E-mail updates
Follow on Twitter
Subscribe to RSS
Ian Williams / NBC News
Testing for malaria in a village near Pailin, Cambodia.
PAILIN, Cambodia – The border crossing between Thailand and Cambodia at Pailin has a rather bleak feel about it at the best of times. In the heavy monsoon rain, the dingy checkpoints are reduced to gray smudges. But a little beyond, on the Cambodian side, the neon of a casino beckons those Thais willing to brave the downpour for gambling tables, illegal in their country.
Until the late 1990s, these border areas were the last holdout of the murderous Khmer Rouge, which was responsible for the deaths of an estimated 1.5 million Cambodians.
But this mosquito-infested area now has another sinister claim to fame – for deadly malaria. This is the region where resistance to just about every major anti-malarial drug has first taken hold.
And history shows that once resistance emerges, it can quickly spread worldwide, rendering the drugs useless in the fight against a mosquito-borne parasite that still kills nearly a million people worldwide each year, most of them in Africa.
The Khmer Rouge have now been defeated, but not drug-resistant malaria. The Pailin area is now the epicenter of a fight to contain a growing resistance to Artemisinin, which is the world's main anti-malarial drug.
Pre-emptive strike
"We've got to contain the parasite before it spreads throughout the region. If that happens it’s going to be a public health emergency," said Dr. Najibullah Habib, spearheading the containment project on behalf of the World Health Organization.
We met Habib not far from the border, where hundreds of health workers are moving from village to village, testing everybody, a pre-emptive strike to try to find, treat and monitor those with malaria symptoms.
"If we lose this first-line drug, this Artemisinin, then we are lost," said Christopher Raymond, an American drug specialist working with the project. He said that as of today there is no good backup if malaria becomes Artemisinin-resistant.
The alarm was first sounded by U.S. Army researchers, who showed that in the border areas Artemisinin was taking far longer to clear malaria than in the past.
Ian Williams / NBC News
Malaria victim at the public hospital in Anlong Veng, Cambodia.
"It was clear that the parasites are becoming less susceptible to the drug," said David Saunders of the Armed Forces Research Institute of Medical Sciences (AFRIMS), which has now extended its study further along the border.
"We've really come in at a crucial time," said Saunders' colleague Stuart Tyner. "We're fortunate to have identified this now," he added, "at a time when it’s just becoming an issue."
He says there is still time to fight it, and working with Cambodian health officials their aim now is to see if it is spreading, how fast, and to test different combinations of drugs to fight it.
"It's harder for parasites to develop resistance to multiple drugs," Tyner told me as he studied through a microscope parasites recently extracted from a patient in the public hospital at Anlong Veng, where AFRIMS has set up a state-of-the-art laboratory.
They also want to learn how the parasite develops its resistance.
Why here?
While U.S. experts are playing a crucial role in the research and containment projects, USAID and the Gates Foundation are throwing millions of dollars into the battle.
But why this border? Why has resistance always started here?
Experts speculate that conflict, poverty and a lot of migrants moving across the border have all played a part.
Resistance also spreads when people don't take drugs properly, and counterfeit and sub-standard drugs are also to blame. They have been rife in the border areas.
"It's a race against time," said Christopher Raymond, an expert in counterfeit drugs, whose project is backed by U.S. Pharmacopeia and USAID. He's been part of a blitz on local pharmacies.
He says the fake drugs are often very good, though others contain just a pinch of the real thing.
"It's like putting out a fire with gasoline. It’s eventually going to explode into resistance because you are constantly under-treating it."
They have also banned the use of pure Artemisinin, figuring that the life of the drug can be better extended if it is used in combination with others.
Ian Williams / NBC News
After the rains. late afternoon near Pailin, the epicenter for drug-resistant malaria.
Officials say they are having an impact, though separately a Cambodian colleague said he was still able to buy banned anti-malarial drugs in three of six pharmacies he visited.
And before Christmas the WHO warned that a suspected drug-resistant strain of malaria has now been found along the Thai-Myanmar border and in a province of Vietnam – an ominous development.
Cambodia's rain-soaked border areas hardly look like the epicenter of anything, but the stakes are high: What happens here over coming months could impact the health of millions worldwide.
