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ACTs: What will happen when the cat gets out of the bag?

April 11, 2011 - 20:47 -- Bart G.J. Knols

Most of us that have worked in the field of malaria for a few decades have gone through periods where we suddenly noticed changes in drug policy. When chloroquine was replaced by sulfadoxine-pyremethamine as a first-line drug, later to be replaced by artemisinin combination therapies (ACTs).

But the world is now faced with a new challenge. That of preventing artemisinin resistance from escaping south-east Asia. Without anything to replace it (yet), this is a looming catastrophe, according to Joel Breman in an interview with It may still be confined to the Thai-Cambodia border, although nobody really nows have far it has spread.

Hence the GPARC, the Global Plan for Artemisinin Resistance Containment. A link to the full document released this month can be found here.

This 87 page document details how the spread of resistance could be contained and focuses on the following objectives: 
“to define priorities for the containment and prevention of artemisinin resistance; motivate action and describe responsibilities by constituency; mobilize resources to fund the containment and prevention of artemisinin resistance; increase collaboration and coordination among relevant stakeholders; and define governance mechanisms and indicators for continual assessment of progress made in implementing the GPARC.”

Philippe Guerin, executive director of the Worldwide Antimalarial Resistance Network WWARN), calls for immediate action:  
“I think now it needs to be followed by specific actions in the region of concern. We can’t wait another one or two or three years to do all the perfect studies in Asia and meanwhile do nothing in Cambodia. Eliminating malaria in Cambodia is probably possible. It’s an achievable target. But that will require lots of commitment from every stakeholder”, he stated in the blog by Patrick Adams.

In our latest poll, in which we asked MalariaWorld subscribers to indicate if they see the potential of success in the action plan, 89% said not (admittedly, we received only 9 responses).

It is hoped that the current plans are more convincing and that Guerin's warning is taken seriously. If the world acts too slowly, the cat will really be out of the bag...