A break from clinic duty today, to attend this meeting at which health agencies keep each other informed about their activities. SMRU disseminates the results of its research, so this was an ideal opportunity for me to get up to speed fast.
I’m not going to go into lots of medical detail, but those who are interested can email me for the specifics. But I will share the take home message, malaria is becoming more resistant to the only decent treatment we have left in the drug cupboard.
Western Cambodia must be cursed. It was the last stronghold of the wicked Khmer Rouge, the land is littered with thousands of mines, and this is the place that has produced the most resistant strains of malaria parasite over the past forty years. It has spread eastwards to the border with Vietnam and skipped to the west, the Thai Myanmar border. So far, Laos to the north has escaped this scourge. But borders do seem to be important. People cross them as economic migrants, often being denied medical treatment at their destination, because they are illegal or not citizens.
If this resistant parasite spreads further west, to Bangladesh and India, without doubt, thousands of people will die. Perhaps we only have a few years to try to control the spread. WHO has been talking about it for five years, but nothing practical has been done. My boss, Professor Francois Nosten, feels that one strategy could be to carry out mass treatment of people in areas where the resistance has been identified. This would happen regardless of whether they have symptoms or not, because modern tests (PCR) demonstrate that in some areas close to 80% of people have low levels of parasitaemia. Pregnant women and babies would be excluded, but the aim would be to achieve 90% coverage. If we can knock out the parasite at this stage it will at least give us some breathing space. Not everyone agrees with him, but I’ve not heard what they are offering to do instead. Some aid agencies want him to carry out pilot trials but these will take years to give us any answers and the horse might have bolted before we figure out how to lock the stable door.
A mass treatment campaign will be an expensive calculated risk. Who knows if it will work or if we will even have the opportunity to put it into effect?