One of the main fears is that the resistant parasite will spread to the African continent. PongMoji/Shutterstock

Fears are mounting about the spread of a new “superbug” strain of malaria. First identified in Cambodia, but since spreading to another four countries in the region, the strain of Plasmodium falciparum is resistant to drug artemisinin, often the first line of defense against malaria infection, researchers report in a letter to The Lancet Infectious Diseases.

“The spread of this malaria "superbug" strain, resistant to the most effective drug we have, is alarming and has major implications for public health globally,” said the Wellcome Trust’s Michael Chew, who was not involved in the study. “Around 700,000 people a year die from drug-resistant infections, including malaria. If nothing is done, this could increase to millions of people every year by 2050.”

This is of serious concern in the global fight against the parasite. The drug that it has been found to be resistant to, artemisinin, is often administered as a first-line treatment for the infection, and expanding access to it is thought to have been crucial in the massive achievements seen globally to reduce the malaria burden, with up to 311 million courses of the drug having been produced in 2015 alone.

The main role of the drug is to reduce the parasite load of infected patients to a level that other combination medicines can tackle. The fact that one strain of malaria has been found to be resistant to this drug could, therefore, have a profound impact on the effectiveness of others, although the World Health Organization does stress that the parasite can still be eliminated with these other medicines, but that it simply takes more time.

“We are losing a dangerous race,” explained Sir Nicholas White, a co-author of the letter. “The spread of this malaria “superbug” has caused an alarming rise in treatment failures forcing changes in drug policy and leaving few options for the future. We need to tackle this public health emergency urgently.”

To date, five countries in Southeast Asia have reported artemisinin-resistant malaria – Cambodia, Laos, Thailand, Vietnam, and Myanmar – but what is of more serious concern is that along the border between Cambodia and Thailand, the parasite has become resistant to almost all treatments.

This resistance is thought to be driven by a number of different factors, including patients not completing their course of drugs and inadequate treatment policies in certain regions, as well as the wide availability of the drug over the counter, including cheap substandard forms.

The fear now is that as the world is far more interconnected that it has ever been, the resistant form of the parasite will easily spread to other parts of the world, most notably the African continent.