World Antimicrobial Resistance Awareness Week 2024: Antimalarial drug resistance must not be overlooked

On 19 November, the MARC SE-Africa Consortium, in partnership with the International Society for Neglected Tropical Diseases (ISNTD), hosted a webinar to address the urgent need for collaborative efforts to tackle antimalarial drug resistance in Africa. This timely event was held in recognition of World Antimicrobial Resistance (AMR) Awareness Week. The webinar recording can be accessed here.

This webinar brought together​​​​ the top global malaria case management experts and hosted internationally renowned speakers. They presented their perspectives on the growing global concern of emerging antimicrobial drug resistance, regional efforts in combatting this problem, insights gained from molecular surveillance of the parasite, and the nuances of therapeutic efficacy in malaria-endemic African countries.

Speakers at the webinar (from left top corner) - Prof Arjen Dondorp, Dr Leah Moriarty, Prof Marc Mendelson, Prof Karen Barnes, Dr Jaishree Raman - and the host, Marianne Comparet.

Prof Karen Barnes (MARC SE-Africa) opened the afternoon’s webinar by introducing the MARC SE-Africa consortium. She detailed the consortium’s drive to uplift the application of research outputs beyond publication level and secure the implementation of data-driven changes to policy and practice, thereby ensuring effective malaria management in Southern and Eastern Africa. She elaborated on the consortium’s efforts driving cross-border collaboration to combat antimalarial drug resistance. In her talk, she highlighted the outputs of the recent MARC SE-Africa-led regional meeting with the East African Community, which facilitated the development of a detailed action plan for responding to antimalarial drug resistance in East Africa.

Prof Barnes spoke of recently developed MARC SE-Africa tools to aid national malaria control programs, researchers, and stakeholders in combating malaria in Southern and Eastern Africa, the most recent of which included the antimalarial resistance dashboard, which equips national malaria control programs and other critical stakeholders with the latest data to combat the emergence and spread of drug-resistant malaria.

Prof Marc Mendelson (University of Cape Town) delivered a compelling talk, framing antimalarial resistance within the larger AMR agenda. He celebrated recent progress, noting this year’s increased emphasis on resistance beyond antibiotics, including antivirals, antifungals, and antiparasitics. Prof Mendelson advocated for a fresh approach to addressing antimalarial drug resistance—one that frames the issue as a human-centred problem, emphasizing its direct impact on lives and livelihoods. This, he argued, is essential to inspire urgent action and mobilize support.

Dr Jaishree Raman (National Institute for Communicable Diseases of South Africa) captivated the audience with her insight on molecular surveillance as an indispensable tool in understanding antimalarial drug resistance. She highlighted how Africa’s next-generation sequencing capacity has grown significantly since the COVID-19 pandemic, providing an unprecedented opportunity to monitor resistance. Dr Raman called attention to Southern Africa’s interconnected nature and the implications of mobile populations potentially spreading resistant parasites. Early findings suggest higher resistance in northern regions (Angola, Namibia, Zambia) compared to southern areas (South Africa, Eswatini). Her talk reemphasized the importance of targeted surveillance to adopt policies and interventions.

Dr Leah Moriarty (Partnership for Antimalarial Resistance Monitoring in Africa) reflected on the role of the Presidential Malaria Initiative (PMI), which is one of the largest producers of artemisinin-based combination treatments (ACTs) in Africa, in assessing the efficacy of therapies. The organisation carries out therapeutic efficacy studies, which have shown that two PMI-supported countries in the SE-Africa region (Tanzania and Uganda) have had concerning findings regarding partial artemisinin resistance and therapy efficacy (measured by whether patients remain parasite-free). Following such findings, PMI encourages countries to observe WHO’s recommendation on responding to antimalarial resistance, which includes strengthening surveillance and optimising diagnostics and therapeutics pre-emptively.

Finally, Prof Arjen Dondorp (Amsterdam Institute for Global Health and Development) presented the experience of fighting antimalarial resistance in the Greater Mekong Subregion. Artemisinin resistance was first identified in West Cambodia, and soon after, ACTs started to lose efficacy rapidly in the region (Vietnam, Cambodia, Lao, Thailand, Myanmar). Prof Dondorp outlined collaborative strategies that proved successful in Southern Eastern Asia to combat treatment-resistant malaria and provided much-needed insight into how these strategies can be applied in an African-specific context.

During the closing discussion, speakers reflected on the broader implications of these lessons for neglected tropical diseases. Key themes included the vital role of community health workers, the cross-cutting challenges posed by climate change, and the growing need for proactive, collaborative approaches to address drug resistance across diseases.

The resounding takeaway? We are stronger together. Cross-border collaboration and shared commitment are indispensable in combating antimalarial resistance. MARC SE-Africa's mission is to unite efforts across regions and disciplines in this critical fight.

Missed the webinar? You can watch the recording, courtesy of the International Society for Neglected Tropical Diseases: