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.
Party discipline is very elastic in the United States, as President Joe Biden well knows. Leading Democrats, almost always the usual suspects (Joe Manchin, Kirsten Sinema), behave like loose cannons, tripping up White House-sponsored bills and sometimes derailing them, but none had gone so far as to push the world to the brink of an incendiary conflict. Nancy Pelosi, the speaker of the House of Representatives and third authority in the country, was awarded that dubious honor thanks to her controversial visit to Taiwan last week, in which she confirmed her commitment to the free world. “America’s determination to preserve democracy here in Taiwan and around the world remains ironclad,” she said last Wednesday in Taipei. Pelosi added the US “will not abandon our commitment to Taiwan and we are proud of our enduring friendship.” But there is concern in Washington about how China will respond to these statements.
Pelosi is one of the heavyweights of the Democratic establishment. She has been a member of Congress for California since 1987, and has served twice as House Minority Leader, between 2007 and 2011, as part of Barack Obama’s term, and in 2019, she became the first woman to be the speaker of the House. Therefore, despite Biden’s warnings about the inconvenience of visiting the island, her initiative does not seem like the decision of a novice, but rather one that responds to her own agenda, and probably also to that of Congress, including many Democrats, in favor of a more determined support for Taiwan than that offered by, in her opinion, timid Washington diplomacy. Hawks from both parties are pushing Biden to toughen his policy on China and the Senate had planned to send $4.5 billion in military aid to Taiwan last week, as well as declaring the island the “main non-member NATO ally,” but the commander in chief has asked for containment so as not to further fuel the fire around a self-governed island that Beijing considers its own.
Politics runs in the family of Nancy Pelosi. Her father, Thomas D’Alessandro, was a prominent Democrat at the time of President Roosevelt’s New Deal. Pelosi is her married surname, also of Italian-American origin and she is faithful to certain cultural traditions such as a large family (five children) and a cultural Catholicism, though not exempt from friction with the curia, such as her defense of the right of women to abort. Like Biden, he too, a Catholic, that position has caused him more than one headache. The first, being denied communion by the archbishop of his diocese. In late June, on a visit to the Vatican, Pelosi, dressed in stark black, took communion at a Mass in St. Peter’s Basilica. There are no images of the communion, which was confirmed by two witnesses next to her, but Pelosi and her husband were photographed with the pontiff before the Eucharist.
After graduating in Political Science in Washington in 1962, Pelosi spent six years raising her children in New York. The Pelosi family moved to San Francisco in 1968, where she began her career as a Democratic volunteer. She was soon recognized for her talent in fundraising campaigns, a key factor in the success or failure of a politician in the US. From there she made the leap to the Democratic National Committee, the party’s bridge of command, and, shortly after, to State Congress. Leader of the party in Congress since 2003 – another breakthrough of the glass ceiling – Pelosi uses her personal experience to arbitrate between opposing factions of the formation. She calls it the “mother of five children” strategy.
Despite the balance that she advocates in favor of party unity, she has given numerous signs of aligning herself with the most open or liberal faction – although the affiliations are sui generis in the US, without allegiance to the precise definition of the concept –, voting in favor of arms control measures and the right to abortion, or against the war in Iraq. Her critics accuse her of “west coast leftism.” The political microclimate of San Francisco, like that of Washington, was one of the targets chosen by Donald Trump to successfully attack the Democratic elites alienated from ordinary Americans.
Pelosi is a wealthy member of the elite. Her husband, businessman Paul Pelosi, owner of the Sacramento Mountain Lions football team, has been involved in several financial operations that sometimes border on insider trading. At the end of July, Paul Pelosi sold nearly 5,000 shares of chipmaker Nvidia for $4 million, just days before the House approved a major legislative package that provided subsidies and tax credits to boost the US semiconductor industry. This is not the only dubious example, but the Speaker of the House has always closed ranks with the father of her children, even after he was arrested in May in California for being drunk while driving a Porsche that was involved in an accident. The leader’s husband pleaded not guilty last week in court.
After the arrival of Obama to the presidency, and during the financial crisis, Pelosi helped the president carry out his stimulus program, worth $787 billion, in February 2019 in Congress; and a year later, the health reform known as Obamacare. Pelosi has never spared support for social measures such as those that Biden encourages today. Her role was also decisive in preventing the closure of the Administration during the last stretch of Trump’s mandate, when she managed to twist his arm. In January 2020, she opened the proceedings of the first impeachment against the Republican, of which he was acquitted, and a year later, she championed the creation of a commission to investigate the assault on the Capitol by insurgent Trumpists.
In the US, representatives are responsible to their constituencies and voters, rather than to the party and, of course, to any other earthly or heavenly authority. Faced with the dilemma posed by the conservative Archbishop of San Francisco, also Italian-American Salvatore Cordileone, retracting from defending the right to abortion or taking communion, Pelosi has responded by qualifying the repeal of the Roe v. Wade ruling by the Supreme Court as “outrageous and heartbreaking” a decision. The fact that Pelosi doesn’t shrink even before a world power is evidenced by her decision to visit Taiwan.
The British government presented a vehemently anti-abortion former US envoy with an award for his services to freedom of religion just days before watering down a statement on gender equality to remove commitments to reproductive rights.
Sam Brownback, a former governor of Kansas who targeted abortion rights while in office and then became Donald Trump’s ambassador-at-large for international religious freedom, was given the award during the international ministerial conference for freedom of religion or belief (FoRB) held in London last month.
Organised by the Foreign, Commonwealth and Development Office (FCDO) and opened by the Tory leadership candidate Liz Truss, the gathering has since become engulfed in controversy after a statement signed by more than 20 countries was quietly removed from the FCDO website and significantly edited.
