How can we protect the cutting edge in the fight against malaria?

Malaria has played a long and lasting role in human history. It is believed that the disease first appeared hundreds of thousands or millions of years ago. Although our understanding of this parasitic disease has greatly improved with the advancement of contemporary science, researchers are still faced with the dilemma of developing appropriate medicines and treatments against it.

Several drugs have been developed against malaria, but all of them have lost their effectiveness due to the ability of parasites to evolve and develop drug resistance. In the 2000s, we saw that the most widely used antimalarial drug, artemisinin, began to lose its effectiveness as well. This has resulted in a dearth of treatment options leaving patients and those at risk of developing the disease – particularly in low- and middle-income countries (LMICs) – in a vulnerable state.

When artemisinin first emerged as a treatment option in the 1990s, it was welcomed by national malaria control programs in some countries. Commenting on the importance of the drug, Maciej Pony, assistant professor of biology at Penn State University, says, “A small series of clinical trials were conducted in South Vietnam in the 1990s. Although few were aware of the drug before that, the studies proved its effectiveness.” Ultimately, artemisinin combination therapies were recommended by the World Health Organization in 2005.

Today, artemisinin is the leading treatment for malaria, but resistance to artemisinin is now common in Southeast Asia and has emerged in East Africa. To slow this phenomenon down and protect as many patients’ lives as possible (and for as long as possible), proper medication monitoring will make all the difference. Usually, resistance appears very slowly and requires constant monitoring. This means we need dedicated networks of scientists working to collect genotype samples,” says Boni. “By creating rapid, responsive surveillance networks, we can help improve treatment in endemic countries and facilitate communication between public health institutions and patients.”

But good surveillance depends on understanding the evolution of resistance in artemisinin and its partner drugs used in many regions of the world. Along with colleagues at Penn State University, Oxford University and Imperial College London, Bonney found that partner drug resistance also promotes early resistance to artemisinin. “We were looking at the conditions that influence the development of resistance,” he says. “The reason it was difficult to distinguish previously was because the early stages of resistance occur slowly. Therefore, it is difficult for public health systems to detect it.”

In particular, the team’s research focused on the artemisinin partner drugs piperaquine, amodiaquine, and lumefantrine. To varying degrees, malaria has already developed some resistance to these drugs, but Boni and her colleagues found that when partner drug resistance levels are high, artemisinin resistance develops more quickly than expected.

He explains that this finding is only further evidence that more surveillance is necessary to manage antimalarial resistance. In doing so, public health agencies and other healthcare stakeholders will be able to respond more appropriately to resistance as it occurs. “If we take Rwanda as an example, we are already seeing signs of artemisinin resistance. With good monitoring, we will have a better idea of ​​when to start enrolling patients in trials of alternative artemisinin-based therapies and to see if the new treatment approach allows them to get rid of the parasite.”

Bonnie and his colleagues at Penn State are now working in collaboration with the World Health Organization and national malaria control programs within the country to assess the current situation in Rwanda, Burkina Faso, and other countries, and to prepare projections for the following five to 10 countries. Years may seem.

“It’s hard to say what things will look like in five years,” he says. “Just as weather reporters can give a forecast for the next few days, but they can’t tell you with certainty what the weather will be like over the next month, we don’t know exactly how the future of malaria resistance will turn out. That’s why it’s so important to start thinking about managing drug resistance early. “

But effective management requires good financing. The better access researchers and national programs have to funding, the easier it will be to establish and strengthen management systems. “In the next 10 to 15 years, we need to see more funding going into this area,” Boni says. “We’ve come a long way when it comes to malaria. 15 years ago it was considered a neglected disease. Although funding has increased dramatically in the two decades “The last two, which has been the right course of action, we need more of it to see a greater impact on patients’ lives. Imagine how far we can go with the right tools and resources.”

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