Threat of drug-resistant malaria parasites

A new study published online in the 19 February, 2015 edition of the prestigious infectious diseases journal, The Lancet, found that malaria parasites which are resistant to artemisinin drugs have started spreading westward from Southeast Asia. Carried out and co-authored by an array of researchers from different parts of the world, the original study relied on a “cross-sectional survey at malaria treatment centres at

55 sites in ten administrative regions in Myanmar, and in relevant border regions in Thailand and Bangladesh” and was carried out over 21-month period between January 2013 and September 2014. Although there is as yet no evidence that the drug resistance parasite has spread to Nigeria or any other part of Africa, it is wise to prepare against such a possibility.

For one, the sheer pace of the spread of the Ebola virus is proof that, in a rapidly globalising world in which people cross regional and international borders with greater ease, things can happen very quickly. In their report, the authors of the Lancet study acknowledge this with their recommendation that “Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided.”

For another, there is a not too remote possibility of the same drug-resistance mutation occurring independently in Nigeria, which still reports an estimated 100 million malaria cases with over 627,000 deaths annually, mostly among children under the age of five. To nip this threat in the bud (and again we want to stress that there has been no detection this far in the country), the Federal Government must mobilise the Ministry of Health, independent think-tanks and medical experts to urgently collaborate on research that will reveal the country’s status. Furthermore, the Federal Government should collaborate with medical authorities in other African countries, especially across the sub-region, in expediting action on developing effective vaccination.

Be that as it may, emergent reports on the mutation and spread of a drug-resistant malaria parasite are doubly disconcerting because, on the two previous occasions when malaria drugs lost their potency due to resistance, the human toll was incalculable. Plasmodium falciparum resistance to chloroquine, first reported in East Africa in the late 1970s, led to an exponential increase in malaria morbidity. The resistance to sulphadoxine-pyrimethamine (SP), the alternative to chloroquine, was similarly lethal. Resistance is a cyclical occurrence in which a parasite - in this case a strain of malaria parasites - ‘adapts to’ and effectively develops immunity against the drug used to combat it.  

Over the past three decades, and no doubt for good reason, much of the attention in the global medical community has focused on the scourge of the human immune-deficiency virus (HIV). The problem is that, in many countries, this has often been to the neglect of other deadly infections. Malaria not only claims more lives than HIV, reports show that it kills twice as many as thought. If there is any silver lining from the Lancet study, it is to emphasis, that as far as malaria is concerned, we are not yet out of the woods.

To beat this latest threat, the Federal Government must combine what it did well during the Ebola outbreak - mobilising authorities and stakeholders across the societal spectrum - with rigorous public enlightenment.

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