Malaria Drugs Rolled Out Two Years After Government Decision

The head of the government’s National Malaria Center said on Tuesday that mefloquine-based malaria drugs began arriving in western Cambodia earlier this month, two years after local and international health experts agreed they were needed to combat the parasite’s growing resistance to other medicines.

Malaria center director Huy Rekol said the government started rolling out artesunate-mefloquine last week in the western provinces where resistance to the former first-line drug against malaria, dihydroartemisinin-piperaquine, is highest. He said another batch of artesunate-mefloquine had just arrived at Phnom Penh International Airport and should reach the provinces within days.

“Now in all the [western] provinces, I hope…the provincial health departments will announce to all the public health clinics in the provinces to change,” he said.

The switch comes amid a significant nationwide rise in malaria cases—from 25,000 over the first nine months of 2014 to 41,000 over the same period last year.

Mr. Rekol said the government made artesunate-mefloquine the official first-line drug against malaria in the country’s west in early or mid-2015 to combat the parasite’s mounting resistance to piperaquine. A new study by the U.S.-based National Institutes of Health, published by The Lancet medical journal last week, confirmed resistance to piperaquine in Pursat and Preah Vihear provinces.

But according to a September 2015 status report on drug-resistant malaria by the World Health Organization (WHO), the government agreed with international health experts to replace piperaquine with mefloquine during a meeting in January 2014.

Mr. Rekol, who took charge of the malaria center last year, said he did not know the reasons for the lengthy delay and referred questions about drug procurement to the U.N. Office for Project Services.

The office has been handling malaria-related grants to Cambodia from the Global Fund to Fight AIDS, Tuberculosis and Malaria—which provides the bulk of malaria-related grants to the country—since a Global Fund investigation exposed rampant graft among some center staff in 2013. A request for comment from the office went unanswered.

Luciano Tuseo, who heads the WHO’s malaria program in Cambodia, said the malaria center planned to roll out artesunate-mefloquine in six provinces between December 28 and this coming Saturday, and appeared to be on schedule.

He declined to comment on why the rollout was happening two years after health experts agreed to make the switch from piperaquine.

The head of the malaria unit at the Pasteur Institute in Phnom Penh, Didier Menard, said the delay may have had to do with the supplier. On Monday, he said the Indian company that Cambodia reached out to initially hesitated because it considered the order too small.

“I think it was the main problem,” Mr. Menard said.

Now that the new drugs are finally here, however, they won’t last long. Mefloquine had to be abandoned in western Cambodia before, and health experts agree that it will only have a few years of life the second time around—at best.

“We assume that every three or five years, the parasite becomes clever to resist” the latest drugs, Mr. Rekol said

Mr. Menard said this period could be as short as one year or less, and that health experts were already considering what to do next. Options included extending drug treatment from three days to five, and moving from double- to triple-drug combinations, he said.

(Additional reporting by Ben Sokhean)

[email protected]

© 2016, The Cambodia Daily. All rights reserved. No part of this article may be reproduced in print, electronically, broadcast, rewritten or redistributed without written permission.