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Subscribe to RSSScientists are battling to stop a drug-resistant malaria that could threaten the lives of millions. "We worry that we are running out of time," one scientist says. NBC News' Ian Williams reports from northwestern Thailand.
MAE SOT, Thailand -- Clipboard in hand, Dr Francois Nosten worked his way down a ward of malaria patients. He stopped in front of five-year-old Ayemyint Than, who sat to attention and smiled. The smile told Nosten as much as his lines of graphs and figures.
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Ian Williams / NBC News
Ayemyint Than, 5, is being treated for malaria in northwestern Thailand.
"She's doing well," he said, moving to an older man, whose pale face and dull sunken eyes told a very different story. "Day five, and he's still positive?" he asked another of the doctors. "That's not very good. It means he was very slow to clear the parasite, no?"
To Nosten, it was further evidence of an alarming rise in resistance to artemisinin, currently the front-line drug in the treatment of malaria. He fears it could be the start of a global "nightmare" in which millions of people could lose their lives.
"We have to beat this resistance, win this race and eliminate the parasite before it’s too late. That's our challenge now," he said.
He said that artemisinin should take about 24 hours to deal with the parasite, but it was now taking three or four days in some cases. "We are going to see patients that don't respond to the treatment anymore,” he warned.
Nosten runs the Shoklo Malaria Research Unit, which is part of the Faculty of Tropical Medicine at Thailand's Mahidol University.
The unit has a string of clinics on both sides of the Moi River, which marks the porous border between Thailand and Myanmar.
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Ian Williams / NBC News
Migrants cross the Moi River, marking the border between Myanmar and Thailand.
Nosten set up the first one in 1986, since when there has been a steady fall in the total number of cases of malaria, but most recently a worrying emergence of drug resistance.
He first sounded the alarm in research published earlier this year, following the emergence of similar drug resistance along the Thai-Cambodia border.
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Nosten’s not sure whether the resistance he's found has spread from the Cambodia border or is home-grown. Either way, he's worried.
"It means that all the progress of the last 10 to 15 years will be lost," he warned. "Now the resistance is here, we worry that we are running out of time."
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Ian Williams / NBC News
Staff examine a baby who has been brought to the clinic with a fever, suspected to be malaria.
The malaria parasite -- carried by infected mosquitoes from person to person -- still kills an estimated 655,000 people a year.
That's almost 2,000 a day, mostly in Africa, with children being most at risk.
If the world loses its front-line drug, the impact could be devastating.
"The nightmare scenario is that the resistance will travel," Nosten said.
"We know what will happen in Africa when resistance is bad because we've been there before in the 1990s with chloroquine (another anti-malarial drug) … millions of deaths," he warned.
"We must prevent artemisinin resistance reaching Africa, but we also need to control it for the people in Asia - for their future."
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Ian Williams / NBC News
Dr Francois Nosten, right, consults staff as he meets malaria patients at a clinic near Mae Sot, Thailand.
Resistance to just about every major anti-malarial drug has started in the border regions that have been home to Nosten for more than 25 years.
Nobody knows exactly why, but poverty, conflict and large migrant and refugee populations constantly on the move all likely play a part. As do fake drugs or a failure to properly complete a course of treatment.
In the case of chloroquine, once the anti-malarial drug of choice, it took less than 20 years for resistance to spread from the borders of Thailand to Africa.
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Nosten is worried that artemisinin resistance is growing much faster than he'd anticipated, with the drug failing initially to fully clear the parasite in more than half the cases he now sees.
"It initially goes after a few days, then it comes back. We see that more and more now," he said.
"In 2009, we still had 90 percent of patients cured. In 2010, it dropped to 60 to 70 percent. Now it's about 50 percent," he added.
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Ian Williams / NBC News
Migrants from Myanmar wait to be examined at a clinic on the Thai side of the border.
Some scientists claim this is too alarmist, since the parasite does eventually die, with longer treatment and higher drug doses, but Nosten sees no room for complacency.
"We have to respond quickly, not next year or three years' time. It's now or probably it will be too late," he said.
Artemisinin comes from a Chinese plant and is quick, potent and with no side effects. Little wonder it has been hailed as a wonder drug, the golden bullet in the global fight against malaria.
What makes the resistance so worrying is that there is no new drug ready to replace it.
Nosten said that although several drugs are in development, they could be five to 10 years away from deployment "if they make it … and we haven't got five to 10 years.”
The Shoklo Malaria Research Unit runs its own labs fashioned out of a sprawling old Thai house in the border town of Mae Sot, where teams of research scientists are working to better understand the parasite and the mosquitoes that carry it from person to person.
It is here that Chiara Andolina keeps mosquitoes that are literally hand-reared -- fed from her arm, which she extends through a mesh hole into a container of the hungry creatures every three days.
"Usually I feed around 600 of them in a cage like this," she said.
Of course these are not infected mosquitoes, though watching them settle on her arm for a good lunch is not a sight for the squeamish.
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In another room, Nosten settled over photographs showing the rapid development of the parasite once it has invaded a blood cell.
"If you can kill them very, very young -- like these -- they don't have time to develop into big fatty ones," he said, his pen jabbing at the photo. "These fatty ones are the ones that get stuck in your brain and kill you."
In other rooms, the DNA of parasites was being isolated and sequenced and drugs were being tested as part of Nosten and his team’s efforts to figure out what's behind the emerging resistance.
They are also looking for vulnerabilities and new ways to attack their enemy.
