Home » Infectious Diseases » Fighting back against drug resistance in malaria

Erika Satterwhite

Head of Global Policy, Viatris

Antimicrobial resistance (AMR) is a global health crisis. Learn about the impact of AMR on infectious diseases, such as malaria, and the race against evolving microbes.

Infectious diseases are driven by microbes seeking to thrive, with little regard for the impact on their hosts. When these hosts are us — humans — we pay particular attention to limiting microbes’ ability to live at our expense.

Antimicrobial medicines are a large part of the answer to this problem — whether for the fight against bacteria, viruses, fungi or parasites. Microbes, however, are determined to live. When a microbe evolves to survive exposure to an antimicrobial medicine, a new strain of resistant infection can be created. When the drug-susceptible microbes die, the resistant strains spread.

This process of natural evolution and survival of the fittest has dire implications globally for human health and can be summarised in three letters: AMR (antimicrobial resistance).

Nearly 80% of malaria deaths are in children under five years of age, equating to one death every two minutes.

Global impact of AMR beyond bacteria

The impact of AMR is felt most acutely for bacterial infections, such as ‘superbugs’ like MRSA (Methicillin-resistant Staphylococcus aureus) and multi-drug-resistant tuberculosis. Bacterial AMR is estimated to kill 1.27 million people annually, with the potential to reach 10 million by 2050.

Much of the collective global public health community’s attention has centred — for good reason — on addressing bacterial AMR. Antibiotics are essential not only for addressing infections but also for supporting essential elements of modern medicine, including chemotherapy for cancer and routine surgeries.

Yet, AMR is not limited to bacterial AMR, and resistant microbes are challenging global efforts to eradicate other infectious diseases, including HIV and malaria, which are facing rising trends of resistance.

Emerging threat of malaria drug resistance

Malaria, a life-threatening parasitic infection, transmitted to humans through the bites of infected mosquitoes, is no stranger to drug resistance.

In the mid-20th century, broad access to an anti-malarial treatment led to gains in addressing the infection. However those gains were jeopardised within 50 years due to widespread resistance to the treatment. The discovery and rollout of an updated combination therapy revived the ability to successfully treat malaria, and it remains highly effective today. 

Unfortunately, troubling signs are gathering for malaria drug resistance. Treatment failure rates have increased, beginning in South-East Asia; and partial resistance has been confirmed in multiple African countries.

The implications for the malaria response across Africa, which bears 95% of the global malaria burden, are severe. Nearly 80% of malaria deaths are in children under five years of age, equating to one death every two minutes. Due to the spread of drug-resistant malaria, there is tangible potential for this threatening development to worsen.

Progress to address AMR in malaria

Work is being done to address the threat of AMR in malaria. Efforts to control malaria involve a combination of vector control, prompt diagnosis and treatment of cases. 

The World Health Organization (WHO) has a strategy to respond to antimalarial drug resistance in Africa. Organisations like Roll Back Malaria and the Global Fund to Fight AIDS, TB and Malaria are coordinating activities and mobilising resources to address the issue.

“Malaria is facing the perfect storm: rising threats from insecticide resistance, the climate crisis, financing gaps and biological threats intensifying the risk of malaria to public health with progress having already plateaued pre-Covid-19. While we do not need to create an alarm for malaria, addressing this issue requires urgency and seeking viable solutions becomes imperative,” says Sherwin Charles, Co-Founder of Goodbye Malaria, who has been at the forefront of global efforts to fight malaria for decades.

“Crucially, tackling this threat demands innovative products along with market-shaping tools to ensure easy market access and scalability, particularly in financially constrained environments. The journey ahead necessitates robust public-private partnerships to navigate and withstand the complexities of this storm.”

Tackling AMR is an ongoing effort. Microbes never stop working to evade the tools developed to stop them. The question is whether we can evolve fast enough to outpace the resistance.

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