WHO Launches New Strategy to Tackle Resistance to Antimalarial Drugs

The World Health Organisation (WHO) has launched a new strategy to respond to antimalarial drug resistance in Africa.

The new strategy aims to minimize the threat and impact of antimalarial drug resistance through four pillars including strengthened surveillance of antimalarial drug efficacy and resistance and regulated use of diagnostics and therapeutics to limit drug pressure through pre-emptive measures.

The other two pillars are limiting the spread of antimalarial drug-resistant parasites and investing more in research geared towards developing new tools against antimalarial drug resistance.

The new strategy launched on Thursday comes after recent studies found the bug to have started resisting existing best treatments in some parts of the continent including Uganda, Rwanda and Eritrea. 

According to their latest statement, WHO notes that there are worrying signs that parasites in some areas may be resistant to drugs that are commonly combined with artemisinin, the best available medicine to treat malaria. 

“Although antimalarial drug resistance is a serious cause for concern, artemisinin- based combination therapies (ACTs) remain the best available treatment for uncomplicated malaria,” notes Dr Pascal Ringwald, lead author of the new strategy and a Coordinator in the WHO Global Malaria Programme. “Health care providers should continue to prescribe and use ACTs to treat confirmed malaria.”

Now, the new strategy recommends twenty interventions which include, for example, generating standardized data on drug efficacy, promoting equitable access to quality diagnostics and drugs, ensuring optimal vector control coverage in priority areas, and developing innovative tools to limit malaria infection and transmission. 

In terms of treatments, the organization  currently recommends six different artemisinin-based combination therapies (ACTs) as first- and second-line treatment for uncomplicated  malaria.

Experts say these medicines that are isolated from the plant Artemisia annua are able to  rapidly reduce the number of Plasmodium parasites in the blood of patients with malaria within the first three days of treatment.

Artemisinin is however combined with another drug when making ACTs and researchers say resistance to artemisinin alone rarely leads to treatment failure but resistance to both artemisinin and the partner drug within ACT drug regimens can lead to high rates of treatment failure. This worries experts. 

“We don’t have that many options for malaria drugs,” notes Dr Dorothy Achu, WHO’s new Team Lead for Tropical and Vector Borne Diseases for the WHO African Region.  As it stands, we just have artemisinin-based combination therapies for uncomplicated malaria. So any threat to these drugs could lead to lots of cases and deaths, which we obviously want to avoid,” she added.

In 2016, researchers at Imperial College London modelled the potential impact of widespread resistance to both artemisinin and a partner drug in Africa. Under this scenario, there would be an estimated 16 million more malaria cases each year, and about 360 000 more severe cases requiring hospitalization – leading, in turn, to nearly 80 000 additional malaria deaths annually. Under this same scenario, the yearly economic impact across the African continent was estimated at US$ 1 billion.

Meanwhile, Sub-Saharan Africa bears nearly the entire global burden of malaria, accounting for an estimated 96% of malaria cases and deaths in 2020; approximately 4 in 5 of these deaths were among children under the age of five

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