The premise of artemisinin resistance containment, if I understand it correctly, is to stop artemisinin resistance from 'spreading to India and then Africa'. I have pointed out before that no one knows whether this is the route taken by previous resistance to antimalarials.
Health scientists studying artemisinin resistance have known for months that resistance is 'near the Indian border'. This is science-speak for "It has already spread to India." It appears that containment has failed. Millions of dollars will continue to be spent on it.
Vit points a finger at the health care system in Myanmar. Easy target. What is not so easy is to examine at the upcoming failure of the artemisinin resistance containment measures in India or the failure of the authorities in China that do not control counterfeit drugs. Health scientists who did not suggest combining artemisinin with other malarials twenty years ago are also forgotten.
The original paper is at http://dx.doi.org/10.1016/S1473-3099(15)70032-0
Jamie
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Malaria in Widening Area Resists Drug, Study Finds
Thomas Fuller
New York Times
19 February 2015
BANGKOK — The world’s best drug for treating malaria, a medicine that is the key
to saving millions of lives in Africa and beyond, is losing its efficacy in a much larger
swath of territory than was previously known, according to research that was
released Friday.
The study, in The Lancet Infectious Diseases, a medical journal, raises the
troubling prospect that resistance to the drug, artemisinin, might one day severely
hamper treatment of a disease that kills hundreds of thousands of people every year.
“This should focus minds,” said Charles Woodrow, one of the authors of the
study. “We have to eliminate these very resistant parasites. The fear is that if we
don’t, we would reverse all the gains that have been made.”
For several decades, artemisinin has been considered an anti-malaria wonder
drug, rapidly ridding the body of the parasite that is introduced into the body by a
mosquito and infects the blood.
Early signs of trouble with the drug were cited a decade ago by scientists
working in western Cambodia. Falciparum malaria, the deadliest form of the disease,
was increasingly resistant to treatment with artemisinin, which is derived from a
plant used in traditional Chinese medicine and is often used in conjunction with
other drugs.
The new study in The Lancet shows that resistance to the drug extends more
than 1,500 miles away from Cambodia, along the border between Myanmar and
India.
It was not known whether resistance had spread overland or whether new
diagnostic tools were revealing a situation that had previously gone undetected.
The Lancet article concluded that resistance to artemisinin treatment “extends
across much of Myanmar.”
One of the sites where resistance was prevalent was 15 miles from the border
with India.
“The pace at which the geographical extent of artemisinin resistance is
spreading is faster than the rate at which control and elimination measures are being
developed and instituted, or new drugs being introduced,” the authors of The Lancet
article wrote. “A vigorous international effort to contain this enormous threat is
needed.”
There is no immediate replacement for artemisinin, which has helped
contribute to steep declines in mortality rates from the disease.
Scientists say any possible substitute is years if not decades away.
Scientists are particularly concerned about the declining efficacy of artemisinin
because it appears to follow a pattern seen in previously used malaria drugs, like
chloroquine. Such drugs were, in their time, mainstays of malaria treatment but are
no longer considered useful because the parasite became resistant.
The Lancet study found that nearly 40 percent of the samples it gathered from
patients across Myanmar showed resistance to artemisinin.
“It’s probably not a matter of if but a matter of when the rest of the world will be
seeing this problem,” said Voravit Suwanvanichkij, a medical doctor who works with
charities that offer health care to people along the Thai-Myanmar border.
Dr. Voravit said Myanmar’s decrepit health care system and the lack of
government control in many parts of the country had abetted the development of
drug resistance.
“In a place like Burma, where you have a health system that is so inadequate,
you have the perfect setup for something like this,” Dr. Voravit said, referring to the
country by its alternate name. “There are a lot of fake and adulterated drugs on the
market.”
Scientists say counterfeit drugs and patients who do not finish their course of
medication encourage drug resistance by giving the parasite greater opportunity to
mutate.
Drug resistance appears to be most acute in western Cambodia, where a
standard three-day course of drugs is no longer effective for many patients, scientists
say. Additional doses are needed to mop up the malarial parasites.
Researchers’ great fear is that resistance to artemisinin will spread to Africa.
Ninety percent of the estimated 584,000 annual deaths from malaria occur in Africa,
according to the World Health Organization.
https://tinyurl.com/n7eqxsk
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