressive measures. The first two key activities should include:
- reduction of the parasite reservoir through effective treatment and use of low-dose primaquine for P. falciparum,
- universal coverage of at-risk populations with LLINs or IRS and supplementary measures where appropriate.
IHO Global has undertaken two projects in high risk malaria affected areas:
The orphans of Jury’s Orphanage in a refugee camp on the Thai-Burmese border need medications to fight off mosquito-borne diseases, in particular, the WHO recommended supply of anti-malarial medication. Jury’s Orphanage needs LLINs and IRS as a preventative supplementary measure against mosquito-borne diseases which are potentially lethal to young children and pregnant mothers.
MineField Village, Cambodia.
MineField Village in Cambodia is four hours’ drive from the Thai border. MineField Village is land on which 500 families, the poorest of the poor, call home. MineField Village families need the WHO recommended supply of anti-malarial medication as well as LLINs and IRS as a preventative supplementary measure to protect against dangerous mosquito-borne diseases.