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Scientists sound warning note over malaria drug resistance in Africa | Global health

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Resistance to malaria drugs in Africa may be starting to take hold, according to a study that maps changes similar to those seen a decade ago when drug resistance spread in south-east Asia.

In Cambodia and neighbouring countries, the artemisinin drug compounds widely used against malaria are no longer always effective. The falciparum malaria parasites have developed genetic mutations that allow them to evade the drugs. There has been great concern that drug resistance could spread to Africa, which has the highest burden of cases of this type of malaria – and the highest toll of child deaths from it.

A study in Rwanda, published in the Lancet Infectious Diseases journal on Wednesday, shows that the feared erosion of efficacy of the malaria drugs may have begun. As happened in south-east Asia, researchers have found that giving a child a course of artemisinin compound drugs does not always clear the malaria parasites from their blood in three days, as it should.

Artemisinins, introduced in the early 2000s from China, are given in combination with a different type of malaria drug to ensure all parasites are cleared and the efficacy of the drugs is not compromised. The most common combination is artemether-lumefantrine, which Rwanda began to use in 2006.

If the artemisinin drug does not clear the parasites promptly within three days, the partner drug comes under pressure and resistance to it may develop in turn. At that point, the treatment may fail, as has happened in south-east Asia.

“Mutations can emerge spontaneously, and previous studies have pointed to isolated cases of resistance. However, our new study shows that resistant isolates are starting to become more common and most importantly, are associated with clinical implications [delayed parasite clearance],” said lead author Dr Aline Uwimana, from the Rwanda Biomedical Centre, in Kigali.

The experts called for more intensive surveillance of drug resistance in Rwanda and other African countries. “Our study showed that the treatment for malaria in Rwanda is still 94% effective, but new studies and ongoing monitoring are urgently needed,” said co-author Dr Naomi Lucchi, CDC resident adviser for the US President’s Malaria Initiative.

The researchers monitored the treatment of 224 children with malaria aged six months to five years in three areas of Rwanda – Masaka, Rukara and Bugarama. In two of the sites, about 15% of children still had detectable parasites after three days, fitting the World Health Organization (WHO) criteria for partial resistance.

The researchers also found certain mutations in the parasites, which are implicated by the WHO in delayed clearance.

Experts believe the warning signs are there. This study, and other data, suggest we are “on the verge of clinically meaningful artemisinin-resistance in Africa, as emerged in south-east Asia over a decade ago”, writes Prof Philip Rosenthal, of the University of California, San Francisco, in a commentary in the journal.

“Loss of efficacy of key ACTs [artemisinin-based combination therapies], particularly artemether-lumefantrine, the most widely used antimalarial, could have dire consequences, as occurred when chloroquine resistance led to enormous increases in malaria deaths in the late 20th century.”

It was impossible to predict the pace of progression in Africa, but close surveillance of the development of resistance in the parasite – with prompt replacement of failing regimens – “could save many lives”, he said.

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Texas Deputy AG Apologizes for Slamming Simone Biles as ‘National Embarrassment’

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US gymnast Simone Biles received immense support from Americans this week after announcing she would not be competing in the Team USA final, nor the women’s individual all-around gymnastics final, due to personal mental health concerns. At the same time, the 24-year-old has received backlash from many individuals who viewed her pull-out as weak.

Aaron Reitz, deputy attorney general for Texas, took to Twitter on Wednesday evening to issue an apology to Biles, and recant a statement in which he panned the record-setting US gymnast as a “national embarrassment.” 

“In a moment of frustration and disappointment, I opined on subjects for which I am not adequately versed. That was an error. I can’t imagine what Simone Biles has gone through,” Reitz claimed. “Simone Biles is a true patriot and one of the greatest gymnasts of our time.”

“I apologize to her, and wish her well,” the deputy AG concluded, emphasizing that his “personal social media comments” do not represent the views of Texas Attorney General Ken Paxton, nor the Office of the Attorney General. 

Reitz’s since-deleted tweet against Biles, who was born in Texas and still resides in the Lone Star State, quoted another post that applauded the 1996 Olympic performance of Team USA gymnast Kerri Strug. Strug, one of the US’ “Magnificent Seven,” severely injured her ankle during the first half of the vault competition, but refused to bow out of the event and ultimately led her team to win the US’ first gold medal in women’s gymnastics. 

“Contrast this with our selfish, childish national embarrassment, Simone Biles,” Reitz said in his quote tweet. 

