malERA: An updated research agenda for insecticide and drug resistance in malaria elimination and eradication
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Resistance to first-line treatments for Plasmodium falciparum malaria and the insecticides
used for Anopheles vector control are threatening malaria elimination efforts. Suboptimal
responses to drugs and insecticides are both spreading geographically and emerging independently
and are being seen at increasing intensities. Whilst resistance is unavoidable, its
effects can be mitigated through resistance management practices, such as exposing the
parasite or vector to more than one selective agent. Resistance contributed to the failure of
the 20th century Global Malaria Eradication Programme, and yet the global response to this
issue continues to be slow and poorly coordinated—too often, too little, too late. The Malaria
Eradication Research Agenda (malERA) Refresh process convened a panel on resistance
of both insecticides and antimalarial drugs. This paper outlines developments in the field
over the past 5 years, highlights gaps in knowledge, and proposes a research agenda
focused on managing resistance. A deeper understanding of the complex biological processes
involved and how resistance is selected is needed, together with evidence of its public
health impact. Resistance management will require improved use of entomological and
parasitological data in decision making, and optimisation of the useful life of new and existing
products through careful implementation, combination, and evaluation. A proactive, collaborative
approach is needed from basic science and the development of new tools to
programme and policy interventions that will ensure that the armamentarium of drugs and
insecticides is sufficient to deal with the challenges of malaria control and its elimination.
used for Anopheles vector control are threatening malaria elimination efforts. Suboptimal
responses to drugs and insecticides are both spreading geographically and emerging independently
and are being seen at increasing intensities. Whilst resistance is unavoidable, its
effects can be mitigated through resistance management practices, such as exposing the
parasite or vector to more than one selective agent. Resistance contributed to the failure of
the 20th century Global Malaria Eradication Programme, and yet the global response to this
issue continues to be slow and poorly coordinated—too often, too little, too late. The Malaria
Eradication Research Agenda (malERA) Refresh process convened a panel on resistance
of both insecticides and antimalarial drugs. This paper outlines developments in the field
over the past 5 years, highlights gaps in knowledge, and proposes a research agenda
focused on managing resistance. A deeper understanding of the complex biological processes
involved and how resistance is selected is needed, together with evidence of its public
health impact. Resistance management will require improved use of entomological and
parasitological data in decision making, and optimisation of the useful life of new and existing
products through careful implementation, combination, and evaluation. A proactive, collaborative
approach is needed from basic science and the development of new tools to
programme and policy interventions that will ensure that the armamentarium of drugs and
insecticides is sufficient to deal with the challenges of malaria control and its elimination.
Date Issued
2017-11-30
Date Acceptance
2017-11-01
Citation
PLoS Medicine, 2017, 14 (11)
ISSN
1549-1277
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS Medicine
Volume
14
Issue
11
Copyright Statement
© 2017 The malERA Consultative Panel
on Insecticide and Drug Resistance. This is an
open access article distributed under the terms of
the Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
on Insecticide and Drug Resistance. This is an
open access article distributed under the terms of
the Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
License URL
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
PLASMODIUM-FALCIPARUM MALARIA
VECTOR ANOPHELES-GAMBIAE
DIHYDROPTEROATE SYNTHASE MUTATIONS
SUB-SAHARAN AFRICA
ARTEMISININ RESISTANCE
CHLOROQUINE-RESISTANCE
DIHYDROARTEMISININ-PIPERAQUINE
MULTIDRUG-RESISTANCE
ARTEMETHER-LUMEFANTRINE
DIHYDROFOLATE-REDUCTASE
Publication Status
Published
Article Number
e1002450