Prospect of drug-resistant malaria stirs concern in Africa

Mosquito net

The number of new malaria cases in Africa fell 42 percent from 2000 to 2015, according to the World Health Organization. The drop was due in large part to insecticide-treated mosquito nets, indoor spraying and better access to effective treatments. But this progress could be derailed by a new wave of drug-resistant malaria that’s currently affecting Asia.

Abdoulaye Djimde, head of the molecular epidemiology and drug resistance unit at the Malaria Research and Training Center in Bamako, Mali, said that “we should be concerned. … Given the frequent interconnection between Asia and Africa — you have direct flights from almost everywhere to several parts of Africa — there is the risk for importing these resistant parasites. [It] is higher today.”

In the 1970s, millions of Africans contracted malaria resistant to the front-line drug at the time, chloroquine. The results were catastrophic.

As of last year, five countries in Southeast Asia had reported cases of malaria resistant to the latest treatment, Artemisinin-based combination therapies, or ACT.

“We need to be alert so that what happened with chloroquine resistance does not catch up with us,” said Eunice Misiani of South Africa’s National Malaria Control Program. “We have to make sure we conduct the efficacy testing standards on a regular basis — every two to three years.”

Fake drugs persist

Counterfeit drugs continue to be a big problem in Africa. The fake drugs, while cheaper, often have lower levels of active pharmaceutical ingredients, and using them can lead to drug resistance over time.

Getting people to complete the treatment regime is also difficult. Many stop taking the pills after a day or two, once they start to feel better.

Hans Rietveld, market access director at Swiss pharmaceutical company Novartis’ Malaria Initiative, said doctors in Africa often over-prescribe anti-malarial drugs.

“First of all, ensure that there is adequate diagnosis before initiating treatment,” he said. “And that is an issue in many countries where the practice … of diagnosing prior to treatment isn’t yet embedded in normal medical practice.”

Some studies show that an estimated 40 percent to 60 percent of cases treated as malaria in Africa aren’t actually malaria.

Rietveld said expanding the use of rapid diagnostic tests in Africa could prevent overtreatment. The at-home tests can diagnose malaria with a finger prick.

Novartis said there are now two new potential drugs in the works. Both treat malaria differently than ACTs. But getting these new drugs onto the market will take at least a few more years.

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