Drug-Resistant Malaria: The World’s Next Health Crisis?

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This is my first column for The Diplomat’s ASEAN Beat. Given the timing, I was tempted to write a reflection on the latest round of Asian summitry in Myanmar or the relevance of the Association of Southeast Asian Nations (ASEAN) following the regional grouping’s 47th anniversary on August 8th.

Instead, I’d like to take this opportunity to shed light on a far less “sexy” but immensely significant issue. A few weeks ago, a study published in The New England Journal of Medicine found that drug-resistant malaria strains were emerging in mainland Southeast Asia, thereby threatening to reverse years of progress in eradicating the disease, which still kills more than 600,000 people every year.

This is the third time since the 1950s that strains of the malaria parasite have become immune to the available treatment, and previous instances have led to millions of deaths. Scientists are now essentially warning that history may repeat itself, with resistance growing to the most effective modern malaria drug artermisinin in Thailand, Cambodia, Vietnam and Myanmar and possibly spreading to India and Africa – a nightmare for malaria control efforts worldwide.

Not all hope is lost, however. Some say extending the course of malaria treatment from the standard three days to six days could help slow the spread of the disease in the short term. Focusing on building healthcare systems in countries like Myanmar – which accounts for nearly 80 percent of all malaria cases in the Mekong region – would go a long way in helping both prevent and treat malaria. More help could also be on the way. Newer drugs now in the pipeline by companies like Novartis and GlaxoSmithKline could enter the market over the next few years. We are also learning more about the malaria parasite which could tell us how to develop even stronger antimalarial drugs in the longer term.

Actually stemming what could be the world’s next health crisis is easier said than done, however. It requires countries that may have divergent views and other priorities to focus on this and coordinate their efforts along with organizations like the WHO and companies such as the Bill & Melinda Gates Foundation to resource efforts to fight drug-resistant malaria. The artermisinin that we widely use now emerged from China and was deployed by groups including the Global Fund to Fight AIDS, Tuberculosis and Malaria, a coalition comprised of governments and private funders. And as the latest Ebola epidemic has shown, living in an interconnected world increases the risk that diseases (and, relatedly, the drug resistance to them) may reach other countries more quickly.

Non-traditional security challenges like diseases and climate change often do not receive the same level of attention that territorial disputes or great power rivalries do. But they should, not just because their consequences could be catastrophic, but because they are more difficult to address since they cross so many borders and require a multitude of actors to resolve, thereby exposing the collective action problems of a world dominated by nation states. When it comes to drug-resistant malaria, the path forward is clear and the time for action is now.

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