Leave a Comment:
Thank you Bill Gates for helping out. Your good fortune is hopefully helping millions of people, and maybe we'll find a cure for this lurking menace. Once again, thanks, Linda
concur
So wonderful that someone who made a huge fortune in the last 30 yrs. "feels" the need to "pay it forward." I guess at a time when there appears to be no heroes, Bill & Melinda fill the bill. Bless their good works given from a generous heart.
(And the Walton Clan do WHAT with their fortune?)
Sorry, off target, but they frost my $ass!
I agree that Bill Gates is doing a very good job with intensely targeted philanthropy (and of tryin g to shame other billionaires into doing the same.)
But one issue that really MUST come to the forefront of worldwide medical practice is antibiotic management. People don't seem to realize that over the past 50 years, we have literally thrown away the greatest advance in medicine in 2,000 years - antibiotics.
1) Physicians in the developed countries routinely prescribe antibiotics in situations where they are worthless or for personal convenience of both the physician and/or the patient. Antibiotics do not work against viruses, only bacteria. Giving antibiotics to patients simply because they request them is not good medicine. And often, rather than finding out what disease mechanism is present, physicians will prescribe antibiotics for convenience sake, rather than testing to see what the cause was and prescribing appropriately.
2) Physicians are not following up on administering antibiotics. As a result, many patients stop them as soon as they are feeling better. This too, is bad medicine.
3) In underdeveloped countries and rural areas in most countries, patients lack even basic public health, but can get antibiotics readily, either legally or illegally, and self-diagnose and self-administer. This is extremely bad public health functioning.
4) Antibiotics are usually prescribed in the drug companies' one-dose-fits-all myth. Antibiotics should be administered with the patient's weight, gender, age, and metabolic factors taken into account. This is virtually never done because drug companies, pharmacies, and physicians all have bought into giving the same dosage to a 26-year-old 300-lb linesman and an 80-year-old frail 120-lb woman. While this is convenient and profitable, it is also bad medicine.
5) The whole "preventing secondary infections" argument is unsupported by science and is simply a drug company marketing practice. If secondary infections occur they you treat them with infection-specific antibiotics if necessary.
Physicians need to be much better trained in the use of antibiotics. Drug companies need to reform their one-dosage-fits-all marketing. Patients need to quit asking for antibiotics for things such as the common cold where it does not good.
Unless we can practice strict world-wide dispensing of antibiotics, we will continue to see rampant new antibiotic-resistant diseases. The only alternative is that we will have to return to chemotherapy as the major treatment for both viruses and drug-resistant bacterial. Whether for cancer or an infectious disease, chemotherapy is not pleasant. The basic premise of chemotherapy is that you massively poison the patient. They you depend on the higher metabolism of the cancer cells or the infectious disease to die before the patient dies. People forget that before antibiotics, most infectious disease had to run its course with only hydration, respiratory support and cleanliness as the normal treatment. If the patient was at death's door or had an intractable disease such as syphilis, then drugs containing mercury, arsenic, lead, cadmium and other highly toxic substances were used. Drug resistance is forcing us to once again to look to some very unpleasant and often deadly treatments.
Bevis ... I believe the Walton Clan (as you call them) are providing jobs here in the US for people that would otherwise be on welfare for the most part. By the way what have you personally ever done for your country or humanity in general?
Gee, how can they live without air conditioning? In the US, people die when their AC break, someone needs to check on their human rights!
Only kidding, I think the Bill and Melinda Gates (Warren Buffett) foundation is an awesome tool and is managed for results. If our government required returns on grants like this foundation I believe the money would be better spent. PS when I say government I don't mean any particular party or people, just management which is difficult to start with.
Only the development of a vaccine will succeed in stopping malaria - money spent on anything else is wasted.
Also interesting how once again, the asian propensity for a quick buck has turned against them (and us).
money wasted? would you say that if your family was at risk and a vaccine was still decades away, if possible at all? I bet you'd be all for vector control and drug development then. Besides, we eliminated malaria from the US with a strategic and well funded vector control campaign combined with widespread treatment efforts. No vaccine, but money well spent anyhow.
