As virulent, drug-resistant strains of malaria spread in Asia, governments in the Asia-Pacific region must redouble their efforts to eradicate the disease, amid the growing risk that these new forms will spread to South Asia, China and Africa, according to participants at a regional conference on the disease.
Experts spoke about their concerns days before the British medical journal The Lancet Infectious Diseases published a study showing that a strain resistant to the fast-acting malaria drug artemisinin, had spread further than experts had feared, to western Myanmar, 25km from the Indian border.
"The potential spread of artemisinin resistance ... into neighboring India poses a serious threat to the global control and eradication of malaria," the journal said in a press release about the study.
Dr. Charles Woodrow from the Mahidol-Oxford Tropical Medicine Research Unit and senior author of the study, said Myanmar is seen as "the front line in the battle against artemisinin resistance as it forms a gateway for resistance to spread to the rest of the world."
"This is a national emergency. It is a regional emergency, but it is also a global emergency," said Dr. Benjamin Rolfe, executive secretary of the Asia-Pacific Leaders Malaria Alliance, an affiliation of government heads. He was speaking on the sidelines of the Bangkok conference, where scientists and officials discussed an agenda for their November summit in Kuala Lumpur.
At the conference, scientists and senior officials urged Asia-Pacific leaders to back efforts to eliminate malaria. More than 2.3 billion people in the region are at risk of contracting malaria, with Cambodia, India, Indonesia, Myanmar, Pakistan and Papua New Guinea facing the greatest danger, according to the World Health Organization.
The WHO says that the fight against malaria has recorded some impressive gains globally, with cases falling by 30% since 2000 because of more intervention.
In the Asia-Pacific region, several countries reported that they had successfully reduced their recorded cases of conventional malaria by more than 75% in 2014. These included China, Malaysia, the Philippines, Solomon Islands, South Korea, Vanuatu and Vietnam. Sri Lanka has reported no indigenous cases since 2012.
The focus now lies on stemming the growth of the drug-resistant strains. Cases were initially detected along the Thai-Cambodian border in 2009, but have spread to Myanmar after cropping up in Thailand, Laos and Vietnam.
Artemisinin, a herbal drug, has been used to fight the disease in recent years. But scientists have warned of growing drug resistance in patients, especially those in Cambodia. The problem, according to experts, stems from people consuming so-called single-use drugs and fake medicines, prompting drug-resistant parasites to flourish.
Malaria is caused by parasites transmitted through the bites of infected mosquitoes. Four types of parasites cause the deadly disease in humans. One particular type, plasmodium falciparum, has proven resistant to most anti-malarial medicines along the Cambodia-Thailand border, according to the WHO.
In 2013 the organization noted another concern: 49 countries reported that mosquitoes had become resistant to at least one commonly-used insecticide.
Rolfe said the emergence of drug resistant strains of malaria has increased the urgency to fight the disease in the region.
Of the estimated 3.2 billion people at risk of malaria, 1.2 billion are in the high-risk category, the WHO says. Governments recorded 28 million cases of malaria in the Asia-Pacific region in 2010, with 38,000 lives lost.
Still, residents of Africa face the gravest dangers, according to medical research. Ninety percent of the 584,000 deaths from malaria in 2013 were in Africa, the WHO said. Some 437,000 children died before age five.
"That is an enormous challenge, not only for this region," Rolfe said. "Should that resistance spread to Africa, where the conditions for malaria are extremely severe, we will see many millions of children die."
"It makes it critical that we eliminate the drug-resistant parasite that causes malaria within the next 15 years," he said.
The East Asian Summit in November hopes to draw leaders from the Association of Southeast Asian Nations, as well as partner states including Japan, the U.S. and Australia. Vietnam and Australia are co-chairing the Asia-Pacific leaders malaria alliance that was launched in 2012.
Rolfe said the current campaign to rid the region of malaria by 2030 will also consider tactics to halt other deadly diseases. "As we engage with malaria, we're also putting in the surveillance systems that you need to report HIV/AIDS, and the testing capacity that you need to report drug-resistant tuberculosis," he said.
Sri Lanka, he said, has set a good example for eliminating local malaria transmission. The nation focused on the issue after complacency led to a return and rapid increase in the disease incidence in the 1960s and again in the past 20 years.
Sri Lanka's Minister for Health, Rajitha Senarate, who also attended the conference, said his country learned from past mistakes resulting from complacency.
In the years after World War II, policy makers were diligent in enforcing an anti-malaria program after an outbreak in the 1930s affected 5.5 million people, including 80,000 deaths. An eradication program reduced malaria cases from 91,990 in 1953 to 17 by 1963.
In the mid-1960s, "preventative measures were relaxed," Senarate said, leading to another outbreak. By 1999, the nation had more than 100,000 cases of malaria. By 2012, there were just 23. The country reported no indigenous cases the year after.
Yet Sri Lanka remains vulnerable because visitors, migrants, tourists and even Sri Lankan travellers can carry the malaria parasite.
Scientists reporting in the WHO publication South-East Asia Journal of Public Health warned in 2014 of the considerable cost to Sri Lanka if the government failed to eliminate the disease. Failure, the authors warned, "would place the country at risk of artemisinin-resistant malaria, which has now extended from its point of origin at the Thailand-Cambodia border, reported in 2009, as far west as Myanmar."
Senarate said that maintaining ready access to health care services in rural areas has been key to the policy's success.
In a sign of growing cooperation between Sri Lanka and India, the two countries are entering joint agreements to combat malaria this year. "We can take some action in the entire South Asian region, so that will give good results," he said.