"Combatting antimalarial drug resistance requires a highly collaborative approach"

2020
Stephanie Williams

Dr Stephanie Williams tells us more about the threat of antimicrobial resistance and what can be done to tackle it.

Microbes evolve naturally to resist the drugs that are used to fight them. This phenomenon, known as "antimicrobial resistance", threatens the public health response to many infectious diseases, including malaria.The best insurance policy against the risk of antimalarial drug resistance is to replenish the pipeline and bring new and novel-acting medicines forward, which MMV has been successfully enabling for over 20 years.

Furthermore, the product development partnership (PDP) model, which brings together the expertise and knowledge of both the private and public sectors, continues to play an important role by stimulating innovation in antimalarial drug discovery, catalysing the development of next-generation combination therapies to combat resistance (pp. 12–13, 18, 30–33), and promoting open source approaches to identify promising drug candidates with irresistible mechanisms of action (p. 35).

How much of a threat to global health and the world’s economy is antimicrobial resistance?  

Antimicrobial resistance remains a significant immediate and long-term threat to global health and the world’s economy. Currently, around 700,000 people die each year due to drug-resistant disease, and if we do not act now to minimize the further spread of resistance, the number of deaths could rise to 10 million per year by 2050.2

Antimicrobial resistance also poses a serious economic threat : by 2030, it could force up to 24 million people into extreme poverty,3 and the cost in terms of lost global productivity between now and 2050 could be as high as USD 100 trillion.4 It is therefore clear that without urgent action, antimicrobial resistance will continue to threaten the public health gains we have made so far.  

What effect could drug resistance have on malaria control efforts?

The success of malaria control and elimination efforts depends largely on the sustained efficacy of artemisinin based combination therapies (ACTs). The evolution of treatment failure to ACTs in the Greater Mekong Subregion5 needs to be monitored closely, as well as the possible emergence of artemisinin resistance in other areas of high malaria burden, which, according to modelling studies, could kill as many as 116,000 additional people per year.6

In economic terms, the predicted medical costs associated with artemisinin resistance (resulting from retreatment of clinical failures and non-artemisinin-based management of severe malaria) exceed USD 32 million per year, while productivity losses resulting from excess morbidity and mortality are estimated at USD 385 million for each year in which failing ACTs are in use as first line treatments.6 

However, the true impact of drug resistance on malaria control efforts is likely to vary between regions, depending on complex factors such as health system infrastructure, population dynamics and the state of each country’s economy. 

What can be done to anticipate and mitigate the emergence of further drug resistance in malaria?

Combatting antimalarial drug resistance requires a highly collaborative approach between different stakeholders, at a national and regional level. From a scientific perspective, we need to implement comprehensive surveillance studies to identify and track resistant strains, as well as monitor the therapeutic efficacy of existing treatments, using the results from these studies to inform national treatment policy and provide early warnings for treatment failures.

Scientific networks such as the Asia Pacific Malaria Elimination Network are key to exchanging knowledge, building capacity, and expanding the evidence base to support regional elimination efforts. Raising political awareness is also crucial, so that recommendations from the scientific community can be implemented in a timely and sustained manner, and adequate funding mobilized at a domestic and global level. 

How do you see the role of MMV in terms of open source innovation to accelerate the development of next-generation medicines?

MMV is one of the most established PDPs working in global health, and is therefore well placed to catalyse international research and development efforts to find effective and affordable drugs for malaria. Today, in April 2020, there is an urgent global need to identify potential drugs for the treatment of COVID-19. Several compounds from MMV’s Pandemic Response Box are currently being tested against SARS-CoV-2 – the virus responsible for COVID-19, highlighting the value of open-source libraries for the international community. 

Collective resources and collaborative initiatives such as these will maximize the impact of efforts to contain antimicrobial resistance and identify treatments for new diseases, while reducing costs and duplication of efforts.

Antimicrobial resistance Microbes evolve naturally to resist the drugs that are used to fight them. This phenomenon, known as ‘antimicrobial resistance’, threatens the public health response to many infectious diseases, including malaria.6 The best insurance policy against the risk of antimalarial drug resistance is to replenish the pipeline and bring new and novel-acting medicines forward, which MMV has been successfully enabling for over 20 years.

Furthermore, the product development partnership (PDP) model, which brings together the expertise and knowledge of both the private and public sectors, continues to play an important role by stimulating innovation in antimalarial drug discovery, catalysing the development of next-generation combination therapies to combat resistance (pp. 12–13, 18, 30–33), and promoting opensource approaches to identify promising drug candidates with irresistible mechanisms of action (p. 35).

 


                                     

1. World Health Organization. Global action plan on antimicrobial resistance (2015) : https://www.who. int/antimicrobial-resistance/globalaction- plan/en/. 

2. Interagency Coordination Group on Antimicrobial Resistance. No Time to Wait : Securing the future from drug-resistant Infections (2019) : https://www.who.int/ antimicrobial-resistance/interagencycoordination- group/IACG_fi nal_ report_EN.pdf?ua=1

3. World Health Organization. Q&A on artemisinin resistance, May 2019 : https://www.who.int/malaria/media/ artemisinin_resistance_qa/en/

4. Review on Antimicrobial Resistance : Tackling drug-resistant infections globally (2016) : https://amr-review. org/Publications.html 

5. Cambodia, China (specifically Yunnan Province and the Guangxi Zhuang Autonomous Region), Laos, Myanmar (Burma), Thailand, and Vietnam.

6. Lubell Y et al. “Artemisinin resistance – modelling the potential human and economic costs.” Malar J 13, 452 (2014). MMV attended the inaugural Global Health Security Conference, Sydney, delivering messages