The Asian propensity? Funny... checked out US bankers lately? Politicians? Media moguls? Oil tycoons? Putin / the Russian mafia? (Well, guess that last one is Asia... ;) )
But really, everyone has people trying to make a quick buck. The ones in this border area made a few bucks, the ones here in the US have made billions screwing us over, their parasitic ways sucking our money out of our bank accounts and indebting the next generations. Thanks to them too - maybe we can infect them with this type of malaria.
Mike BC, your ignorance is on full display in your post. While having a vaccine would certainly be nice, it is absurd to say that any money spent other than on a vaccine is a waste of money. I could easily see that stopping the spread of a drug resistant form of malaria would be worthwhile. The attempt could of course fail, but not addressing the problem would be foolish.
Your statement the "asian propensity for a quick buck" is very problematic. The issue is not "race" but poverty. I think a modicum of research will show that counterfeit drugs are common in poor areas. I know I've seen reports of counterfeit malaria drugs in Africa. The issue is poverty.
Mike BC I for one would like to see your credentials or work history on your research in either the eradicating of malaria or economics.
We know how to control malaria. DDT.
http://www.21stcenturysciencetech.com/articles/Fall02/DDT.html
And vaccines when they work are only effective for a few years. In the case of other diseases, natural exposure to the real disease is the only way to get lifetime immunity. Malaria, however needs to just be avoided. And DDT or something like it is the only effective method we've come up with.
@Ben,
DDT will also control all those pesky bald eagles and numerous species of fish. The best method of control of malaria, dengue fever, etc is to go after the vectors - mosquitoes. And that is difficult and expensive. DDT was never nearly as effective as draining swamps. Your particular reference does not mention that DDT has any user side-effects or environmental effects. But it does.
DDT is lipid-soluble. That means it is stored in fatty tissue and has a very long half-life (>10 years.) This makes it a serious food-chain threat since DDT eventually ends up in streams, lakes, rivers, and oceans where it is taken in and stored by fish. Everything that eats fish then takes it in, concentrates it even further and stores it in fat. It is also estrogen-like and combines with other estrogen-like chemicals in the environment (such as dioxins, BPA, PVC, and many others) to destabilize the gender-selection processes in every organism that ingests it. Feminization does not sound all that bad, but it reaches a certain threshold and interferes with reproduction. In short, it has very-reaching environmental and human-toxic effects that often don't show up in mammals for over 20 years. The use of DDT is iffy at best, but a shortened lifespan may end up being the only answer for some people in some areas.
I didn't point out the down side because I assumed everyone knew about that. I think, however, we should look at how many millions have died from malaria that could have lived a normal life. Obviously, DDT would have to be used extremely sparingly and HEAVILY regulated. I'm not saying it's perfect. Years ago when it was available everywhere, it was not used properly, and it did turn up in places it didnt' need to be. I would also venture to say that there could be a way to improve it to where it were not such a health threat. I would also say that none of this will happen because malaria is a natural way to keep the population numbers down.
So illegal immigration is an international drug resistant disease vector--but not an international priority for action.
Malaria is not transmitted person to person, you can only get malaria from the Anopheles mosquito.
Carl, well put, per the comment above yours our quick buck vote pandering politicians will soon destroy our ability to protect ourselves.
Malaria would NOT be a problem if these people were allowed to use pesticides, but they've been banned worldwide thanks to the environmentalist movement. Pesticides like DDT got a bad rap in the 1950s and 60s because of rampant overuse. But they DID virtually eradicate malaria at the time. But now we're unnecessarily risking the deaths of tens of thousands of people worldwide, just to avoid even the slightest potential harm to the environment. Is it worth it?
Good point - it's been pointed out that the WHO is indirectly responsible for millions of deaths because of their support of a DDT ban. A few years ago they admitted as much and now support the use of DDT for the greater good despite the drawbacks. Trouble is, it may be getting too late as DDT resistance has shown up among anopheles.
Kammeyer, you bonehead. Your post parrots assertions made in John Berlau’s book, “Eco-freaks.” If you really cared about this issue, you’d have made an earnest attempt to actually inform yourself of the facts. Instead, you simply seek out sources of information that mimic your predispositions, never choosing to question the information presented in those sources. Even worse, you choose to spread the falsehoods that you blindly accept as truth. In this way, you function like the malaria parasite.
