Our time is limited, it seems, when it comes to our faltering abilities to fight infectious diseases. Evidence has suggested for some time now that bacteria are becoming immune to common antibiotics. Similarly, malaria parasites have also been developing resistance to antimalarial drugs, including a powerful combination drug introduced in the mid-1990s called artemisinin. In a new study, scientists say that “radical measures” must be taken to prevent resistance to these drugs, otherwise, countries where the disease is prevalent will face a huge setback.

The study was led by Nicholas White of Oxford University, who is also chair of the Worldwide Antimalarial Resistance Network. It found that malarial resistance to artemisinin, and the drugs it’s used in combination with to fight the disease, is spreading across major parts of Southeast Asia, including Cambodia, Thailand, Vietnam, and Myanmar. “Resistance to artemisinin has not been contained, and has now emerged or spread across Southeast Asia,” the researchers wrote, adding that resistance to these drugs “may well reverse the substantial gains in malaria control. New antimalarial drugs are under development but will not be available for several years.”

Derived from wormwood, artemisinin has been available for centuries (ancient Chinese used it), however, it only became a widely used antimalarial after other antimalarials, chloroquine and sulfadoxine-pyrimethamine, became obsolete from resistance. Roughly 3.4 billion people are at risk of a malarial infection, which is still prevalent throughout 97 countries, according to the World Health Organization. If artemisinin continues down the path of resistance, malaria will come back to affect a growing number of people, negating any advances the health community has made.

“It’s worse than we expected,” White told the BBC. “We have to act quickly if we are going to do anything.” To do this, the study suggests increasing the amount of time a person who’s sick with the disease undergoes treatment. Rather than taking antimalarials for three days, they would take them for six days — this solution, however, is only temporary.

The researchers discovered how bad resistance was by testing the blood of infected patients in 10 countries where malaria was prevalent. Each patient underwent a three-day regimen of an artemisinin derivative and then three days of an artemisinin combination therapy. In patients living along the Thailand-Cambodia border, the median amount of time it took the parasite to be cleared from the blood was seven hours. Meanwhile, patients who lived in the Democratic Republic of Congo, one of three African countries also tested in the study (the other two were Kenya and Nigeria), had their blood cleared of the parasite in a little less than two hours, according to a press release.

These findings were the silver lining on the whole issue. The researchers found that despite such high resistance to artemisinin in Southeast Asia, all three African countries that were tested showed little resistance. That’s huge, considering that over 90 percent of malaria deaths occur in sub-Saharan Africa. The researchers believe that by analyzing the DNA of the resistant parasites, they’ll be able to map the spread of resistance, and hopefully prevent it from reaching Africa, The Guardian reported.

“It may still be possible to prevent the spread of artemisinin-resistant malaria parasites across Asia and then to Africa by eliminating them, but that window of opportunity is closing fast,” White said. “Conventional malaria control approaches won’t be enough — we will need to take more radical action, and make this a global public health priority, without delay.”

Source: White N, Ashley E, Dhorda M, et al. Our time is limited, it seems, when it comes to our faltering abilities to fight infectious diseases. Evidence has suggested for some time now that bacteria are becoming immune to common antibiotics. Similarly, malaria parasites have also been developing resistance to antimalarial drugs, including a powerful combination drug introduced in the mid-1990s called artemisinin. In a new study, scientists say that “radical measures” must be taken to prevent resistance to these drugs, otherwise, countries where the disease is prevalent will face a huge setback.

The study was led by Nicholas White of Oxford University, who is also chair of the Worldwide Antimalarial Resistance Network. It found that malarial resistance to artemisinin, and the drugs it’s used in combination with to fight the disease, is spreading across major parts of Southeast Asia, including Cambodia, Thailand, Vietnam, and Myanmar. “Resistance to artemisinin has not been contained, and has now emerged or spread across Southeast Asia,” the researchers wrote, adding that resistance to these drugs “may well reverse the substantial gains in malaria control. New antimalarial drugs are under development but will not be available for several years.”

Derived from wormwood, artemisinin has been available for centuries (ancient Chinese used it), however, it only became a widely used antimalarial after other antimalarials, chloroquine and sulfadoxine-pyrimethamine, became obsolete from resistance. Roughly 3.4 billion people are at risk of a malarial infection, which is still prevalent throughout 97 countries, according to the World Health Organization. If artemisinin continues down the path of resistance, malaria will come back to affect a growing number of people, negating any advances the health community has made.

“It’s worse than we expected,” White told the BBC. “We have to act quickly if we are going to do anything.” To do this, the study suggests increasing the amount of time a person who’s sick with the disease undergoes treatment. Rather than taking antimalarials for three days, they would take them for six days — this solution, however, is only temporary.

The researchers discovered how bad resistance was by testing the blood of infected patients in 10 countries where malaria was prevalent. Each patient underwent a three-day regimen of an artemisinin derivative and then three days of an artemisinin combination therapy. In patients living along the Thailand-Cambodia border, the median amount of time it took the parasite to be cleared from the blood was seven hours. Meanwhile, patients who lived in the Democratic Republic of Congo, one of three African countries also tested in the study (the other two were Kenya and Nigeria), had their blood cleared of the parasite in a little less than two hours, according to a press release.

These findings were the silver lining on the whole issue. The researchers found that despite such high resistance to artemisinin in Southeast Asia, all three African countries that were tested showed little resistance. That’s huge, considering that over 90 percent of malaria deaths occur in sub-Saharan Africa. The researchers believe that by analyzing the DNA of the resistant parasites, they’ll be able to map the spread of resistance, and hopefully prevent it from reaching Africa, The Guardian reported.

“It may still be possible to prevent the spread of artemisinin-resistant malaria parasites across Asia and then to Africa by eliminating them, but that window of opportunity is closing fast,” White said. “Conventional malaria control approaches won’t be enough — we will need to take more radical action, and make this a global public health priority, without delay.”

Source: Ashley E, White N, Dhorda M, et al. Spread of Artemisinin Resistance in Plasmodium falciparum Malaria. The New England Journal of Medicine. 2014.