Via the Hindustan Times: Mutating parasite may foil India’s plans to be malaria free by 2030. The parasite is Plasmodium falciparum. Excerpt:
Scientists acknowledge that the parasite is a formidable foe that has managed to evade global attempts to destroy it over six decades. Armed with the safe, inexpensive drug chloroquine and the powerful insecticide DDT, the WHO launched the Global Malaria Eradication Programme in 1955 with the goal to eliminate the disease within a decade.
Billions were spent in distributing the anti-malarial medicines, insecticide-treated bednets and fogging with DDT, but the parasite and mosquito survived new drugs, insecticides and habitat changes to continue to infect and kill people in 97 nations.
Over the past decade, the parasite is steadily developing resistance to every frontline anti-malarial drug.
The parasite is now so entrenched across most parts of India that it can be controlled only with a combination of drugs. India’s National Vector Borne Disease Control Programme (NVBDCP) rolled out the WHO-approved fast-acting combination called artemisinin combination therapy (ACT) in 2010. Under the national programme, ACTs are provided free for all, as are long-lasting insecticidal nets, which stay effective for three years and help in lowering transmission.
ACTs are made using artemisinin-based compounds in combination with other classes of anti-malarials. The ACT combination of artesunate and sulphadoxine-pyrimethamine (AS+SP), for example, is the first-line treatment for uncomplicated P. falciparum malaria. With cases of resistance to AS+SP reported in the northeastern states, the Centre gave its nod to the artemether and lumefantrine (ACT-AL) combination for use in the region in April 2013.
Finishing the job
Adding to the problem is the mosquitoes growing resistance to pesticides, the mainstay of vector (mosquito) control. The Anopheles mosquito has grown resistant to DDT and malathion, but is still sensitive to pyrethroid.
GSK’s malaria vaccine triggers the immune system to defend against P. falciparum when it first enters the human bloodstream and/or when the parasite infects liver cells. The vaccine, however, is only partially effective and at best can help control, and not eliminate, malaria. “The way ahead is rapid-diagnostic testing and using ACTs for treatment to prevent severe illness. That, along with the use of indoor residual spraying and long-lasting insecticidal nets in endemic areas, are the tools we know work against malaria,” says a Union Health Ministry official.