The war on malaria faces a daunting array of challenges
Sixtieth session of the Regional Committee for the Western Pacific, 21–25 September 2009, Hong Kong (China)
HONG KONG (China), 23 September 2009—Calling for urgent containment, the World Health Organization (WHO) today warned that winning the war against malaria may be jeopardized if drug resistance in the Cambodian-Thai border spreads to other regions of the world, including Africa, where the highest burden of the disease is concentrated.
"Artemisinin-based combination therapy, the most effective anti-malaria treatment to date and among the last resources in our arsenal of drugs against the disease, is seriously threatened by evidence of resistance to the treatment in the Cambodian-Thai border," Dr Shin Young-soo, WHO Regional Director for the Western Pacific said in his report to the Regional Committee for the Western Pacific, WHO's governing body in the Region. "Artemisinin-resistance needs urgent containment to prevent further spread of drug resistance."
In addition to artemisinin resistance, the proliferation of counterfeit drugs, a significant problem in the Region, further aggravates the situation. Interpol, in collaboration with Member States and WHO, has strengthened efforts to stem the flow of counterfeit drugs across the Region and beyond.
Half of the world's population is at risk of malaria, with Africa reporting up to 86% of cases and over 91% of deaths. Although morbidity and mortality in the Western Pacific Region have been significantly reduced, malaria remains a public health problem in 10 endemic countries in the Region: Cambodia; China; Lao People's Democratic Republic; Malaysia; Papua New Guinea; the Philippines; the Republic of Korea; Solomon Islands; Vanuatu and Viet Nam.
In 2008, there were 248 141 confirmed malaria cases and 1005 malaria deaths reported in the Region. These figures are based on reports from the public sector alone, and thus seriously underestimate the true burden of disease. WHO is coordinating efforts to beat artemisinin-resistant malaria through strategies such as utilization of long-lasting, insecticide-treated bednets, intensifying case detection, and promoting the use of appropriate drug combinations.
Anti-malaria activities in countries have intensified with the pouring in of funds from key stakeholders and partner agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Bill and Melinda Gates Foundation. But even with this unprecedented external funding for the Region of US$ 605 million in July 2009, sustainability remains an issue. "Successful malaria control and elimination will rely on intense up scaling of activities demanding significant amount of resources over a long period of time," Dr Shin noted. "Member States will also need to incorporate malaria elimination efforts into their respective health systems and commit significant funding and human resources to achieve this target."
Plasmodium falciparum, the deadliest species causing malaria in humans, has been the key focus of anti-malaria programmes. However, WHO also stressed the need to address Plasmodium vivax, which has a more complex life cycle characterized by dormant stages in the person's tissues where they can live for years. Under appropriate conditions such dormant stages may lead to renewed morbidity and possibly even death in those affected who do not receive adequate treatment.
Effective malaria control in the Region is, therefore, extremely challenging as the epidemiology of the disease is variable. Different epidemiological situations call for specific control strategies adapted to particular risk groups, vector behaviour, local health infrastructure, and environmental conditions.
In order to address these challenges, Member States in collaboration with WHO and other key stakeholders developed a Regional Action Plan for Malaria Control and Elimination (2010–2015) to serve as a road map in the Western Pacific Region. The Regional Committee is now encouraged to endorse this Action Plan.
The Regional Committee is currently meeting in Hong Kong (China) to review WHO's work and to provide guidance on future policies.
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