A new drug-resistant strain of malaria in Myanmar has reached within 15 miles of the country's border with India. If it crosses over, researchers expect that it could soon threaten millions of lives around the world and undermine years of work and billions of dollars that have been invested in combating the disease.
A study published in Lancet Infectious Diseases last week raised alarm about a variety of malaria resistant to artemisinin — the primary treatment against the disease, used in combination with other drugs. The researchers examined 940 samples collected from 55 malaria treatment centers for mutations in the parasite's kelch protein (K13), which is a known marker of artemisinin drug resistance.
The K13 mutation was found to be present in 39 percent of the samples they took, including in Homalin, Sagaing Region — an occurrence closer to the Indian subcontinent than researchers had previously known.
"Myanmar is the frontline in the battle against artemisinin resistance, as it's considered to be the gateway for resistance to spread to the rest of the world," Dr. Charles Woodrow, a clinician-scientist with the Mahidol-Oxford Tropical Medicine Research Unit and senior author of the study, said in a statement. "The mid- to long-term concern is that we could lose our ability to treat malaria in the way we have done."
Artemisinin resistant malaria has been present in Cambodia for over a decade and has been present on the Thai-Myanmar border for years.
The spread of the strain from Myanmar into neighboring India poses a serious threat to the control and eradication of malaria all over the world. The study warned that if drug resistant malaria spreads from Southeast Asia to Africa, as was the case with previous strains, "millions of lives will be at risk."
"This is a public health emergency with global consequences that we only have a very few years to act on," Dr. Ben Rolfe, executive secretary of Asia Pacific Leaders Malaria Alliance (APLMA), told VICE News. "This is not a Greater Mekong Subregion story, or an Asian story — this is global story. The vast majority of these deaths will be in Africa. They will be African children."
The United States, Australia, India, China, and other nations have pledged their support to APLMA to eradicate malaria from the Asia-Pacific region by 2030.
Chloroquine was once the main drug used to treat malaria, but in the 1960s chloroquine resistance developed in Southeast Asia and spread from Myanmar to India and elsewhere in the world, killing millions of people in the process.
"Just as we saw chloroquine resistance spread, we're seeing artemisinin resistance spread," cautioned Rolfe. "As quickly as we can measure it, it's spreading."
The World Health Organization has warned that almost half of the world is at risk of malaria — an estimated 3.2 billion people, with 1.2 billion at high risk. The disease kills almost 600,000 people annually, mostly in Africa and mostly children.
"If drug resistance escapes from this handful of countries, the gains of two decades of the global malaria struggle could be undone," Sir Richard Feachem, co-chair of the Asia Pacific Malaria Elimination Network, said in a press statement last year. "Hundreds of millions of dollars in previous investments could be lost, and we could see a massive resurgence of the disease."
"It was a real success story, but now everyone is more worried than they were six months ago," said Rolfe. "The experts are speaking with one voice and the evidence couldn't be clearer. Once this gets into India and Bangladesh, the cost in human life will rise exponentially."
Even if artemisinin resistance does not spread in the way some have predicted, it's prevalence in an expanding area of Southeast Asia raises major concerns for local public health officials.
"There's been no greater public health investment than malaria," Rolf insisted. "What a terrible tragedy that will be if we don't eliminate this disease in the short time we've got."