A WHO report says the country’s dependence on a single drug to treat the disease could prove counterproductive in the long-run
New Delhi: India could see up to a 75% reduction in malaria infections by 2015, but the country’s dependence on a single drug to treat the disease could prove counterproductive in the long-run, possibly resulting in a drug-resistant form of malaria, a report by the World Health Organization (WHO) has said. India saw 870,000 malaria infections in 2013 and this number could go to between 435,000 and 220,000 in 2015. India and Thailand are on track to achieve a 50-75% decrease in malaria cases by 2015, according to the World Malaria Report 2014 released on Tuesday.
The report also highlighted India’s dependence on the oral drug artemisinin to treat malaria. The use of such single-drug therapies threatens the long-term efficacy of artemisinin-based combination therapy (ACT), a key intervention to treat malaria, as it increases resistance to the drug. The number of countries that allow marketing of oral artemisinin-based single-drug treatments has declined rapidly across the world. As of November, only eight countries allowed the marketing of such treatment. The report said that 24 pharmaceutical companies, mostly in India, continue to market such drugs.
WHO recommends that oral artemisinin-based treatments be withdrawn from the market and that marketing of these therapies should cease. Artemisinin resistance is a major obstacle in the fight against malaria, as it leads to persistence or recurrence of malaria parasites after appropriate drug treatment. Resistance to artemisinin has been detected in five countries including Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Vietnam, but data on malaria transmission is insufficient. WHO had earlier warned that with the continuously increasing levels of population movement in Asia and the Pacific, the geographic scope of the problem could expand quickly. In 2013, 392 million courses of ACT were procured, up from 11 million in 2005. On the positive side, India also dominated in the number of microscopic examinations performed to diagnose malaria—it performed 120 million slide examinations out of the global total of 197 million.
Increased testing of suspected malaria cases is due in part to a higher number of patients tested by microscopy, both in the WHO African Region and globally. “We can win the fight against malaria,” said Dr Margaret Chan, director-general, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.” The number of confirmed malaria cases reported in the Southeast Asia region decreased from 2.9 million to 1.5 million between 2000 and 2013. Three countries accounted for 96% of cases in 2013: India (58%), Myanmar (22%) and Indonesia (16%). An estimated population of 3.2 billion is at risk of mosquito-borne malaria which is entirely preventable and treatable. The malaria mortality rate has fallen by 47% worldwide, and by 54% in Africa between 2000 and 2013, according to the report.
WHO highlighted the threat to malaria treatment and interventions in the Ebola endemic countries, especially Guinea, Sierra Leone and Liberia where most of the inpatient facilities are now closed. “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” said Pedro L. Alonso, director of WHO’s Global Malaria Programme, who added that with sufficient funding and commitment, huge strides can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” Alonso said.
