The World Health Organization (WHO) released a plan today to deal with a threat that could undermine the recent success in malaria control: the emerging resistance against artemisinin drugs, which are the cornerstone of malaria treatment worldwide. WHO hopes that donors will help pay the cost, estimated at $175 million annually, including $60 million for new research.
Over the past few years, researchers have seen resistance against artemisinin derivatives—which are combined with other drugs in so-called artemisinin-based combination therapies—emerge in Cambodia, in an area along the border with Thailand. There are indications that resistance may occur along the Thai-Myanmar border and in Vietnam as well (Science, 14 May 2010, p. 844).
At the moment, no other class of drugs is available to replace artemisinin, and none are near the end of the development pipeline. Scientists worry that if resistant parasites make their way to Africa, where the vast majority of malaria cases occur, mortality will soar. "It is no exaggeration to say that the consequences of widespread resistance to artemisinins would be catastrophic," WHO Director-General Margaret Chan said today during a launch event for the plan.
The Global Plan for Artemisinin Resistance Containment (GPARC) doesn't contain detailed strategies; it's billed as a "call to action and a high-level plan of attack." The idea is to enlist governments, international agencies, nongovernmental organizations, funders, scientists, and industry in a multipronged approach. Among other things, GPARC calls for halting the spread of resistant parasites in Cambodia by strengthening malaria control locally, ramping up monitoring and surveillance to detect resistance, and investing in new research. On the scientific agenda are identifying molecular markers for resistance, which would simplify testing; accelerating the development of alternative drugs; and studying the effectiveness of mass screening and treatment to eliminate malaria in the areas where resistance occurs.
Most of the $175 million needed has yet to be found, says Robert Newman, head of the WHO Global Malaria Programme. But donors like the Bill and Melinda Gates Foundation, the U.S. President's Malaria Initiative, and the Wellcome Trust—all of which were present at the launch—are interested, he says. The U.K. Department for International Development has already agreed to fund a large project to improve surveillance and map the precise extent of the problem. Part of the money can also be "wrangled out of existing programs," such as the Global Fund, Newman adds. Given the high stakes, the price tag is "pretty modest," he says.
"It's a good plan," says Christopher Plowe, a malaria specialist at the University of Maryland School of Medicine in Baltimore and one of more than 100 scientists WHO consulted during the inception of GPARC. "What they propose to do is generally sound," he says. But Plowe says he's still "anxious" that the funding may not come together or that implementation will move too slowly to contain resistance.
In the past, some scientists have criticized WHO for not doing enough to tackle the problem. Newman disagrees but concedes that it has been hard to get international attention for the problem. "Activities have been going on for years, but there just wasn't global political traction," he says. "The plan is also an effort to raise the profile of a very important issue. ... I wanted to elevate it on the radar screen."