Malaria - a slow-burning global emergency

[webfact]

A slow-burning global emergency
Jim Pollard
The Nation


A Cambodian boy is tested for malaria at a clinic along the Thai-Cambodian border.

Thailand is playing a key role in countering a major threat to public health - growing resistance to the most effective drug to counter malaria

BANGKOK: -- News that resistance to the anti-malaria drug artemisinin has spread across mainland Southeast Asia is a slow-burning global emergency, according to Bangkok-based malaria expert Nick White.

Professor White is the chairman of the Worldwide Anti-Malarial Resistance Network and Professor of Tropical Medicine at the Mahidol Oxford Tropical Medicine Research Unit (MORU), part of Mahidol University in Bangkok, which has just released a new study.

The study, which analysed blood samples from 1,241 malaria patients in 10 countries across Asia and Africa, found that artemisinin resistance in Plasmodium falciparum - the most deadly parasite that causes malaria - is now firmly established in western Cambodia, Thailand, Vietnam, eastern Myanmar and northern Cambodia. There are also signs of emerging resistance in central Myanmar, southern Laos and northeast Cambodia.

This essentially confirms what White and malaria experts have feared ever since resistance to artemisinin was observed in western Cambodia seven years ago, before "jumping" to the Thai-Myanmar border in recent years. The news has reared like a cloud over the substantial gains made in the worldwide fight against the disease over the past decade and a half.

"We see the potential for our main tool [to fight malaria] being lost … artemisinin resistance is clearly established across most of mainland Southeast Asia, and knocking on the door of India," Prof White said, in an interview after the findings of the survey were announced at the start of the month.

"The drugs are still working but beginning to fail. And a new drug is at least five years away."

A British doctor with an interest in tropical diseases, who first arrived in Thailand back in 1980, White - and a handful of local and foreign scientists based in Bangkok and Mae Sot - is now at the forefront of international efforts to track resistance to artemisinin and develop strategies to contain the spread of a disease that is re-emerging as a major health concern.

Billions of dollars have been spent under multinational campaigns led by the Global Fund for HIV, TB and Malaria and backed by the World Health Organisation to reduce malaria deaths through the distribution of insecticide-treated bed nets, and the use of artemisinin combination therapies. These are estimated to have saved about three million lives - mainly because of a big drop in the death rate among children in Africa - since the turn of the century, White said.

But the malaria parasite is fighting back, as it did against chloroquine, the world's main anti-malarial drug from the 1950s to the 1970s. Indeed resistance to chloroquine in malaria parasites also arose near the Thailand-Cambodia border, and spread across Asia and Africa at a cost of millions of lives. Resistance to SP, the drug which followed chloroquine, also arose in the same place, and also spread to Africa. So there are deadly precedents to the current problem of artemisinin resistance.

Three sites in Africa were included in the latest survey - in Kenya, Nigeria and the Democratic Republic of the Congo - and artemisinin resistance was not detected in these locations. However, White was quick to concede this was a "minuscule" sampling on a large continent, and that artemisinin resistance "could be there".

But mosquitoes differ around the world and there is some hope, he said, that African mosquitoes may be less accommodating to artemisinin-resistant malaria parasites - and that resistance may not spread as quickly as it has in Southeast Asia.

White is concerned that the global response to the emergence of artemisinin resistance has been muted, partly because those who get malaria are often "disenfranchised rural people". He also fears that world leaders are notoriously difficult to prod into radical action for "slow-burning emergencies".

"The only time we've taken pre-emptive action is for nuclear bombs - to try to stop the spread of nuclear weapons. ... Our response to slow-burning emergencies is profoundly disappointing."

Climate change comes to mind, but White gave a brief history of penicillin, the development of antibiotics and the Chinese discovery of artemisinin.

"Some say resistance to anti-microbials [medicines] is the single greatest threat to human beings," he said. "Antibiotics and anti-malarials are miracles. But we're these using these incredibly precious medicines like [chocolate] Smarties, and we're not discovering new antibiotics quick enough to keep up with the development of resistance."

In the year 2000, roughly 3,000 people were dying from malaria every day. That figure has since dropped to about 2,000 a day (approximately 600,000 deaths a year worldwide), thanks largely to the availability of artemisinin and scaled-up activities by national health ministries.

Thailand has less than 20,000 cases a year, mainly in areas adjacent to forests and provinces such as Tak where many people who may carry the parasite pass through. But the annual death toll is small, in the dozens, he said, unlike in neighbouring countries. In Myanmar, malaria probably kills thousands every year, many of them unreported.

Thailand could eliminate malaria if it wanted, but Myanmar, he said, had enormous needs and after 40 years of weak government funding - among the lowest health investment per capita worldwide - was only really beginning to confront a disease that flourished during decades of civil war and internal strife. There has been substantial recent improvement, but Nay Pyi Taw has also been swamped by the arrival of dozens of non-government groups, all with their own agendas.

White said the MORU survey of artemisinin resistance was conducted over three years and cost about Bt300 million. Funding was provided by Britain's Department of International Development, the Wellcome Trust, and the Bill & Melinda Gates Foundation. It will be followed by a second three-year study, funding for which has already been approved.

"In tropical diseases Thailand has a very good reputation for research. We see our role as a regional or international research hub. The latest international survey was coordinated from Bangkok - science shouldn't have any borders - and Thailand is well regarded. It has good scientists and leads the world in clinical research on malaria and its treatment.

