Abstract

Despite the scaling-up of existing control measures and the commitment to controlling malaria the global situation has worsened. Concurrently, the drug, which was hailed as the biggest hope for eradicating malaria, Artemisinin by having significant activity against developing gametocytes, is showing signs of resistance at the Thailand-Cambodia border. This article purports to draw on lessons learnt from this epicentre of drug resistance and raise a red flag for sub-Saharan Africa. Firstly, the limitations of the current weapons of the WHO Global Malaria Control Strategy will be highlighted in both low transmission and high transmission settings. Secondly, it will be explored how a malaria-transmission blocking vaccine (TBV) as a community approach would have a high value in combination with drug treatment and other stage vaccines to break the vicious cycle of antimalarial drug resistance. Thirdly, it will be argued that prioritising vaccine development over improving diagnostic capacity may constitute a threat to the control strategy. Finally, it will be argued that if the ambitious aim of achieving malaria elimination is to be pursued, investment in TBV research should be stepped up.

Key words: Artemisinin combination therapy, transmission blocking vaccine, drug resistance, improving diagnostic capacity.