The intelligence of a species like the protozoan we call Plasmodia is amazing. I have followed the response of patients to ACTs since their introduction a few years ago...The parasite clearance and symptomatic relief seems to be getting more sluggish with time.
I am convinced we will soon have resistance to ACTs and here's why.
We have, inexplicably, chosen to combine artemisinins with rather weak partners in the fight against malaria. Lumefantrine has never eally been used in Africa against malaria to any notable levels, has it? The strongest instinct of a species must surely be the survival and propagation of the species. It has been proven repeatedly in the past that Plasmodia will not take any fights lying down. Remember, this is a one-celled organism!
We need to consider triple or quadruple drug ACTs (that include a drug active against gametocytes) - similar to the approach taken against TB and HIV - if we are to have any hopes of limiting the development of resistance to new drugs since we are fast running out of options...