Daily News Analysis ‘Artemisinin Resistance: A Renewed Threat to Global Malaria Contro’ : 16 December

Why in News?

• A new global study has reported early warning signs of artemisinin resistance emerging in Africa, raising concerns about the future effectiveness of the world’s most important anti-malaria drug.

Background: The Malaria Drug Crisis

• During the Vietnam War, malaria caused more deaths than combat due to chloroquine resistance in malaria parasites.
• Vietnam sought help from China, leading to the launch of Project 523 to find new anti-malarial drugs.
• This effort marked a major turning point in malaria treatment history.

Discovery of Artemisinin

• Chinese scientist Tu Youyou identified artemisinin from the plant Artemisia annua (qinghao).
• She used low-temperature extraction, based on ancient medical texts, to preserve the active compound.
• Artemisinin proved highly effective, rapidly clearing malaria parasites, including chloroquine-resistant strains.
• It later became the foundation of artemisinin-based combination therapies (ACTs) used worldwide.

Global Impact and Recognition

• Artemisinin-based therapies became the backbone of global malaria control after the 1980s.
• The discovery saved millions of lives, especially in Africa and Southeast Asia.
• In 2015, Tu Youyou won the Nobel Prize in Medicine, highlighting the drug’s global significance.

Emergence of Artemisinin Resistance

• By the late 2000s, delayed parasite clearance was observed in Southeast Asia.
• Resistance was linked to mutations in the kelch13 gene of the malaria parasite.
• These mutations allow parasites to survive drug exposure by slowing their growth temporarily.
• Strong regional surveillance helped contain resistance in Southeast Asia, preventing global spread.

New Evidence of Resistance in Africa

• A large study published in eLife analysed 1.1 lakh parasite samples from 73 countries.
• It found rising kelch13 mutations in Northeast and East Africa, especially in Rwanda, Uganda, Tanzania, Ethiopia, and Sudan.
• Around 10% of samples in Northeast Africa showed resistance markers.
• These mutations appear to be locally emerging, not imported from Asia.

Why Africa Is at Risk

• Heavy use of artemisinin, poor treatment adherence, and weak surveillance increase resistance risk.
• Resistant parasites survive longer and spread more easily through mosquitoes.
• Once resistance becomes widespread, it is very difficult to reverse, as seen with chloroquine.
• Africa still has a window of opportunity because resistance levels remain low in most regions.

Data Gaps and Surveillance Challenges

• Malaria surveillance weakened after 2019 due to COVID-19 and funding cuts.
• Sample collection declined, especially from Southeast Asia, a historic resistance hotspot.
• Differences in genetic testing methods may have missed rare mutations.
• These gaps highlight the need for stronger and more consistent global surveillance.

Way Forward and Global Significance

• Experts call for urgent action to prevent a full-scale resistance crisis in Africa.
• Key steps include improving genetic surveillance, diversifying malaria drugs, and monitoring partner-drug resistance.
• Sustained funding and rapid policy adjustments are essential to protect ACT effectiveness.
• Artemisinin’s story shows that scientific breakthroughs must be matched with vigilance, not complacency.