Threat from new strain of drug-resistant malaria

 Sunday August 10, 2014

BY BRIER DUDLEY

Aedes mosquito

A big new threat in the fight against malaria is looming.

One of the world’s most challenging and deadly races is underway in the forests of Myanmar.

A new strain of drug-resistant malaria has emerged in Myanmar just as the country is emerging from a half-century of isolation, increasing the risk that the lethal scourge will spread into India and Africa.

If the strain reaches other regions, it could undo huge gains made over the past decade – at a cost of billions – to corral the illness.

Malaria mortality has fallen 42% worldwide since 2000, but the disease continues to sicken more than 200 million people and kill 500,000 children a year, or about one every minute of every day, according to the World Health Organisation (WHO).

Fighting malaria has been a Sisyphean task over the past century. Major attempts to eradicate the disease – caused by a parasite transmitted by a particular mosquito species – failed in part because it’s a moving target that evolves and develops resistance to drugs and pesticides.

Yet, the latest push has brought eradication in sight, at least for some experts and the Seattle-based Bill & Melinda Gates Foundation.

Eliminating the disease is one of the most ambitious projects the world’s largest philanthropic organisation has undertaken.

With more than US$2bil (RM6.4bil) committed, the foundation is the leading private supporter of research into new treatments, vaccines, diagnostic tools, disease mapping and other weapons to fight malaria.

This research should help the foundation press the global community for a renewed attack that could begin about 2020, putting to use new drugs now in the pipeline.

As long as the drug-resistant strain spreading in the forests of Myanmar can be contained, that is.

“Myanmar is the linchpin country, really,” said Tom Kanyok, a former WHO scientist and now the foundation’s senior malaria programme officer for the Greater Mekong region, which includes Myanmar, Thailand, Cambodia and Vietnam.

Anopheles mosquito.

Opening up

This comes as Myanmar – formerly called Burma – emerges from 50 years of repression, moves toward a democratic state, and opens to trade, tourism and foreign investors.

Burma was the most prosperous country in South-East Asia until a military coup in 1962. It’s now one of the poorest in all Asia.

Myanmar borders 40% of the world’s population, with China to the north, Thailand and Laos to the east, and India and Bangladesh to the west.

Being a crossroads may help the country catch up to the economic growth that Vietnam and Thailand have seen, but it also positions Myanmar to export drug-resistant malaria.

After decades of spending little on healthcare, the country is especially hard hit by the disease. Myanmar accounts for nearly 80% of malaria cases and 75% of malaria deaths in the Mekong region, according to a 2012 assessment funded by the Gates Foundation and Australia.

Overall, more than 40 million of Myanmar’s about 60 million people live in malaria-endemic areas, according to WHO.

As the economy grows, people may travel and unwittingly bring malaria parasites along. One carrier may infect 100 others, who may infect 1,000 others.

Myanmar’s government appears to be moving in the right direction as it builds up a healthcare system. It’s working with WHO, the Gates Foundation and other groups to tackle malaria.

“From our region, we’re now trying to scale up our activities – all our activities,” said Dr Thaung Hlaing, deputy director of the Health Ministry’s National Malaria Control Programme.

Dr Hlaing said the plan is to contain the resistant strain and eliminate it before it spreads west to India, and then to Africa, creating “more disaster”.

“This is not about a Myanmar problem; this is a global concern,” he said.

So close

The risk that this strain of malaria could spread and reverse hard-fought gains isn’t hypothetical. It happened before with tragic results.

Eradication was in sight in the 1950s and succeeded in the US and southern Europe.

But the effort faltered because of funding shortfalls, war, scattershot participation – and the emergence in the 1960s of a drug-resistant strain in South-East Asia. It reached India and Africa, where severe cases and deaths doubled or tripled in some countries.

Research in China led to artemisinin, a derivative of wormwood and traditional herbal treatment. It took years for this medicine to emerge from China, and it wasn’t widely used until after 2000.

Then it became a key part of a renewed attack on malaria funded largely by the Global Fund, a coalition of governments and private funders to which the Gateses have given US$1.4bil (RM4.48bil).

Over the past decade, this attack saved more than three million lives.

“Now, it’s such a magical drug, we’re doing everything we can to avoid drug resistance,” Bill Gates said at an April health product forum in Seattle. “We’re super-dependent on it.”

He’s helping fund a new arsenal for the malaria fight, including next-generation drugs, but they won’t be ready for perhaps four or five years. A single-dose malaria pill isn’t expected until 2023.

