CHIANG RAI – Across S.E. Asia millions of people who not long ago would have died after contracting malaria are instead living healthy, productive lives. Cases have been cut by 75 per cent in many countries in line with a target adopted by the World Health Organisation (WHO) at the turn of the century.
Still, malaria remains a serious threat to lives and livelihoods. Endemic in 22 countries across Asia-Pacific, it is contracted by an estimated 32 million people in the region annually and kills 47,000 of them. The poor suffer most, as the sick can’t earn an income for their families, children miss school, and households struggle with crippling medical bills.
The most deadly form of malaria is best tackled with medicine based on the drug artemisinin, and mosquito control measures such as insecticidal bed nets and insecticide spraying. Artemisinin-based therapies emerged two decades ago, averting a more severe global epidemic after resistance to existing drugs had raised the specter of a world defenseless against malaria.
These advances are now threatened by a worrying re-emergence of resistance to pesticides and drugs, particularly in the Greater Mekong Sub-region. Malaria is on the move again and decisive steps must be taken before time runs out for Mekong countries, the rest of Asia, and the world.
Not only are mosquitoes developing immunity to sprays that have until now killed them, but malaria parasites are growing resistant to artemisinin. Resistance was first reported in western Cambodia in 2005. Since then it has spread, and is now firmly established in eastern Myanmar, western Cambodia and Thailand and southern Vietnam. It is emerging in southern Laos and northeastern Cambodia.
Alarmingly, resistance may soon knock on India’s door. If it spreads on the Indian subcontinent or, worse still, in sub-Saharan Africa, all gains from the global struggle against malaria may be undone. The social, health and economic costs would be incalculable.
Why is resistance spreading again?
The main culprits are the widespread use of fake and substandard malaria drugs. Add to this the unknown numbers of people in remote, resistance affected areas who are beyond the reach of health services. These people often do not figure in population surveys and move across borders, potentially spreading resistant infections.
It’s time for a new strategy. Eliminating malaria before drug resistance can spread would get rid of malaria while it can still be treated effectively. Instead of targeting areas with resistant parasites and hoping they don’t spread elsewhere, a frontal assault would eliminate resistant parasites across the region.
Elimination is an immense task, but an achievable one. It is a disease of the past for a number of countries once plagued by malaria, including Sri Lanka which is likely to be certified as free of the disease by the WHO next year. At least 15 other countries in Asia-Pacific are also pursuing elimination, but malaria does not respect borders; their efforts will be in vain if remaining pockets of the disease are not addressed.
Eliminating malaria demands bold action well beyond health services, with strong commitment at the highest levels of government. The region’s countries have the capacity to pursue an elimination goal. To reach it, they will need to prioritise the disease and act together.
Already, some outstanding work is being done. While affected countries provide the bulk of financing for national efforts, organisations such as the Global Fund to Fight Aids, TB and Malaria, the Bill & Melinda Gates Foundation, and the development agencies of Australia, Britain and the United States, also provide crucial financing.
The Asian Development Bank recently started the Regional Malaria and Other Communicable Disease Threats Trust Fund, with support from Australia and the UK, to raise resources to fight malaria and other diseases. The WHO has set up the Emergency Response to Artemisinin Resistance for the Mekong nations, based in Phnom Penh.
Perhaps most encouraging is the Asia Pacific Leaders Malaria Alliance (APLMA), a heads-of-government grouping jointly established last year by Vietnam’s Prime Minister Nguyen Tan Dung and his Australian counterpart Tony Abbott at the East Asia Summit in Brunei Darussalam.
APLMA is the first high-level regional alliance to tackle public health threats. It aims to work with regional leaders to accelerate progress towards a regional elimination target: a malaria-free Asia-Pacific by 2030.
The challenge of beating malaria is not technical, but political and financial. APLMA’s secretariat is urging regional heads of government to put malaria on the agenda at November’s East Asia Summit in Myanmar, giving impetus to the campaign for malaria’s elimination.
The region can beat malaria again. But this will take political breakthroughs, as well as therapeutic ones.
Patricia Moser is lead health specialist at the Asian Development Bank.
Ben Rolfe is deputy executive secretary at the Asia Pacific Leaders Malaria Alliance.