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TropIKA.net Partnerships

Resistance to antimalarials: new initiative will gather data and inform policy

17 Jun 2009

Paul Chinnock

Source: WorldWide Antimalarial Resistance Network (see original article)

An international network has been launched to map the emergence of resistance to malaria drugs, and guide global efforts to control and eradicate the disease. The new initiative comes at a time when the appearance of resistance to the most effective antimalarial, artemisinin, in Cambodia is causing international concern (see TropIKA.net News.)

The WorldWide Antimalarial Resistance Network (WWARN) is described as a “collaborative, global effort to create a truly worldwide, comprehensive, and inclusive network that will provide quality-assured information on antimalarial drug resistance”.

“With this critical mass of data, we will have powerful evidence to help inform decisions by policy makers,” said Dr Philippe Guerin, Director of WWARN and an epidemiologist in the Centre for Tropical Medicine at the University of Oxford, UK. “It is crucial that we provide all patients with access to the right drugs at the right time.”

WWARN has received a $20m (grant from the Bill & Melinda Gates Foundation and aims to become global resource facilitating optimal use of antimalarial drugs. It will focus on four areas critical to the control and elimination of malaria:

• Establishing reliable information on antimalarial drug effectiveness around the world

• Rapidly identifying new areas of drug resistance

• Bringing together pharmacological data on drugs with molecular and in vitro information on resistance to optimise combination therapies

• Mapping global trends in antimalarial resistance.

Resistance threatens to derail global efforts against malaria

“Antimalarial drug resistance is the greatest biological threat to the global initiative to eliminate malaria. We need readily accessible, quality assured and up-to-date information essential intelligence,” says Nick White, Professor of Tropical Medicine at Mahidol University in Thailand and Oxford University, and Chair of the Board of WWARN.

Current guidelines stipulate that artemisinin should be given in combination with other antimalarials to protect as much as possible against the development of drug resistance. However, this advice is being undermined by the lack of access to artemisinin combination therapies, their cost, and the prevalence of poor quality and counterfeit drugs in many parts of the world. One recent study from South East Asia found that 195 antimalarial drug samples out of 391 were fakes.

“This situation is the best way to ensure the malaria parasite rapidly develops resistance to our best treatments,” says Dr Guerin. “We must do better. Poor quality or fake drugs expose the malaria parasite to smaller amounts of the drug which gives the parasite the opportunity to evolve ways to evade the drug”.

Working together

WWARN will integrate the efforts of researchers, NGOs and public health experts in malaria-endemic areas around the world. Four years in planning, the initiative was born in the scientific community as malaria scientists became aware that broad collaboration was critical to achieving the long-term goal of eliminating the disease. The international collaborative effort will be administered and supported from Oxford University. WWARN will work in close collaboration with WHO to enhance antimalarial resistance surveillance.

The collaboration will provide a platform for malaria scientists to share results, improving the coverage, quality and timeliness of the available data. This will give an up-to-the-minute picture of the effectiveness of antimalarial drugs at national, regional and global levels, and enable policy makers to respond more quickly to early signs of resistance.

The WWARN initiative will be led by director Philippe Guerin and research director Professor Carol Sibley of the University of Washington in Seattle. Oxford University will provide the necessary IT infrastructure and software for sharing datasets on this scale. Other institutions forming part of WWARN include:

• Menzies School of Health Research in Darwin, Australia will lead the clinical efficacy module with the University of Oxford

• The Center for Vaccine Development at the University of Maryland School of Medicine will lead the molecular markers module

• The Centre National de Reference du Paludisme at the Institut de Médecin et d’Epidémiologie Appliquée (IMEA) in Paris will lead the in vitro module

• The University of Cape Town, South Africa, together with Mahidol University, Thailand, will lead the pharmacology module.

Regional sites will also be established in East Africa, West Africa, Asia and Latin America to coordinate with scientists and public health groups involved in the collection of data.

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