Here are a few facts for which you are unaware: DDT is still used in some countries for vector control. Malaria control involves more than just the use of insecticides. Homes in poor, tropical and subtropical countries often lack solid walls and windows with screens, hindering the effective indoor use of insecticides. Heavy use of insecticides, DDT included, can lead to cohorts of mosquitoes resistant to those chemicals.
It’s obvious that you’re most interested in politicizing issues, simply to take jabs at some perceived enemy. You only care about this issue in as much as you see it as a chance to demonize the “environmentalist movement.”
“Bugs are not going to inherit the earth. They own it now.” T. Eisner.
Sounds as if the attack against this particular strain of Malaria, is a one pronged attack. You'll NEVER WIN going at it this way. You're going to have to drain swamps, commit to a chemical attack and you'll need some growth regulators that prevent the misquotes from becoming adults.
Then and only then will you begin to CONTROL the disease. Better bring a phat check book too !!!
You can't drain the swamps- my goodness they are natural Eco systems and environmentally protected. Must save everything, including the mosquito. Maybe Global warming will fix those nasty critters.
Drain the rice fields too? Drain the Mekong river and Tonle Sap lake? LOL! You need to get out and learn a little bit about the world before stating such uninformed nonsense.
It is time to bring back DDT.
There is no single answer. This parasite is an ancient enemy of great sophistication and flexibility. Never were the words "life finds a way" better demonstrated. Vaccines are certainly the ideal approach when available- disinformed paranoiacs notwithstanding (I have an autistic nephew- his mother still thinks the vaccines did it- she's intelligent, but lacks the background required to understand the proofs debunking ideas published by murderously irresponsible idiots).
In the interim, the nets being deployed world wide by the Bill and Melinda Gates foundation and others will greatly reduce the rate of infection- which slows the rate of spread too. Anyone who advises we do nothing because we might be able to do something more effective in future advocates discarding lives simpler tactics might have spared for the sake of an unrealized hope.
I can't support that any more than I can support the high tech laser defense system some people are playing with that sonically targets mosquitoes and blows them out of the air of your bedroom- a personal nightstand anti-aircraft battery against the flying carriers of this deadly disease. I suppose it's great fun for rich technophiles- but its wildly impractical as a real world solution.
Make the donation- support the nets.
Excellent points, Rusty. My previous point that resources should be concentrated in one area (i.e. vaccine development) presupposes that resources - and time - are limited and should be directed accordingly. I guess if money is unlimited we can afford to attack on all fronts. Nets are comparatively cheap and have an undeniable feel-good factor going for them that attracts celebrities and makes us feel there is something we can do.
Mike BC.
You don't appear to be a very sophisticated thinker. You seem to be operating on the premise that if funds are limited, then all funds must be directed to only one facet of treatment. That's an absurd premise. There is no reason why limited funds cannot be allocated to multiple means of amelioration.
If we were to use your mode of thinking we would halt all cancer treatment, HIV treatments, etc. etc. until vaccinations were devised for those diseases. Medication has been used for decades against malaria to reduce the disease burden, yet according to you that was all wasted. If you were infected no doubt you would be clamoring for help and you would drop your absurd idea in a jiffy.
This is especially scary to my American family living in Phnom Penh Cambodia.
don't they call it "Kampuchea" now? If so, why the change? Hope ur fams ok, God look over them i pray.
So my trip to SE Asia puts me in jeopardy? Has it reached Bangkok, Phuket? Damn its true about the fughazi the chicoms peddle. Its true about them. They are amoral and greedy, the whole PLA, the gov., etc. Im sick of the chicoms./
Congrats to those involved in this fight, keep doing what you know needs to be done.
Sit back and watch America... this is what's to come for us if we continue to overmedicate for every little sniffle. Our bodies naturally develop immunities to medications, but so do the "bugs" that infect us. Vaccines are not the answer either. They also contribute to the development of super-bugs. But we have been so trained to believe that the pharmicutical companies will keep us safe. (That's not their goal... their goal is to make money. The best way to do that is not to heal diseases, but to treat the symptoms so we get hooked.)That it's not normal for people to die or get sick. Guess what. We weren't meant to live forever and never have a moment of sickness.
