Can malaria researchers slow the spread of drug resistance?

For people living in parts of the world where malaria is endemic, losing loved ones to the mosquito-borne disease has long been a fact of life. “As a young girl growing up in Africa, the disease claimed lives in so many families, including my siblings [and] neighbours,” says Corine Karema, a Rwandan epidemiologist and interim chief executive at the RBM Partnership to End Malaria (formerly known as Roll Back Malaria). “That was normal,” she says. “It was accepted.”

Over the past few decades, however, the image of malaria as an inevitability has begun to change. In 2000, the annual incidence of malaria in Africa was estimated at 373 cases per 1,000 people living in areas where transmission occurs; in 2021, the figure was 229 cases per 1,000 people. Deaths owing to malaria are falling even faster. In Rwanda, where Karema led a national malaria-control programme between 2006 and 2016, the malaria mortality rate has dropped by nearly 70% since 2000. “Losing family members due to malaria is no longer a norm,” says Karema.

Africa’s progress in the control of malaria rests on several strategies. There has been a marked increase in the use of prevention tools, such as mosquito nets treated with insecticides. Around two-thirds of people who are at risk of malaria in sub-Saharan Africa had access to such nets in 2015, compared with just 7% a decade earlier. The fight is also heavily reliant on antimalarial drugs that target the Plasmodium parasites carried by mosquitoes.

The most notable are treatment regimens that involve a drug based on artemisinin. These have been used to shorten hospital stays, reduce mortality and even help to bring down transmission. But a problem is emerging: the parasites are increasingly resistant to artemisinin-based treatments. Resistant parasites were first reported around 15 years ago in southeast Asia. Later, they were detected in Africa — initially in Rwanda in 2014.

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