Today, the artemisinins in ACTs are taking longer to kill parasites in Cambodia, Vietnam, Thailand and Myanmar. Recently, a young patient in our clinic tested positive for malaria for more than seven days after starting treatment (instead of the usual two), and when we sampled her blood after six days of treatment, the parasite was still healthy. If P. falciparum becomes totally resistant, then the ACTs would become ineffective and all investments in their development and distribution would be lost, with dire consequences.

Over the years, millions of dollars have been spent on fighting malaria. Late last year, the Global Fund to Fight AIDS, Tuberculosis and Malaria allocated $100 million to tackle artemisinin resistance in the Mekong region where I work. But all this well-intentioned money keeps us only a step ahead of the parasites. We have to keep coming up with new combinations of drugs before our patients taking the old ones start dying. And bed nets, on which at least $20 million will be spent, aren’t always effective here in Southeast Asia, where many mosquitoes that carry the parasite bite outside and early in the evening. Of course, an effective vaccine could save us but, despite the frequent announcements that we’re close to developing one, it has never materialized because we do not fully understand the underlying biology.

We have to accept that these strategies of control are failing and instead start figuring out how to eliminate the parasite altogether, as we have in Europe, Russia and North America.

In pilot studies in Cambodia, Vietnam and here on the Thai-Myanmar border, we have begun testing one approach to rapid elimination. Doing surveys of the population, we discovered that in some communities, many villagers — sometimes more than half — carry malaria parasites in their blood but are not ill and therefore are not treated. Because these “healthy” carriers have only a small number of parasites in their blood, they are difficult to detect with conventional tests. So eliminating the parasites may require treating everybody in the village, an approach that is used for other parasitic diseases, like river blindness and filariasis. Because P. falciparum infects only humans, if we can treat entire populations, we should be able to eliminate this parasite from certain regions.

Giving medicines to large numbers of villagers in remote areas who are not ill is not an easy task. It cannot work without the trust and participation of the local population. And we would need to hit whole regions at once. Even then we don’t know that it would work; the effectiveness, feasibility and economics of mass treatment are still being studied. But what else can we do to stop the seemingly inevitable spread of drug-resistant malaria across Asia to Africa, and the enormous consequent death toll?

Some funding bodies — like the Bill & Melinda Gates Foundation, the Wellcome Trust and Britain’s Department for International Development, which also support our research unit — are moving in this direction already. But for now, governments and medical organizations need more evidence, and they need leadership from the W.H.O.

For years, the fight against malaria in tropical countries has been compromised by politics. Here on the front line, our work is more difficult because of the bureaucracy, the inertia and sometimes the incompetence of the people in control. Money and its corruptive power are flying around. And the more money we throw at malaria, the bigger the problems get. We have the science to defeat malaria. We just have to act, before it defeats us.