Throughout history, almost every antimalarial drug has eventually faced the threat of parasite resistance. Today, partial resistance to artemisinin threatens the efficacy of artemisinin-based combination therapies (ACTs), the current first-line treatment for malaria. This resistance, which first emerged in Southeast Asia and evolved separately in Africa, now poses a serious threat to malaria control and elimination efforts in Africa, where approximately 95% of cases and deaths occur — primarily among children under five. The authors of a 2024 article in Science highlight the urgency of acting against partial-artemisinin resistance in Africa, where resistance to previous antimalarial drugs resulted in triple the malaria deaths in young children recorded between the 1980s and 2004. 

 Antimalarial drug resistance — and antimicrobial resistance more broadly — will be a key focus at the 2024 Annual Meeting of the ASTMH, where experts will discuss strategies to address this growing challenge. 

The global malaria community has called for, “urgent action to address antimalarial drug resistance and to make existing ACTs available and affordable.” At the 79^th session of the United Nations General Assembly, key malaria donors The Global Fund, the Bill & Melinda Gates Foundation, the U.S. President’s Malaria Initiative and Unitaid committed to supporting this urgent action and working with stakeholders to explore ACT diversification as an action that can mitigate the emergence and spread of resistance.  

 The World Health Organization (WHO) has also sounded the alarm on this threat, publishing its strategy to respond to antimalarial drug resistance in Africa in 2022. The strategy comprises four key pillars and includes the immediate diversification of ACTs to prevent the emergence and spread of resistance. One way this can be achieved — and which has already been piloted in Kenya and Burkina Faso — is by deploying multiple first-line treatments (MFT) to extend the efficacy of existing antimalarial drugs. Inspired by this groundbreaking work, over a dozen African countries have come together under the banner of the African Leadership for ACT Resistance Mitigation (ALARM) partnership, with support from MMV and partners, to accelerate MFT deployment in their own countries.  

The WHO strategy also highlights the future role of new medicines such as triple ACTs and novel, non-artemisinin treatments. 

Investment in research and development is crucial to ensuring the discovery, development and ultimately the deployment of next-generation malaria treatments. In one example, at the 2024 Annual Meeting of ASTMH, the symposium titled, "Ganaplacide (KAF156): a next-generation, non-artemisinin, for the treatment of P. falciparum malaria" will feature expert discussions on the Phase 2 clinical trial results of ganaplacide-lumefantrine. 

The study results are promising: The medicinal candidate was found to be just as efficacious in children 6 months to 12 years as artemether-lumefantrine, which is currently the most-used ACT in sub-Saharan Africa. Ganaplacide-lumefantrine is currently undergoing a Phase 3 clinical trial with results expected in 2025. 

As the malaria community continues to leverage partnerships across governments, industry and nonprofits to develop new tools to treat and prevent malaria, it is also crucial to ensure that people can access new interventions and existing ones for as long as they remain effective. It is a matter of saving lives.