Malaria crisis looms as bug mutates. Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female mosquitoes, and in 2015, approximately 3.2 billion people – nearly half of the world’s population – were at risk of malaria. As compared to others, some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers.
Normally, the treatment for malaria is straightforward – it is a drug called artemisinin, which is administered in combination with a partner drug. Artemisinin kills most of the parasites quickly; over a longer period the partner drug gets rid of the virus remaining. This has worked for years, driving down the number of malaria cases. However, in a small rural village situated by the outskirts of Mae Sot, Thailand, two oral doses and one injection of an artemisinin and partner drug combination failed to remove the parasite from the blood of 29-year-old man. According to Dr Aung Pyae Phyo, he had arrived in the morning. “At dinner that evening he was okay,” Dr Aung remembers. “He ate the food. Then just a couple of hours later, he became confused. And then he died.”
With the rise in cases of mosquito-borne diseases such as dengue and Zika, the malaria disease has fallen off the media radar in recent years as a life-threatening tropical disease.
In contrast to the increasing number of cases of both the dengue and Zika virus, the number of malaria cases has been on a steady decline. Yet, this diminishing number has in reality been masking the slow build-up of drug resistance, which could kill millions if it gains ground. The dreaded multidrug-resistant parasite is spreading in Myanmar and Cambodia, raising red flags among those in the scientific and medical community working in the field.
At present two drugs are being developed to counter the parasite and SMRU is helping to test them. But the best estimate is that the drugs will be available in four to five years. They could take even longer to be actually deployed and used.
Though the looming emergency is a large cause for alarm, scientists in the field, who are seeing drug resistance building first-hand, are frustrated at the lack of attention to the looming problem. “Here we are on the edge of the cliff, but where is the international outrage, where is the political leadership and dynamism?” said Professor Nick White, 64, chairman of Wellcome Trust’s tropical medicine research programmes in South-east Asia, and a world authority on malaria. “It’s the third time around,” he said, referring to two previous surges of malaria as the parasite developed resistance to earlier drugs. “But I’m not sure we are going to win this one. There isn’t enough political interest.
In addition to this statement, Dr Aung logged into his computer and pulled up the data on the patient who died last November. The lines on the graph showed clearly how the parasite was almost unaffected by the treatment. “If we have more cases like this, we are doomed.”
Though the multi-drug resistant malaria disease has not reached our little red dot yet, it is quickly gaining ground to the neighbouring countries around us. To prevent this virus from ever occurring within Singapore, Singaporeans are encouraged to carry out the 10-minute 5-step Mozzie Wipeout. Though these actions may seem insignificant at present, every action is a blow against the malaria-as well as the other mosquito-borne diseases which pose a threat to our health.
Chloe Wong (2L)