“I think there probably isn’t the right tool kit yet to say with confidence that we can get to elimination and eradication, but there’s an entire field pointed in this direction,” said Dyann Wirth, chair of Harvard University’s Department of Immunology and Infectious Disease.

Artemisinin resistance was detected in Cambodia in 2006, and has since been found around the Mekong region. Today, with international travel more common, resistance could spread farther and faster.

“If it happens now, we are going to have a big problem,” said Dr Gawrie Nirdoshi Loku Galappaththy, malaria technical officer in the WHO Yangon office. “That’s why it’s really important. We have to stop (it) here.”

Dr Gawrie has a team of 15, funded partly by a US$100mil (RM320mil) Global Fund grant to fight drug-resistant malaria in the Mekong. The largest share, US$40mil (RM128mil), went to Myanmar, but it will last only until 2016.

Challenging approaches

Dr Gawrie has been an intermediary of sorts between the ambitious attack on malaria the Gates Foundation is pursuing and the government’s measured approach.

Somewhat controversial is the foundation’s interest in mass administration of drugs, carpet-bombing parasites by treating everyone in problem areas whether they seem sick or not, an approach it’s testing in the region.

Success with pilot programmes could help make the case for a new, aggressive malaria-eradication plan. The work also helps them learn about drug distribution and other aspects of the challenge.

“I think this is going to be a great learning time for our team as we start to look at these very local eliminations – about all the pieces in the chain that need to get done,” Melinda Gates said at the Seattle forum.

While Myanmar supports the malaria work, it’s also sensitive to being used as a laboratory for new approaches.

Locally, the malaria crisis is overshadowed by ethnic tensions and a highly anticipated election in 2015, seen as a test of whether Myanmar is truly reforming and legitimising its government.

The country also struggles with other health risks.

“There’s a lot of other things that kill not just children, but all ages,” said Simon Khin, a former software engineer who as a child lived in border areas. “That includes the war, dengue fever, TB, typhoid.”

Khin, who immigrated to Seattle 30 years ago and now runs a refugee-assistance programme, said people who live around malaria generally aren’t as alarmed by its prevalence.

“It’s pretty much a fact of life,” he said.

Such acceptance complicates the issue of administering drugs to masses of people, including those without symptoms. WHO isn’t yet pursuing this approach. But with drug resistance now an emergency, it has called for large-scale pilot studies.

Meanwhile, the Gates Foundation is testing mass drug administration in border areas and hopes to treat 250,000 people by 2016.

“There’s a little bit (of) unhappiness or misunderstanding about this with the national programme, but we were not consulted by anyone,” Dr Gawrie said.

Kanyok said he meets regularly with the health ministry and they have a good relationship. In Myanmar, it’s deferring to the government, he said.

“It’s a health and humanitarian issue that everyone can grab on to because people see the results of malaria in the country,” he said. – The Seattle Times/McClatchy-Tribune Information Services

http://www.thestar.com.my/Lifestyle/Health/2014/08/10/Threat-from-new-strain-of-drugresistant-malaria/

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Myanmar's royals choose ordinary lives

08 Nov 2013 15:56



One of Myanmar's last remaining royalty Princess Hteik Su Phaya Gyi shows
oil paintings of her parents at a relative's house in Yangon (AFP/Soe Than Win)

After decades of colonialism and military rule, most of Myanmar has forgotten about the country's last king,Thibaw, whose descendants lead ordinary lives while remembering a lost era

YANGON: In a modest Yangon apartment, the granddaughter of Myanmar's last king lives poor and unrecognised by her neighbours -- a far cry from the power and riches of her ancestor.

Princess Hteik Su Phaya Gyi said the childhood days when her family had a bevy of servants and retained some of its royal status were now a distant memory.

The British colonial regime dethroned her grandfather, King Thibaw, in 1885 and later the military rulers who led the country for decades, kept the family out of the public eye.

"They didn't want us to be somebody," said the silver-haired princess, swathed in a shimmering purple shawl worn especially for the rare interview.

"I have lived as an ordinary person for 60 years," she told AFP.

"Of course I repent a little over the glorious times that we had when we were young," she said, displaying a lively wit undimmed by her 90 years.

At the demolition of the monarchy by British colonial rulers to the country then called Burma, King Thibaw and his wife, Queen Supayalat, were swiftly deposited in the small Indian seaside town of Ratnagiri.

When Thibaw died in India aged 56 in 1916, after suffering a heart attack, the family eventually fractured.

Some settled in India while others made their lives in Burma, later renamed Myanmar.

"Most of Myanmar has forgotten about the king," said deputy culture minister and royal historian Than Swe, who has spearheaded a campaign to return Thibaw's body to Myanmar.

