Drug-Resistant Malaria Poses New Challenges for Gates Foundation

A new strain of drug-resistant malaria has emerged in Myanmar just as that country emerges from a half-century of isolation, threatening to undo the gains made to contain the disease in other regions, the Seattle Times reports.

In an effort to eradicate malaria, the Bill & Melinda Gates Foundation has committed $2 billion in support of research on new treatments, vaccines, diagnostic tools, and disease mapping. Those efforts, in turn, could lead to clinically vetted drugs to fight the disease by 2020 — assuming that the drug-resistant strain spreading in the forests of the country formerly known as Burma can be contained. More than two-thirds of Myanmar's population lives in malaria-endemic areas, according to the World Health Organization, while a 2012 assessment (34 pages, PDF) funded by the Gates Foundation and the Australian Agency for International Development found that Myanmar accounts for 78 percent of malaria cases and 75 percent of malaria deaths in the Greater Mekong sub-region, which includes Cambodia, Laos, Myanmar, Thailand, Vietnam, and the Yunnan Province of China.

"Myanmar is the linchpin country, really," said Tom Kanyok, a former WHO scientist who is now the Gates Foundation's senior malaria program officer for the region. Myanmar borders China, Thailand, Laos, India, and Bangladesh — which together  account for 40 percent of the world's population — a fact that positions the country for economic growth but also increases the risk that drug-resistant malaria will spread into the Indian subcontinent and Africa, reversing hard-fought gains in those regions. After a major setback in the fight against malaria in the 1960s due to the emergence of a drug-resistant strain, it took years for artemisinin, a derivative of wormwood and a traditional herbal treatment developed in China, to become widely used. Resistance to artemisinin was first detected in 2006 and, with international travel more common and Myanmar opening up after years of isolation, could spread quickly.

The Gates Foundation has funded pilot projects in border areas of the region to test the viability of the mass administration of anti-malaria drugs, with the goal of treating 250,000 people by 2016. If successful, the pilot programs could help make the case for a new, aggressive malaria eradication effort. But while Myanmar's government supports the fight against the disease, it is sensitive to the country being used as a laboratory for new approaches. "There's a little bit [of] unhappiness or misunderstanding about this with the national program, but we were not consulted by anyone," said Gawrie Nirdoshi Loku Galappaththy, a malaria technical officer in the WHO's Yangon office.

"I would say this is without doubt the most challenging operational environment I've ever worked in," said Chris White, senior malaria technical adviser with Population Services International. "All the places where you really need to reach in terms of malaria transmission are often forested, mountainous border areas that are also areas of high sensitivity politically, areas with conflict, internal displacement, let alone logistically difficult."

Brier Dudley. "Gates Foundation Battling Big New Threat in Malaria Fight." Seattle Times 07/06/2014.