A DRUG-RESISTANT strain of malaria observed on the Cambodian-Thai border threatens to overturn decades of progress in the worldwide fight against the disease, doctors from the World Health Organisation (WHO) warned at a regional conference in Hong Kong on Wednesday.
“Artemisinin-based combination therapy, the most effective antimalaria treatment to date, and among the last resources in our arsenal of drugs against the disease, is seriously threatened by evidence of resistance to the treatment in the Cambodian-Thai border,” said Shin Young-soo, WHO regional director for the Western Pacific.
“Artemisinin-resistance needs urgent containment to prevent further spread of drug resistance.”
Artemisinin is only the latest antimalarial drug to be compromised by resistance developed on the Cambodian-Thai border.
A 2007 WHO report on the phenomenon describes how, beginning in the 1970s, Cambodia reported malaria strains resistant to the drugs chloroquine, sulfadoxine-pyramethamine and mefloquine. Infections treated with artemisinin have already begun taking longer and longer to clear, requiring increasingly elaborate multi-drug treatment courses.
According to government figures, the number of malaria cases and deaths has risen in 2009. The National Centre for Parasitology, Entomology and Malaria Control reported that in the first six months of 2009, 27,105 people caught the disease and 103 died. In comparison, 25,033 were infected during the same period last year, causing just 65 fatalities.
WHO officials at the conference said the spread of malarial drug-resistance in Cambodia is being fuelled by an abundance of cheap counterfeit drugs containing little or no active medicine. Rather than clearing out the infection completely, inadequate treatments kill only the weakest parasites, leaving behind the strongest and most resistant.
Sharon Wilkinson, country director for Care International in Cambodia, told the Post that the fake malaria drugs her group had found on the affected border area were not only prevalent but also disturbingly realistic.
“These [counterfeits] were beautifully packaged, bubble-wrapped and holographed. They turned out to contain only chalk,” she said, adding that the first counterfeit drugs were discovered seven years ago.
“Aside from consuming the drugs, there is no way to detect this without a laboratory.”
Wilkinson added that the circulation of counterfeit drugs was made easier by “porous borders and very limited government control over
“If you walk into a pharmacy here and look at who gives you the drugs, half of the time it isn’t the pharmacist. It could be the pharmacist’s child helping out. There should be tighter supervision.... Cambodia is in a state of pharmaceutical anarchy.”
In addition to promoting the use of real drugs in effective combinations, the WHO said it was pursuing a further array of strategies to beat artemisinin-resistant malaria in Cambodia, including improving the rate of case detection and distributing long-lasting, treated bed nets.