A visit by President Thein Sein to Thibaw's tomb in Ratnagiri during an official trip to India last December reignited some interest in Myanmar's monarchy.

While the princess is "grateful" that President Thein Sein took the time to visit Ratnagiri, she believes her grandfather should not be moved from his final resting place.

Thibaw was born into a courtly lifestyle within the walls of a gilded teak palace in Mandalay.

"This man was a demi-god in Burma. He was worshiped by his people," said Sudha Shah, author of "The King in Exile: The Fall of the Royal Family of Burma".

Even after British rule and independence,  the royal family was held in great esteem, said the author.

When military leaders tried to enlist royal help to counter communist insurgents, they were "taken aback ... by the depth of public sentiment demonstrated for the royal family" as local people thronged to catch a glimpse of the family and women knelt and spread their hair on the ground for the family to walk on, recounts Shah.

The family had a brief period of public activity when princess Hteik Su Phaya Gyi and her siblings set up the "Miss Burma" beauty contest -- she was in charge of catwalk training.

Her eldest brother, Prince Taw Phaya Gyi, also became involved in the Olympics before he was assassinated by insurgents in 1948.

Today, the princess and her younger brother Prince Taw Phaya, are the only surviving grandchildren of the last king, with the 89-year-old prince being a potential heir of the Konbaung dynasty.

The royals, refusing the small allowance offered after the British left, made their own way in the world.

The princess used the impeccable English she picked up as a child studying in a Catholic school in the southern city of Mawlamyine to land positions at both the Australian and US embassies before settling as a teacher -- a job she still holds today.

Several members of the family scraped together the money to travel to India in the early 1990s -- her only visit to her grandparents' home in exile.

She recalled her own mother's stories of the exiled queen standing on a balcony overlooking the sea and weeping for her homeland.

"When I went there, I looked up at that little veranda and the sun was setting.  I said 'Oh my grandmother must have felt the same', and I had tears in my eyes."

After a family quarrel in the late 1990s, the princess lost her inherited home and now lives with her daughter, who works at a burial association.

None of her six children, 20 grandchildren and eight great-grandchildren show an interest in reviving the royal line.

- AFP/sf

http://www.channelnewsasia.com/news/asiapacific/myanmar-s-royals-choose/879156.html

GM Crop Adoption In South East Asia To Take Off From 2012

Sameer Mohindru
DOW JONES NEWSWIRES
12 Aug 2011 10:12 BST

SINGAPORE (Dow Jones)--The adoption of genetically modified crops in South East Asia is likely to increase considerably over the next few years as a slew of initiatives involving corn, cotton, sugarcane, potatoes, rice and eggplant start to bear results, an industry executive said Friday.

The spread of GM crops in the region has been slow due to concerns over bio-safety, but there has been a gradual change in that view. Global cultivation of genetically modified crops hit one billion hectares in 2010 but bulk of it has been in North and South America.

Next year is crucial for transgenic crops in the region because commercial planting of new GM varieties is expected in Indonesia and Vietnam, said Randy A. Hautea, global coordinator of International Service for the Acquisition of Agri-Biotech Applications, an agency that tracks the adoption of GM crops worldwide.

The multi-location trials in both GM corn and GM sugarcane in Indonesia and GM corn in Vietnam are now complete and bio-safety approval for commercial use is expected in 2012, he said on the sidelines of the Asian Food Security Conference.

This will likely be the first commercial cultivation of GM sugarcane anywhere in the world.

Hautea said this is significant because global prices of agricultural commodities are on the rise and an improvement in yields through the use of pest-resistant varieties can limit the need for imports.

He cited the example of the Philippines, which imported 500,000 tons corn annually before it permitted transgenic corn eight years ago, making the country nearly self-sufficient in corn production. Around half the country's yellow corn crop is now the transgenic variety.

Both Indonesia and Vietnam import GM corn from the Americas and local cultivation will be a logical next step, he noted.

Hautea said a large body of research on GM crops in Southeast Asia is being done by government-run institutions as part of national efforts to boost agricultural productivity.

A case in point is developing drought resistance in Indonesia's sugarcane crop through genetic modification, crucial for many islands of Java, he said.

The Indonesian government has also launched field trials for GM potatoes to tackle the Late Blight Disease, using the same technology deployed in Bangladesh and India, Hautea said.

Meanwhile, research on transgenic rice, eggplant and cotton is being conducted in the Philippines.

Growers in Myanmar have been informally planting GM cotton for a few years and in 2010, the government officially allowed its use in the country. Around 75% of Myanmar's cotton growers now use transgenic seeds, Hautea said.