Here is an article from the Global Fund.

It includes the statement: 'If resistance were to reach neighboring India or sub-Saharan Africa, where most world malaria cases occur, the public health consequences could be disastrous.'

I agree that artemesisin resistance in India or Africa would be a problem. But is there any evidence that malaria resistance to any previous drug 'spread' from Myanmar as opposed to developing de novo in India and Africa?

Jamie

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Building Peace in Myanmar

For decades, they sat on opposite sides of an ethnic divide that unleashed war, forced displacement and poverty in Myanmar. Today, Dr. Aung Kyaw Htwe, a Burmese, and Dr. Ed Marta, a member of the Karen ethnic minority, are fighting together against a common enemy: malaria. Enlisted in a regional initiative to combat drug resistance supported by the Global Fund and many partners, the two men are also contributing with their work to building peace and reconciliation in Myanmar. Since a 2012 cease-fire was signed between the central government and the Karen National Union (KNU), former foes are now collaborating in the field and sharing information in the fight against the insect-borne disease in Kayin state, a hilly and densely forested region in southeastern Myanmar that borders Thailand. The government’s National Malaria Control Program has donated 20,000 malaria treatment doses to the Karen Department of Health and Welfare (KDHW), the medical arm of the KNU, and expanded health care to communities that in the past were not able to participate. Government health workers, armed with microscopes and malaria kits, are becoming a common sight in villages in ethnic areas, where violence raged only a few years ago. With peace, villagers are also seeing the benefits of more health volunteers and of mass distribution of insecticide treated nets, sharply bringing down mortality and morbidity rates in the state. In meetings that would have been unthinkable before the peace accords, officials from the government’s Vector Borne Disease Control, Kayin State Health authorities and the KDHW have held orientation sessions on the national guidelines for malaria treatment to improve services, and have discussed setting up joint training programs. “We fought against each other for many years. Now Burmese doctors and Karen doctors are working together with one single objective: to serve the people,” said Dr. Marta, a senior consultant for the KDHW. “Health can bring people together. We are building peace. Maybe our politicians can learn from this.” Dr. Kyaw Htwe, the government’s health director for Kayin state, echoed that spirit. “People need peace. Health is neutral. It benefits poorly educated people and highly educated people. Health is a meeting point for all stakeholders. Maybe health can be a building block for peace.”

But many challenges remain. An estimated 70,000 people out of Kayin state’s 1.5 million remain uncovered because they live in hard-to-reach areas in the jungle or due to funding gaps and lack of human resources, including poor maternal and child care. Migrant workers who toil at mosquito-infested rubber plantations add to the risk of transmission. Low-quality malaria medicines sold at village stores are also a problem. Government health workers are still not allowed to operate in some ethnic areas, where distrust simmers. All these factors make fighting artemisinin resistance, a rising global health threat, even more challenging. “We are still struggling with the effects of the conflict in terms of health care and development,” said Dr. Kyaw Htwe. “If the peace process succeeds we will see more development in our state, including in the fight against malaria.”

Under a $100 million, three-year, regional initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria will invest $40 million in Myanmar to fight resistance to artemisinin, the main drug used to fight malaria. The initiative, the result of a collaborative effort between external funders, multilateral agencies, technical partners, the Ministries of Health of five countries and local communities, aims to achieve elimination of P. falciparum malaria by 2030. In Myanmar, artemisinin resistance containment activities will be implemented in 52 townships across six states along the eastern border. UNOPS, the regional Principal Recipient for the initiative, is working with international organizations, the National Malaria Control Program, several NGOs and non-state actors.

Dr. Kyaw Htwe and Dr. Marta are keenly aware of the size of the enemy they are facing, and say the need to collaborate is more pressing than ever. If resistance were to reach neighboring India or sub-Saharan Africa, where most world malaria cases occur, the public health consequences could be disastrous. “Everybody has to participate,” said Dr. Marta, a former high-ranking official of the KNU who fled violence to the United States and returned to Myanmar after the peace accords. “We have to work hand in hand, only then there will be success in our program.”

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