World must help Myanmar fight malaria strain that could kill 200,000 children a year if it reaches India and Africa, says doctor
YANGON (AlertNet) – The world must help Myanmar fight a drug-resistant strain of malaria that could kill up to 200,000 children a year if it reaches India and Africa, a veteran health worker in the Southeast Asian country has warned.
But Frank Smithuis, former head of medical charity Medecins Sans Frontieres (MSF) in Myanmar, said major donors had excluded the country from their anti-malaria programmes, seriously jeopardising a concerted international effort to contain the epidemic.
Scientists reported this year that a drug-resistant strain had appeared along the Thai-Myanmar border. They found that patients were taking longer to get better when treated with combination therapies containing artemisinin – a drug which is derived from the sweet wormwood shrub and which is recognised as the best treatment against malaria.
The first cases of confirmed artemisinin resistance were found in western Cambodia along the Cambodia-Thailand border in late 2006 according to the World Health Organization (WHO).
In the past, two other drug-resistant malaria parasites originating in Cambodia have reached Africa after spreading via Myanmar and India. Many migrants travel between Myanmar and India, and between India and Africa.
“Myanmar has the largest malaria burden in the region … the parasite could spread easily,” said Smithuis, who has worked as a doctor in the country since 1994.
“If this artemisinin parasite reaches India and Africa, it is estimated an additional 100,000 to 200,000 children’s lives will be lost per year,” he told AlertNet.
Smithuis urged donors to support the government’s Myanmar Artemisinin Resistance Containment plan (MARC).
WHO says Myanmar’s extensive migrant population and proximity to India, along with its widespread use of less effective monotherapy - relying on artemisinin alone without a second drug, mean the country is critical to efforts to prevent the emergence of artemisinin resistance globally.
But donors have traditionally been reluctant to fund programmes in Myanmar for fear of propping up the previous military regime, which ruled for five decades. A reformist government took over last year.
UNDERFUNDED
Over 40 million people, or an estimated 69 percent of Myanmar’s population, reside in malaria-endemic areas and 24 million live in high-transmission areas, according to WHO.
It said there were 650,000 malaria cases and 788 malaria-related fatalities in 2010 in the public sector alone. But a precise figure is hard to come by as 40 percent of malaria cases seek treatment through the private sector.
Myanmar’s Ministry of Health has set up the MARC plan to tackle drug-resistant malaria with the help of United Nations and non-governmental organisations, but Smithuis said it was seriously underfunded.
He said hopes for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria had been scuppered last year by a funding freeze.
In a turn-around, the Global Fund recently announced it had an additional $1.6 billion for the next three years, but it is not yet clear how this will be allocated.
Smithuis said it was “most frustrating” that major donors had not included Myanmar in their programmes to contain the spread of the resistant strain, given the seriousness of the threat.
The Gates Foundation, Britain’s development agency DFID and the U.S. development agency USAID included Cambodia, Thailand and Vietnam in their programmes but not Myanmar, he added.
He contrasted the response to that for Cambodia where many parallel initiatives had been set up with more than $100 million in funding when artemisinin-resistant malaria was found.
UNWRITTEN HUMANITARIAN BOYCOTT
Smithuis said it was a grave error to exclude Myanmar which had by far the highest malaria burden in the region and which could present the biggest risk for the strain's global spread.
“I think that was a very big mistake and that was in line with the thinking that it was politically incorrect to support work in Myanmar. And that it was not possible to work in Myanmar. That’s not true,” he added.
Smithuis pointed to the fact that MSF had for years run a very effective malaria prevention programme, treating over 1.5 million patients in Rakhine state in western Myanmar, mostly in cooperation with government clinics.
Healthcare in Myanmar needs a serious cash injection but the West has ignored the needs for many years, according to Smithuis, who called it “a humanitarian boycott”.
“Even though there was no official humanitarian boycott there was an unwritten one. When I asked for money anywhere, it was like, 'We don’t want to give money there, because we don’t like the regime”,’ he said.
Myanmar’s new government, which took over in March 2011, has embarked on a string of reforms, leading many western countries to suspend their sanctions. Smithuis said donors should take the opportunity to target malaria.
He said they had started to support MARC but funding was “still critically insufficient”.
“We are dealing with an epidemic and time is crucial before the epidemic spreads further,” Smithuis added.
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