Malaria could be quickly eliminated in south-east Asia by an all-out effort combining early diagnosis and treatment with dosing whole populations in “hotspots” regardless of whether people have symptoms or are healthy, say experts.

The radical programme may be the best way to outpace rapidly spreading resistance to anti-malarial drugs, they believe.



The risk to the rest of the world is significant, we can’t let resistance to the drugs get out of control.

An experimental programme involving 365,000 people across 18,000 square kilometres of Myanmar has succeeded in substantially reducing and even sometimes clearing malaria completely from villages.



The Oxford University team who ran the study believe this “nuclear option” is urgently needed to wipe out malaria in south-east Asia before growing resistance to the best drugs now available – the artemisinin compounds – spreads to India and Africa.

They are calling for urgent political and financial backing from donor governments and the World Health Organization. “It is hard. People don’t want to move outside their comfort zone of the current approaches. We need very high level political commitment and the money,” said Professor Sir Nick White, chair of the Mahidol Oxford Tropical Medicine Research Unit which ran the study and board member of the Worldwide Antimalarial Resistance Network (Warn).

“We think the risk to the rest of the world is significant and we can’t afford to let this get out of control. If it extends to India and Africa that’s it. All the gains could be reversed.”



The team set up a network of 1,200 field clinics in remote parts of eastern Myanmar. Crucially, said White, they ensured there was somebody in each village, who could be a midwife or a traditional healer, to diagnose and treat malaria cases. In 50 “hotspot” villages, comprising 12,465 people, there were three rounds of mass drug administration, one month apart. Children under six months, women in early pregnancy and anyone with an allergy to the drugs were not given them. No serious side-effects were reported.

The incidence of P. falciparum malaria – the type causing most disease and death in the region – reported in the villages dropped from 25 cases per 1000 people every month to around 5, their paper in the Lancet medical journal shows.

“There has been no clear containment strategy so, despite substantial international investment in regional malaria control, drug-resistant malaria now extends across the whole of the Greater Mekong sub-region. However this study provides hard evidence that it is possible to eliminate artemisinin-resistant falciparum malaria rapidly if the will and the financial support are forthcoming,” said Oxford University’s Prof François Nosten, director of the Shoklo Malaria Research Unit in Mae Sot, Thailand.

“We are losing a dangerous race to eliminate falciparum malaria before drug resistance spreads beyond South-East Asia and into Africa – and this study shows us how to do it.”

• This article was amended on 30 April 2018 to clarify details of the study, including the number of people involved in the mass drug administration part of the trial.