Bad News from Cambodia

Some news has recently come out of Cambodia that is bad for not only that country and Asia, but for the rest of the world as well.

As somebody who works in infectious disease control, resistance is possibly my least favorite word. Viruses, bacteria and parasites, through a normal process of mutation and evolution and the process of survival of the fittest, develop resistance to drugs designed to kill them. Likewise, mosquitoes and other vectors of disease develop resistance to insecticides. Resistance to the insecticide DDT is a part of the reason why the campaign to eradicate malaria in the 1950s-70s failed in many regions.

Due to resistance, pharmaceutical and chemical manufacturers are in a constant race against our little enemies. Most drugs that are developed eventually lose their efficacy as resistance develops. This phenomenon threatens our ability to control AIDS, tuberculosis, malaria, and countless other organisms that threaten our health.

The news out of Cambodia is that our key weapon against the malaria parasite maybe losing its effectiveness. The introduction of artemisinin combination therapy (ACT) revolutionized the treatment of malaria, and came at a time when the disease was being treated by increasingly useless drugs. The new compounds are meant to be given only in combination with other drugs in the hope that this would slow the development of resistance. Up to now, things were looking good and the drug was saving lives. Now resistance has been found in southeast Asia, the spot where resistance to all the other antimalarial drugs began. There is little on the horizon in terms of new drugs. This is what we all knew would happen, but hoped would be delayed as long as possible.