The Artemisinin Resistance in Southeast Asia: An Imminent Global Threat to Malaria Elimination

Abstract

Malaria remains a leading cause of mortality and morbidity in many low-and middle-income countries. Artemisinin combination therapies (ACTs) have contributed to the substantial decline in the worldwide malaria burden, renewing the optimism that malaria elimination is achievable in some regions of the world. However, this prospect is threatened by the emergence of artemisinin resistance in Plasmodium falciparum leading to clinical failure of ACTs in Southeast Asia. Historically, drug resistance in P. falciparum has emerged in SEA and spread to Africa. Today, resistance to ACTs could reverse all the achievements of control and elimination efforts globally. With no new drug available, P. falciparum malaria must be eliminated from the Greater Mekong before it becomes untreatable.

<p>Antimicrobial Resistance: Implications and Costs</p>

“…According to the HIV drug resistance report in 2017, such continuous trends in resistance to HIV medicine threaten the global goal of putting an end to AIDS by 2030 63. In addition to tuberculosis and HIV, in the past 50 years, Plasmodium falciparum , the causative agent of malaria, has become resistant to anti-malarial medicines and this trend is predominantly seen in southeast Asia 64. The increase in resistance to malaria drugs obstructs malaria control which attempts to decrease the average 445,000 deaths that take place annually due to this deadly disease 65…”

Assessing the spatiotemporal malaria transmission intensity with heterogeneous risk factors: A modeling study in Cambodia

“…The World Health Organization (WHO) reported in 2021 that malaria places nearly four billion people at risk and creates heavy public health burdens in over 80 countries, especially low-income and undeveloped countries ( World Health Organization, 2021b ). Moreover, the emergence and exacerbation of artemisinin resistance in parasites and resistance of mosquitoes to insecticides, which could reverse all efforts to control and prevent malaria and lead to large-scale outbreaks and epidemics, necessitate the acceleration of malaria elimination ( Phyo & Nosten, 2018 ; World Health Organization, 2021a ).…”

“…To validate the effectiveness of the proposed model, we conduct a case study on 15 malaria-severe districts in Cambodia, one of the most malaria-endemic countries in the Western Pacific Region ( World Health Organization, 2021b ). Although the number of malaria cases decreases greatly in recent decades in Cambodia ( Ministry of Health Kingdom of Cambodia, 2021 ), i.e., the number of indigenous cases decreases from around 107,000 in 2001 to around 10,000 in 2020, the artemisinin resistance ( Phyo & Nosten, 2018 ), the suitable climate and environment for mosquito breeding ( Kar et al., 2014 ; Kerkhof et al., 2016 ; Suwonkerd et al., 2013 ), the hard-to-trace imported cases ( Guyant et al., 2015 ), and the limited surveillance resources ( Ministry of Health Kingdom of Cambodia, 2021 ) make malaria elimination in this region very challenging and necessitate better targeted control of malaria risk.…”

Antimalarial Activity of Bidens pilosa Root Extract Co-spray Dried in the Presence of β-Cyclodextrin or Aerosil:Microcrystalline Cellulose Blend

“…Artemisinin, the active substance from Artemisia annua L., was identified in 1972 and is considered the most relevant and effective phytopharmaceutical antimalarial drug. However, its success has been threatened by the emerging of resistance of P. falciparum Southwest of Asia [6] and, more recently, in Rwanda [7], leading to the inefficacy of the antimalarial therapies based on artemisinin. Therefore, research and development into new antimalarial medicines is the best insurance policy against the risk of antimalarial resistance [8].…”