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Feature Infectious disease

Researchers and WHO clash over global threat of drug resistant malaria

BMJ 2017; 359 doi: (Published 10 November 2017) Cite this as: BMJ 2017;359:j5127
  1. Sophie Arie, freelance journalist
  1. London, UK
  1. sophiearie{at}

Researchers funded mostly by the Wellcome Trust want the World Health Organization to declare an international emergency over drug resistant malaria in South East Asia—a move WHO says is alarmist. Sophie Arie reports

On 22 September Jeremy Farrar tweeted, “Time to call PHEIC? @WHO?”

A PHEIC is a “public health emergency of international concern.” Farrar, director of the Wellcome Trust, one of the world’s largest private funders of scientific research, was asking WHO if it should trigger international action, under International Health Regulations, to prevent a pandemic.

This was not because of Zika, Ebola, or bird flu—but because of malaria.

Research, funded mainly by Wellcome, has warned in recent years of a “sinister development” in South East Asia: a particular strain of malaria has become immune to the most effective treatment for the disease and spread, despite the efforts of WHO and local governments, from Cambodia to Thailand to Laos and most recently to Vietnam.

Losing a dangerous race

Researchers published a letter in October in Lancet Infectious Diseases warning of “alarming rates of failure” of dihydroartemisinin-piperaquine, the preferred antimalarial drug in the region.1

As a result, a resistant strain of Plasmodium falciparum, the parasite that causes around half of all malaria cases, has spread and become dominant, the researchers, at the Mahidol Oxford Tropical Medicine Research Unit (MORU), led by Nicholas White, said.

Public health teams—through careful monitoring of new cases and treatment with the only other effective artemisinin based combination therapy (ACT), artesunate mefloquine—are keeping the numbers of cases and deaths down in the greater Mekong subregion (GMS). According to WHO estimates, malaria case incidence in GMS countries fell by 54% between 2012 and 2015. Malaria death rates fell by 84% over the same period. Last year, there were around 200 malaria deaths and fewer than 300 000 cases reported in …

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