The deputy AG’s attempt at using Strug’s story to chastise Biles fell flat, as the two-time Olympian threw her support behind the 24-year-old on Tuesday. 

Furthermore, it is worth noting that Biles is no stranger to performing with adversity. When the US Women’s Gymnastics team took home gold at the 2018 World Championships in Qatar, Biles dominated in nearly every competition, despite intense stomach pains from what was later confirmed to be a kidney stone. 

Despite her pull-outs this year, Biles has continued to root for her fellow Team USA gymnasts. She also expressed in a Wednesday social media post that “the outpouring [of] love & support I’ve received has made me realize I’m more than my accomplishments and gymnastics which I never truly believed before.”



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Aid cuts make a mockery of UK pledges on girls’ education | Zoe Williams

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With all the fanfare Covid would allow, the global education summit opened in London this week. Ahead of the meeting, the minister for European neighbourhood and the Americas was on rousing form. “Educating girls is a gamechanger,” Wendy Morton said, going on to describe what a plan would look like to do just that.

The UK, co-hosting the summit with Kenya’s president, Uhuru Kenyatta, plans to raise funds for the Global Partnership for Education, from governments and donors. The UK government has promised £430m over the next five years.

There followed a number of reasons why the issue is so important, all of them absolutely sound: on any given indicator, from GDP to infant health and beyond, a nation stands or falls by how well, for how long, and how inclusively it educates its girls.

The issue has never been more important than during this pandemic, which in many countries is hitting a peak having already affected girls disproportionately.

These are all the right words, even in the right order, yet they land completely at odds with the government’s behaviour.

Lis Wallace, head of advocacy at the One campaign, is most immediately concerned with these pledges being fully funded. There are two core targets: one is to increase girls’ access to education, the other is to boost the key milestone for all children – that they’re able to read and understand a simple story by the age of 10.

The past 18 months have been devastating for education, particularly in countries where it’s harder to access to online learning. About 1.6 billion children are out of school across the world. There’s a target to raise $5bn (£3.6bn), “which is a drop in the ocean of what is required to meet the global learning crisis”, Wallace says. It looks as though this summit will raise no more than $4bn, which is nothing less than a “failure of statecraft”, as Wallace explains: “It’s challenging when the host government is stepping back and making aid cuts for it then to ask other countries to step up.”

This is a depressing echo of the G7’s failure earlier this year; commitments to share vaccine doses with low-income countries came too little, too late, with devastating results, and it’s hard to avoid the question of whether that outcome would have been different if the host nation had role modelled some generosity.

Furthermore, there’s some confused causality in the minister’s assertion that staying in school protects girls from “forced child marriage, gender-based violence and early pregnancy”. The exact inverse is true: it is largely teenage pregnancy that forces girls out of school in the first place, and to try to use education in lieu of sexual health and reproductive provision is illogical.

Esi Asare Prah, who is a youth and advocacy officer in Ghana for MSI Reproductive Choices, describes a situation in which 5,000 to 7,000 girls drop out of school each year after becoming pregnant – last year, 2,000 of them were between 10 and 14. Across sub-Saharan Africa, MSI estimates that up to 4 million girls drop out or are excluded from school every year due to pregnancy.

“These girls are most likely to be on the street, doing menial jobs; their children will not make it into higher education. It creates a cycle of poverty and a cycle of slums. For me, the foundation of it is that you can’t seek to invest in education for girls in sub-Saharan Africa and cut down funding for sexual and reproductive health. If you treat development issues as isolated, you will have the same issues of 50 years ago chasing you into the future.”

Here, the recent cuts to the aid budget make a mockery of these pledges on education: UK funding to the UN Population Fund recently went down by 85%.

There is inspiration to take from this summit, nevertheless; President Kenyatta has been leading the charge not only on education but also on the climate crisis, and there is a solidarity and sense of purpose between poorer nations that may yet inspire greater generosity from donors. Whatever it achieves, though, it will be despite its UK host not because of them.

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[Ticker] US backs WHO plan for further Covid-origin investigation

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US secretary of state Antony Blinken affirmed his country’s support to conduct additional investigations into the origins of the Covid-19 after meeting with the head of the World Health Organization, Tedros Adhanom Ghebreyesus, on Wednesday, Reuters reported. “He stressed the need for the next phase to be timely, evidence-based, transparent, expert-led, and free from interference,” a US state department spokesperson said in a statement.

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