UN health agency pushes for better monitoring of anti-malaria drugs

Only 34 per cent of countries with endemic malaria are complying with United Nations World Health Organization (WHO) recommendations to routinely monitor anti-malarial medicines, according to a report released today.

The agency’s “Global report on anti-malarial drug efficacy and drug resistance: 2000-2010” urges countries to be more vigilant in drug monitoring to allow for earlier detection of resistance to anti-malarial treatments.

“A greater political commitment to support and sustain national monitoring of the efficacy of anti-malarial medicines is critical to prevent a wider emergence of artemisinin resistance,” said Dr. Pascal Ringwald of the Drug Resistance and Containment Unit, within WHO’s Global Malaria Programme and one of the report’s authors.

Artemisinin is currently the most effective treatment against malaria, but resistance to the drug when used alone to treat the disease was found in February 2009 on the Cambodia-Thailand border.

“The emergence of artemisinin resistance on the Cambodia-Thailand border has been a wake-up call to the world to prevent its spread, increase monitoring, and preserve ACTs (Artemisinin-based Combination Therapy) as the only effective treatment we have for falciparum malaria,” said Dr. Robert Newman, Director of WHO’s Global Malaria Programme.

Although efforts to contain the spread of artemisinin resistance on the Cambodia-Thailand border are ongoing, early evidence suggests the emergence of resistance on the Myanmar-Thailand border. There is also concern that this resistance could spread from Asia to Africa, as happened with other treatments in the 1960s and 70s.

“Anti-malarial drug resistance is like a cancer, it must be fought at every level,” said Nicholas J White, Professor at the Mahidol-Oxford Research Unit in Bangkok, Thailand. “Affected countries need to be in the frontline in combating the emergence of drug resistance. WHO should be empowered and supported to take a strong lead. It is crucial to protect ACTs as they are the best treatments for millions of people against malaria.”

The report found that ACTs currently recommended by national malaria control programmes remain effective against malaria, with cure rates generally above 90 per cent. In countries with cure rates lower than 90 per cent, policy change is ongoing to implement efficacious replacement malaria treatments.

The use of artemisinin monotherapy is considered an important factor in the survival and spread of drug resistant strains. If the efficacy of the artemisinin component continues to decline, the risk grows of increased resistance to other drugs used in the combination.

In response to the findings in the report, WHO is working with partners to develop a Global Plan for Artemisinin Resistance Containment, which will be released in January 2011. On World Health Day 2011, WHO will launch a public awareness campaign on antimicrobial resistance and its global spread, calling on governments and stakeholders to implement the policies and practices needed to safeguard medicines for future generations.