"Having two papers in the latest issue of the top international medical journal [The New England Journal of Medicine], Thailand should be proud that it's playing on the world stage, as a leading contributor to global health and a major player in top medical research. These health benefits will be greatest in other countries, in Africa, or Asia."

After 30 years of work in Thailand, White fears that the clock is counting down and millions of lives are at risk. It would take a major effort - a big ramp-up in national spending and commitment by all states in Asean plus international lending bodies - but attempting to kill the spread of the disease before it jumps to other continents is "surely worth a shot", he says.

"We haven't got time to slowly build evidence and consensus. The fire is already burning, and threatening to get out of control. We've got to take risks. I think it's an emergency. We're looking for a leader to lead this - what we need to do is eliminate falciparum malaria in this area."

Source: http://www.nationmultimedia.com/opinion/A-slow-burning-global-emergency-30240789.html

[thenation]2014-08-13[/thenation]

[DrLom]

Pat yourself on the back, why don't you? Billions of dollars available to you, at the forefront. Good luck with your new sponsors.

 

Now, back to headlice... what was it again?

[shirtless]

Expect these types of deceases to become more prevalent as background radiation lower peoples immunity. We can thank Japan and the incompetent people at Tepco for the spread of radiation world wide thanks to Fukushima. The world probably can deny these factors and they will until it becomes to obvious. we may have another 5 years of the good life.

[DrLom]

Expect these types of deceases to become more prevalent as background radiation lower peoples immunity. We can thank Japan and the incompetent people at Tepco for the spread of radiation world wide thanks to Fukushima. The world probably can deny these factors and they will until it becomes to obvious. we may have another 5 years of the good life.

The planet looks after itself, despite man's attempts to destroy it. It finds new ways to cater for equilibriums, fortunately for human what's-left-of-them- beings. ;)

[Cats4ever]

Alarming news. Mosquito nets and repellents to the fore. This insidious disease has a huge amount of research going into it, but, despite encouraging reports over the years, it keeps on hangin on.

[Krataiboy]

Not a word about prevention, which is a measure easily taken - for example in parts of Africa where the use of mosquito nets is reducing the incidence of malaria. But of course, Big Pharma doesn't make mosquito nets. It grows fat on the profits from products it has been marketing for half a century or more - many of them clearly well past their sell-by date.

 

Major drug manufacturers are reluctant to settle for jam tomorrow by investing in the expensive research,development and marketing necessary to produce new vaccines and cures for diseases which are becoming increasingly resistant to our current arsenal of chemicals.

 

It's good to see Bill Gates and other philanthropic billionaires ploughing back some of their vast fortunes into the fight against resurgent scourges such as malaria and HIV-AIDS. Perhaps they, together with the UN and the WHO, could be asked to help set up a new publicly-owned, non-profit-making pharmaceutical company tasked specifically with producing new, inexpensive drugs to fight potential global epidemics.

 

The international emergency sparked by the new Ebola outbreak, which kills the vast majority of its victims, is a sobre reminder to the wealthy West that we ignore the health problems of underdeveloped nations at our peril. If Big Pharma won't help, then we need to find ways of helping ourselves.

[wileycoyote]

Serious problem ,that requires attention at a local ,ampher level

[harleyclarkey]

Malaria in the East and bacteria in the West.

Two horrors that have the potential to wipe tens of millions of us off the planet. I remember an opening statement in a book.

"bacteria allow us to live on their planet"

 

Disgraceful over prescription for antibiotics by doctors for flu and colds (both virus based) and other problems and the failure of the patient to finish the course has led us here.

 

The world currently is not a safe place.

[chingching]

I had read that malaria has killed half of all the people who have ever lived.   This guy: http://rdparasites.blogspot.com/2014/04/malaria-killed-half-people-who-have.html  runs the numbers and thinks that that many deaths from malaria is possible.   We have lived in the golden age of antibiotics, but that is coming to an end.

[Ragzilb]

Expect these types of deceases to become more prevalent as background radiation lower peoples immunity. We can thank Japan and the incompetent people at Tepco for the spread of radiation world wide thanks to Fukushima. The world probably can deny these factors and they will until it becomes to obvious. we may have another 5 years of the good life.

 

To make matters seem more gloomy, would be that world wide we have over 600 nuclear facilities,. We saw what happend to Fukuhima, and what it is doing to the west coast of US, Imagine a global collapse due to a solar storm or a economic menlt down. If just 2 or 3 more nuclear facilities should melt down we are all in deep. Well We are doomed cause we dont know what to do with the waste of those 600 facilities. 

 

What a world we have created.

 

:( 

[brain150]

I know this will be CENSORED but I say it anyway:

It is a proven fact that the Red Cross is supressing ALL cures for any of the major deseases.

 

Malaria is cureable [and pretty easily] just like HIV.

 

There is too much money involved so that the Big Corporations and Organizations like the Red Cross or the WHO

are not at all interested in having a cure for these health issues ... unless they make BIG profits out of it !!!

 

 

[chingching]

I know this will be CENSORED but I say it anyway:

It is a proven fact that the Red Cross is supressing ALL cures for any of the major deseases.

 

Malaria is cureable [and pretty easily] just like HIV.

 

There is too much money involved so that the Big Corporations and Organizations like the Red Cross or the WHO

are not at all interested in having a cure for these health issues ... unless they make BIG profits out of it !!!

 

 

I believe Thaivisa forum does not automatically censor posts just because they are paranoid fantasies.   What is a "proven fact" ?   I think it would help your cause if you could demonstrate or link to such "proofs".