Fighting Drug-Resistant Malaria Where It Lives

Migrant workers cross over the border between Thailand and Myanmar. Steady migration facilitates the spread of the malaria parasite and makes total eradication difficult.

Source Catherine Davison

Why you should care

Drugs are no longer working to stop the spread of the deadliest malaria parasite. But these posts are.

“We don’t need to panic, but we need to be fast,” says Dr. François Nosten, director of the Shoklo Malaria Research Unit (SMRU), a research institute for malaria on the border between Thailand and Myanmar, as he leans back in his chair and frowns. “If we don’t stop it where it is now, it’s going to spread.” It is a warning that is echoed by scientists across Southeast Asia, where reports of a new drug-resistant form of P. falciparum, the deadliest malaria parasite, began to emerge in 2015.

If the parasite jumps the border to the Indian subcontinent, it would likely prove unstoppable — in Africa, it would kill millions (it’s happened before). There are no new drugs to fight it, and researchers estimate it will be another five to 10 years before they have one. It is what Gilles Delmas, the program director for SMRU’s Malaria Elimination Task Force (METF), calls a “time bomb.” So the METF is going grassroots with its approach and aiming to completely eradicate malaria.

The program started by mapping villages along the border and providing local community workers with basic portable test kits. Now the SMRU has malaria posts in more than 1,200 communities. The good news: If a villager comes to a post with symptoms within two days of contracting a fever, the parasite can be killed before it produces gametocytes, which spread the disease when transmitted in infected blood via mosquitoes.  

These timely treatments, which kill the parasite before it can spread, as well as weekly reports to the main research unit in Mae Sot, is the secret to success. “Malaria is a little bit like a forest fire,” Dr. Nosten explains. “If you want to extinguish the fire, you have to go quickly.”  

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Professor François Nosten, director of SMRU, at his desk in the Mae Sot office.

Source Catherine Davison

In 2014, the METF also started a program of mass drug administration (MDA), which gave antimalarials to all villagers in “hotspots” where more than 20 percent of the population have asymptomatic malaria. The malaria parasite can survive undetected for weeks, even months, in the liver of hosts without any outward signs — which means mosquitoes can transmit the parasite from seemingly healthy people. MDA is controversial, as it involves treating everyone, the sick and the healthy, and critics fear that this could lead to increased resistance. 

 

Still, researchers at SMRU say that MDA is essential for eradication. In fact, “asymptomatic people are the main source of infection,” asserts Victor Chaumeau, an entomologist who studies mosquitoes collected from the malaria posts.  

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Thi Dar Nwge is an 8-year-old Burmese migrant who crossed the border into Thailand to visit SMRU’s Wang Pha clinic after coming down with a fever. She hides under a mosquito net.

Source Catherine Davison

The combination approach of malaria posts and MDA has seen considerable success in the region. Clinics run along the border for Burmese migrants once saw 50 to 60 malaria cases every day, but now there’s only one every few months, and it’s usually referred from a remote malaria post. As a result, maternal mortality rates in the region have plummeted. Malaria, which can cause complications in pregnancy such as premature births, used to be a leading cause of maternal mortality in the region. 

But as Dr. Nosten points out, malaria control and elimination “are not the same,” and eradication is hampered by free, often undocumented migration along the borders. In order to win the race against drug-resistant P. falciparum, he says, efforts must be focused on total eradication of the parasite before resistance has a chance to spread. 

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After a checkup, a Burmese family waits outside the Wang Pha clinic for the boat to take them back across the border to Myanmar.

Source Catherine Davison

In the meantime, however, a lack of political will and potential loss of funding continues to threaten the METF program. As the threat of malaria appears to be dwindling, governments and NGOs are increasingly focused on issues such as traffic accidents and cardiovascular disease as mortality threats to the region. 

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Mosquitoes are collected from malaria posts in remote regions along the border and brought back to the lab in Mae Sot to study.

Source Catherine Davison

“Except that we know what happens,” laments Dr. Nosten. “Resistance is gaining pace again; it’s winning the race against us. The drugs are less and less effective. And if we don’t act now, there will be a lot of damage.”

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