Drug-Resistant Malaria Pushes Rural Thailand to Shoulder Global Role

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As Thailand braces itself to combat drug-resistant malaria, a spread of small, nondescript buildings scattered close to corn and rice fields along its hilly, western border are being cast into a bigger, international role.

Hundreds of these health clinics and malaria posts have become a pivotal frontline to detect the genetic mutation of Plasmodium falciparum, which makes the deadly parasite resistant to artemisinin, the most effective anti-malaria drug used globally.

“They have been equipped to test and treat local people and migrant workers who come down with fever in that malaria belt,” says Wichai Satimai, director of the bureau of vector-borne disease at the Thai Public Health Ministry. “The results of a blood test are given in 15 minutes and the staff will be able to assess if the patient has malaria and what strain.”

This healthcare for the largely farming and migrant labour community has taken on added significance after medical researchers revealed signs of drug-resistant malaria along the border Thailand shares with Myanmar (or Burma) in April this year.

“These blood tests have to be carried out more regularly and frequently in the environments that are conducive to spread the parasite from carriers of drug-resistant malaria,” Wichai told IPS. “The health staff must regularly monitor and treat the patients.”

The efforts to contain drug-resistant malaria in the isolated areas along the border “makes the fight more difficult,” noted Fatoumata Nafo-Traore, head of the Roll Back Malaria Partnership, a global initiative coordinating the drive against the disease, following a recent visit to health clinics along the Thai-Myanmar border. “There are communities living in forest areas and remote areas.

“We need to contain the resistance in these local areas,” she said in an interview with IPS. “This has to be seen as a global concern because there is no other highly effective anti-malaria drug than artemisinin therapy.”

But even as the border health clinics begin to shoulder a bigger role, concerns about funding the free health services offered to local and migrant communities are also growing. Officials of the Thai health ministry warned early this month that the Southeast Asian nation may have to meet the cost of containing drug-resistant malaria if international funding dries up.

Currently, the Global Fund to Fight Aids, Tuberculosis and Malaria, which finances programmes to combat these three killer diseases in the developing world, remains a major contributor. It has disbursed 40 million dollars for a range of malaria control programmes, including the running of the 300 malaria posts and health clinics along the Thai border.

Thailand’s fear of a looming funding crisis was echoed in the ‘World Malaria Report 2012’, which was released by the World Health Organisation (WHO) this week. “International funding for malaria appears to have reached a plateau” that is below the estimated level to meet internationally-agreed global malaria targets, it states.

“An estimated 5.1 billion U.S. dollars is needed every year between 2011 and 2020 to achieve universal access to malaria interventions in the 99 countries with on-going malaria transmissions,” it adds. “While many countries have increased domestic financing of malaria control, the total available global funding remained at 2.3 billion U.S. dollars in 2011 – less than half of what is needed.”

The need for sustained funding was underscored by malaria’s global transmission, with 2010 witnessing an estimated 219 million cases occurring, while the disease killed about 660,000 people, mostly children under five years in Africa, according to the WHO’s report.

While South and Southeast Asia’s number of 2.4 million malaria cases in 2010 may be dwarfed by the global rates, the annual malaria report singled out the Mekong River region – shared by Cambodia, Myanmar, Thailand and Vietnam – as the epicentre of drug-resistant malaria.

“If resistance to artemisinin develops and spreads to other larger geographical areas, the public health consequences could be dire, as no alternative anti-malarial medicines will be available for at least five years,” the WHO warned.

Artemisinin is the active ingredient in the anti-malarial drug artesunate. It comes from the wormwood plant in China and is the most potent antidote to falciparum malaria, the parasitic strain of malaria responsible for most deaths.

Artemisinin replaced chloroqunine, a once potent anti-malarial drug, following a resistance strain which emerged in Thailand’s eastern border it shares with Cambodia. The resistance to chloroquinine was first detected in Pailin, a Cambodian town that was once the stronghold of that country’s genocidal Khmer Rouge regime, and was then detected along the Thai-Cambodian border before spreading across the world.

Fear of such a repeat with artemisinin also haunts health clinics and malaria outposts along the Thai-Cambodian border, where artemisinin-resistant strains have been detected and contained.

“Good malaria control and elimination will contain the artemisinin-resistant malaria,” said Steven Bjorge, head of the malaria and vectorborne disease section at the WHO’s Cambodia office. “There is no way of knowing that a case of malaria is resistant or sensitive a priori, so detecting and treating each and every case is the proper and necessary means of containing the resistant cases.”

Cambodia’s western provinces such as Pailin, Oddar Meanchey and Battambang – once the spawning ground for the lethal parasite – have seen a reversal of the falciparum strain. “This is an indication of success in preventing transmission,” Bjorge told IPS. “The overall incidence rate has dropped. Deaths have dropped.”