The battle against malaria in Africa faces a significant challenge as new research reveals the declining effectiveness of artemisinin, a lifesaving drug that rapidly eliminates malaria parasites. A study published in the Journal of the American Medical Association (JAMA) highlights the emergence of resistance to artemisinin among children with severe malaria in Africa, marking a troubling first for the continent.
Artemisinin, combined with a longer-acting partner drug in regimens known as artemisinin-based combination therapies (ACTs), has been the World Health Organization’s (WHO) gold standard treatment for malaria. The disease, caused by the parasite Plasmodium falciparum and spread through mosquito bites, remains a leading cause of mortality in Africa. In 2022, the continent accounted for 95% of the 608,000 global malaria-related deaths.
The study, conducted in Uganda, analyzed 100 children hospitalized with severe malaria. It found that 11 children had developed partial resistance to artemisinin, with the malaria parasites carrying genetic mutations linked to drug resistance. Chandy John, a co-author and specialist in pediatric infectious diseases at Indiana University, emphasized the significance of the findings. “If this is verified by other studies, it could change guidelines for the treatment of severe malaria in African children, the largest target group by far,” John told Nature.
In addition to artemisinin resistance, the study revealed that 10 children experienced a recurrence of malaria after completing treatment. This raised concerns about the effectiveness of lumefantrine, the partner drug administered in ACTs. “The recurrence suggests that maybe the partner drug is not working as well as it should,” John noted, warning that resistance to lumefantrine could further complicate malaria treatment.
The emergence of drug resistance in Africa mirrors trends observed in Southeast Asia in the early 2000s, where artemisinin resistance was first identified. Experts now fear that the slower action of artemisinin and resistance to partner drugs could lead to higher mortality rates and undermine malaria control efforts.
Philip Rosenthal, a malaria specialist at the University of California, San Francisco, described the findings as a major threat to malaria control. “Even if the drug still works, that slower action could lead to higher levels of mortality,” Rosenthal warned.
With malaria control at risk, researchers stress the urgency of understanding and addressing this emerging resistance to safeguard the progress made in combating the disease and protecting vulnerable populations across Africa.
