WHO Plan Unveiled to Stop Malaria Drug Resistance

Top officials from the World Health Organization (WHO) were in Phnom Penh on Thursday to launch a three-year, $400 million plan to prevent the “imminent threat” of an increasingly drug-resistant strain of malaria from escaping the region, a plan that puts Cambodia at its core.

Launched to coincide with World Malaria Day, the Emergency Response to Artemisinin Resistance in the Greater Mekong Subregion aims to stop that resistance from spreading to Africa, where most of the world’s 216 million people infected each year by the malaria parasite live. The mosquito-borne disease kills more than 600,000 of them annually.

“I think it’s fair to say we’re at a tipping point in our battle with malaria,” said John Ehrenberg, director of the WHO’s regional office for combating communicable diseases.

“This is something that threatens all the gains that we’ve achieved through the years,” he said. “If this would go unchecked, and if this would spill over to other regions, especially Africa, this would have absolute disastrous effects…. We’re dealing with an emergency situation here and one that cannot wait.”

A paper prepared by a team of malaria experts released in No­vember predicted that more than 700,000 additional people could die of the parasite over the next five years if drug resistance were to reach Africa.

“Around the world, people have their eyes today on how these countries…are working together responding to a major public health problem,” said Robert Newman, director of the WHO’s global malaria program.

Malaria first started showing signs of tolerance to the world’s current front-line drugs against malaria—Artemisinin-based Combination Therapies, or ACTs —in 2007 along the Thai-Cambodian border, where resistance in some parts has now hit 40 percent among those tested.

With the WHO’s help, and a $22 million grant from the Bill and Melinda Gates Foundation, Cambodia launched a two-year plan to contain the resistance in 2009. The early stages of resistance have since been confirmed in parts of Vietnam and Burma as well, though scientists still don’t know if they emerged on their own or spread from the Thai-Cambodian border.

Despite that, a thorough as­sess­ment of those efforts launched by the WHO and its partners in 2011 concluded that health workers were doing most things right, they just weren’t doing enough of it.

“The number one finding out of that joint assessment was that, although great things were happening in the field and we were making progress, it wasn’t happening at enough of a scale to actually overcome that problem,” Mr. Newman said.

What emerged out of that review was the plan launched Thursday in Phnom Penh, not a change in course but a guide to do what they’ve been doing bigger and better. It lays out 15 steps for expanding and intensifying their efforts, tightening coordination among all involved, collecting better data on what they’re doing and improving re­gional oversight.

In addition to Burma, Cambodia, Thailand and Vietnam, where resistance has been confirmed, the plan also draws in Laos and a few southern regions of China.

Mr. Newman said they would need some $400 million dollars for the scale-up to cover the next three years. So far, they have $100 million pledged by the Global Fund to Fight Aids, Tuberculosis and Malaria. And to help coordinate it all, the WHO is in the process of moving its regional office on malaria drug resistance from Bangkok to Phnom Penh. They hope to have a director in place by the middle of the year.

They chose Cambodia over Burma for the new hub in part because it, among all the countries included in the plan, was facing the most acute trouble with resistance.

And that, said Mr. Newman, has given it a wealth of experience.

“One of the reasons to put it in Cambodia is that Cambodia has been fighting the problem a long time, and one of the things that this whole experience is supposed to be about is sharing knowledge and sharing experience,” he said. “And Cambodia, over these years of fighting, has gained a lot of experience in what works and what doesn’t work, and they will have a lot to share with the other countries that may not be as far along in their fight.”

The gains have been dramatic.

The number of recorded malaria infections in Cambodia has dropped steadily since the containment project launched here in 2009, from nearly 52,000 cases to just more than 14,000 between 2011 and 2012 alone.

Deaths over the same period fell from 93 to 45. And over the first three months of this year, the country has recorded only three deaths, compared to 22 over the first quarter of 2011.

The province of Pailin, the epicenter of drug resistance in the region, has not seen a malaria death in more than two years.

Not all of Cambodia’s experience has been positive, though.

In November, the Global Fund said it had uncovered “serious fi­nancial wrongdoing” at the Cambodian government’s National Malaria Center (CNM) in its hand­ling of a current grant from the fund. The Global Fund has yet to release a report of its investigation or any other details, however, and will not say how much money was allegedly misspent, only that it amounted to less than half a million dollars.

All future grants from the fund to Cambodia—including its share of the new $100 million, yet to be worked out—will now flow into the country through the U.N. The CNM has declined to comment on the allegations.

At the launch of the new plan on Thursday, Health Minister Mam Bunheng both praised the government’s gains against malaria and stressed the need to face the growing drug resistance here, especially along the border and among migrant workers.

“Failing to contain and control this resistance will have serious implications for Cambodia and should be considered a regional and potentially even a global emergency,” he said.

“This new three-year program that will be implemented in close collaboration with the national malaria programs in the six countries underlines the urgent need to address artemisinin resistance,” he said.

Other officials attending the launch of the plan included Shin Young-soo, the WHO’s regional director for the Western Pacific, and Benedict David, the principal health specialist for the Australian government’s foreign aid arm AusAid, a major donor in the fight against malaria. Princess Astrid of Belgium, special representative for the Roll Back Malaria Partnership, also attended.

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