"It's hugely important to understand what's going on and contain it if we can," Nosten said. "We need to try things. We need to explore. It’s like exploring new territories in malaria."
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The French scientist has spent most of his working life in the tropics, initially with the medical humanitarian group Médecins Sans Frontières.
He believes he is engaged in a vital battle -- "a race against malaria" -- as he puts it.
After so many years on the malarial front lines, the battle has become deeply personal.
He dreams of completely eliminating this familiar but wily enemy.
However, he also knows that with the emergence of artemisinin resistance the stakes have never been higher.
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DDT anyone?
No, it might slightly harm various animals, if used in too large of quantities.
Drug resistant tuberculosis fast approaching 1 million and now we have malaria showing increasing drug resistance. Not good.
Also, as the planet warms up due to climate change the range of territory the mosquito can adapt to will widen as well.
Jazzy. Yes, mosquitoes are still resistant to DDT and DDT killed millions of birds and other animals. DDT did not eliminate the mosquito problem. The mosquito that carries malaria has always been extremely uncommon in non tropical areas and usually concentrated in swamps. It was draining the swamps that got rid of the mosquito and not DDT. Quinine no longer works against malaria and hasn't for 100 years. Sorry, there is no natural way to treat malaria. If there were, millions of Africans and people in S. America would be buying quinine at local markets rather than going to a doctor. Big pharma has worked on a vaccine that could be given to people in malarial prone areas but so far it is only about 50% successful and needs further work. Yes, they will make a profit by selling the vaccine to governments around the world. Quite likely it will be given to poorer countries. All this about big pharma but nothing about the scams of big natural medicine a multi billion dollar business that has to prove nothing.
In the past nature would restore balance to population numbers when they exceeded the carrying capacity of their environment. Now humans are not only unwilling to accept natures help but do not want to voluntarily reduce birth rate growth. Mindless reproduction an arrogant assumptions based upon the belief that we are stewards of this planet. We are ore like butchers of this planet than stewards.
Much of what was allegedly documented in "Silent Spring" has long since been rejected. Besides, we are talking human lives here. Forget the rats and bats and alleycats. If the DDT is laid down judiciously the side effects will be minimized. It is beyond my ken that some reject a more or less sure answer to the anticipated epidemic deaths of human beings because of concerns about cats. And the 'big business' canned paranoia? Bizarre!
It's not nice to fool around with mother Nature - malaria, tuberculosis, AIDS, germs in general - nature has evolved these over eons to control and balance the numbers of life on the planet. We have decided to upset that balance, now we are finding that nature will win anyhow. Control and reduce the numbers of humanity, or nature will do it for you!
just bring them all to the united states and we will use our welfare program to help them for free.
Wow if you believed every article the media writes predicting death and destruction we'ed just dig a hole in the back yard and wait to die.
Malaria already a plague--gigantic proportions if unchecked--US vulnerable, especially deep south and Florida--scary stuff. Malaria next black death?
That which does not kill you, makes you stronger.
Hi, there, Idiomic, have some hemlock and if you survive it, are you healthier or not?
Use DDT -- it was banned on the basis of junk science.
I'm going to these regions this year. I wonder if having a steady stream of Doxy in you system is enough to repel this strain. I guess using the right repellant is your best bet.
Steve -
Look into Vitamin B6.
Start it well before you go, and continue use while there.
I have spent a lot of time golfing and fishing in Southern lowland areas, and seldom get bitten by mosquitos.
mpa.....you are a crackpot. thanks.
The US government again testing their viruses and plagues on other nations..God don't forgive them. hell awaits all these lying pigs.
That's not Fair, God.
Drug-resistant AIDS would be better, if we have to have a drug-resistant disease, not malaria. You can choose not to have AIDS, you can't choose much of the time on malaria.
Some forms of the HIV virus are starting to show drug resistance. Careful what you wish for.
As the disease we are, people are always trying to make people perpetuate / live longer.
However, if we continue to fight the will of GOD, ultimately people will consume all the resources on earth and have nothing left but each other to consume.
GOD is getting serious about controlling the population of people and we are not entitled to inherent the earth - as the foolish believe.
Feel free to thank retched Rachel Carson and her throngs of hippie activists for the return of malaria....they got DDT banned just prior to the African effort [to rid the continent of the offending mosquitos] being completed.
D. D. T.
Only when the Idiocracy elite realize that mosquitoes also carry the AIDS virus will they run screaming for the DDT!
To our dear liberal onlookers who find it impossible to take responsibility for their actions:
Here's a you-tube of Michael Crichton telling us how the DDT ban ended up killing 30 million people worldwide:
thank you Rachel Carson
1. For every action there is a reaction. No exceptions. It's just which is the more rewarding. Some laboratory is producing these diseases. How they are released is another matter I won't even think about. Rarely starts in our so called very socialized countries.
2. Which one appears that does not have an antidote backup that will somehow escape knowledge until tons of funds $$$ reaches that certain pharmaceutical company whereby it can patten the cure and lick their lips all the way to the bank.
3. Lastly. They had better be ready as, "It's not nice to fool Mother Nature".
If only science was so advanced to rid the Earth of this illness. I pray for the children so that they are strong and do not suffer from this but rebound after getting treated.
China is right next door, and as the world leader in the manufacture of electrified plastic tennis rackets it is time for them to step up in the worldwide war on skeeters!
The good news is we have locked-down boarders both north and south and we have the TSA and Obamacare.
What could go wrong?