One out of every two people who have ever lived died of Malaria.
not true at all. not even close.
We almost had the most fatal type of Malaria (Falciprium) beat in the late 1970's, I work in the Medical Intelligence field and remember how excited we were at the prospect of eradicating the disease, like we did with Smallpox. Unfortunately, our best weapon against the mosquitoes that caused the disease was DDT, which for good reason got banned. Malaria Falciprium has exploded worldwide in the years since, since no other pesticide on the market today is as effective as DDT was. Until a new non-residual pesticide is developed to match the effectiveness of DDT to kill Malaria-borne mosquitoes, millions of people, mostly children will continue to die. Until then, all one can do is use lots of mosquito netting, use mosquito prophylaxis when travelling (Doxycycline is the best med), and use your DEET in areas heavily-populated by mosquitos in areas outside the United States. It's all one can do until medical advances are made. Sadly, many of the items I mentioned are too expensive, or unavailable in Malaria-endemic areas for many of the people who actually LIVE there.
loss of effective mosquito control, provided by now-banned chemistry, is the fault of imbeciles that used the " more is better" application method.
There are many [banned] chemicals capable of doing the deed, tho' must be applied sparingly by certified handlers. DDT for one, and possibly Chlordane.
A good use for tobacco, i.e. cheap foul cigars not worth smoking, can make a simple "tea" containing a fair amount of nicotine, which is an effective control for carpenter and other ants. Half life of nicotine in people, suggests it doesn't hang around long in the environment, as some of the banned chemicals do.
Purveyors of counterfeit drugs, should be given the disease, and left to fend for themselves with their bogus products.......cruel ? maybe........necessary ? absolutely.
And if you go back a few years ago, [few in the big picture] you can find that DDT took M from 100,000's of cases per year, down to 100's of cases per year, in Indonisa alone! A retired friend of mine worked, in that area, as a public health director [US program that worked] for several years. His opinion is that the world was about one year from ending M with DDT when DDT was outlawed. What a different world we could have if politics could stay focused on Defense, Highways, and INDIVIDUAL FREEDOM!!
Ben, DDT has proven disasterous to the bird populations that feed on the mosquitos and the birds that feed on them.
http://www.stanford.edu/group/stanfordbirds/text/essays/DDT_and_Birds.html
I believe a best alternative would be the release of genetically modified mosquitos.
http://science.howstuffworks.com/environmental/life/genetic/gm-mosquito.htm
It's not perfected but would leave mosquitos in the ecological food chain while stopping the development of malaria inside it.
Yes, way to go!put not just millions put trillions in to it, lets put America in some more debt.I don't think their problem should be our concern.A good way to prevent malaria from coming here is,, to quarantine anyone who comes from there, to here,or send them back. Wasteful spending again!what about cancer, and Alzheimer's put the money in that.
Even George Clooney got malaria in Africa. I expect that he did not use proper personal protection against Anopheles mosquitoes. This means to use the Bayer German repellent product containing 7% Autan (also called Picardin). This compound was a modification of a USDA-invented series of chemical repellents based on DEET, About 30 of these piperidine-based compounds were found to be effective repellents against malaria mosquitoes in the '80s. I personally worked on this project at USDA. Unfortunately the US Army did not support further development of these compounds work, despite the FACT that DEET is a poor repellent of malaria mosquitoes. NOTE: DEET does not work for these Anopheline mosquitoes anywhere in the world. Naive Westerners should avoid getting malaria, since there is no guarantee that medical treatment will work. I know 2 professional entomologists who died from malaria. People in the rest of the world are at severe risk, with sadly limited options or solutions.
Malaria only exists because the US banned DDT and withholds aid from countries who do not abide by the ban.
Over a million people die every year because some hippies were worried about a few birds.
Dacarls
Naive Westerners should avoid getting malaria, since there is no guarantee that medical treatment will work. I know 2 professional entomologists who died from malaria.
Decarls, are you saying the Westerns (the whole western hemisphere) that are not naive should get malaria? Only kidding, I get your point.
A preventive measures is the very first step to prevent any infectious diseases. The preventive measures are from hand washings, utensils, sanitary system, to personal hygiene and environmental problems.
U.N. may send International Red Cross or WHO healthcare teams to help them.