A disaster is unfolding in Cambodia: multidrug resistant (MDR) malaria. In some places 60 percent of the parasites are resistant to both artemisinin and the partner drug used in artemisinin combination therapies, or ACTS, the mainstay of malaria treatment, raising for the first time the specter of untreatable malaria.
It is just a matter of time before MDR malaria spreads across the Greater Mekong Subregion (GMS), alarmed experts say, and from there perhaps to Africa, where treatment failure could rival the loss of chloroquine in the 1950s and 1960s, when millions of children died.
This wasn't supposed to happen. When resistance to artemisinin alone emerged in the GMS the late 2000s, the WHO tried to build a firewall around the hotspots before resistance could spread. But the emergency containment strategy failed, and artemisinin resistance is now widespread across the five countries of GMS. And where artemisinin resistance is, MDR will soon follow, malariologists warn, as it has in Cambodia.
The only way to avert this crisis is to eliminate all malaria parasites from the entire GMS—an audacious plan that the WHO, international donors, and countries in the region are now launching. As Leslie Roberts reports in this project, it won't be easy. Wiping out every last parasite means detecting and treating every single infection—but how do you do that when highest risk populations move constantly through the forest fringe in search of jobs, and half of all infections are asymptomatic and undetectable with standard tests?