It has now emerged that a number of participants to the conference, which Fiona Bruce, the prime minister’s special envoy for religious freedom or belief, was involved in organising, are known for their strong anti-abortion views.
Three, including one speaker, were from ADF International, the global wing of a US legal advocacy organisation considered a hate group by the Southern Poverty Law Centre (SPLC), which monitors extremist groups in the US.
Founded by leaders of the Christian right, the Alliance Defending Freedom (ADF) has long opposed abortion. It writes on its website: “In 2022, the pro-life movement achieved what was thought impossible by many: the overturning of Roe v Wade. But there’s more work to be done.”
Other participants were from the Religious Freedom Institute (RFI), a rightwing thinktank based in Washington DC, which, alongside the ADF, is pushing for more laws protecting anti-choice medics from performing “procedures in violation of their conscience”, from abortion to gender transition surgery.
Ján Figel, a former EU special envoy for FoRB, was among the speakers. Figel’s mandate was not renewed in 2020 after a group of pro-choice MEPs complained he had “undermined [the mandate’s] credibility … by showing highly problematic acquaintances with organisations opposing women’s sexual rights and LGBTI people’s rights.”
Figel said the MEPs’ criticism had been rooted in “false arguments … based on lies”, and added that he had nothing to do with the statement.
It is understood that Brownback, who received warm applause at the London conference, was given the award by the UK government in conjunction with the Dutch special envoy for FoRB, Jos Douma, in recognition of their work on FoRB around the world.
While in office, Brownback signed a number of pieces of anti-choice legislation. Last week, he bemoaned the decisive victory of pro-choice campaigners in a Kansas referendum on abortion, adding: “We fight on defending all life, mother and child, from beginning to end.”
According to one participant at the London conference, who requested anonymity: “The UK government says it advocates ‘freedom of religion or belief for all’. But some of those featured and celebrated at the ministerial don’t support this. What they do instead is use their ‘religious freedom’ as an excuse to trample the rights and freedoms of others. People like Sam Brownback and the ADF, who seek to take away others’ freedom of choice in this way, should be challenged, not celebrated.”
The conference is an annual gathering that began in the US during Trump’s presidency. This year it was held on 5-6 July.
Its agenda was centred on how to “protect and promote freedom of religion or belief internationally”, with topics ranging from the persecution of Uyghur Muslims in the Xinjiang region of China to the terrorist attacks of Boko Haram in Nigeria discussed by academics, analysts, politicians and faith leaders, including the archbishop of Canterbury, Justin Welby.
But its aftermath has been controversial, since it emerged that its statement on FoRB and gender equality had been edited to remove commitments to “sexual and reproductive health and rights” and “bodily autonomy”. The FCDO initially said it had made the changes to focus on key FoRB issues and to achieve a broader consensus of signatories.
Tariq Ahmad, a Foreign Office minister and former FoRB special envoy, said last week the statement had been edited to become “more inclusive of all perspectives and views” and “to allow for a constructive exchange of views on all issues”.
However, the watering-down of the statement, which had been painstakingly worked on and signed by more than 20 countries, provoked anger in a number of governments, many of which are refusing to sign the modified version. It currently has eight signatories, including Malta, where abortion is illegal, and the UK.
It is understood that the pushback on the gender equality statement began the day after the conference, at a “next steps” meeting at Lancaster House, convened by Bruce. Among those present were Jim Shannon, of the Democratic Unionist party, and David Alton, a crossbench peer, who were also conference speakers.
Rachael Clarke, chief of staff at the British Pregnancy Advisory Service, said the vast majority of British people saw through the “fiction” that there was significant opposition in the UK to abortion rights. But words mattered, she added, which was why there was concern over the conference statement.
“I think what we’ve really seen when it comes to abortion rights is the power of words and the power of the direction that governments are moving [in] … I think what we really are concerned about seeing is any indication from this government or the next government that they are valuing women’s reproductive rights as less than where they are currently,” she said.
Clarke added that, with Bruce as special envoy, it would have been hard for the government to put out a statement on freedom of belief that was not inclusive of “incredibly anti-abortion views”. “[Bruce] is the most anti-abortion MP in the House of Commons.”
A spokesperson for Brownback said he had no involvement in drafting the conference statement or in organising the event. Brownback was “proud to be pro-life”, a stance that is “immaterial to his support for freedom of religion or belief”, he added.
“Ambassador Brownback has not tried to connect his support of unborn human life to the issue of religious freedom … Ambassador Brownback believes that anyone can support FoRB regardless of their position on abortion. At a time when people are being killed and persecuted for what they choose to believe, Ambassador Brownback believes that the FoRB movement best moves forward by focusing on FoRB and not diverging into non-FoRB issues.”
The ADF denies the accusation it espouses hate, accusing the SPLC of besmirching “huge swaths of well-respected, mainstream, conservative America” in that categorisation of its beliefs.
A spokesperson said: “As the world’s largest organisation committed to protecting religious freedom, ADF International were proud to take part in the ministerial. Our current projects include defending girls in south-east Asia who have been abducted, forcibly married, and ‘converted’ from their faith; challenging the Russian authorities for prohibiting church communities from gathering to worship; and supporting those on death row for ‘blasphemy’ in Pakistan to escape to safety in Europe. We believe in the equality and dignity of all people.”
Nathan Berkeley, communications director of the RFI, said the thinktank worked to advance religious freedom throughout the globe and to defend those of all faiths who were persecuted.
An FCDO spokesperson said: “We invited experts and representatives from a wide range of different fields and beliefs to the conference in the spirit of fostering positive discussion and collaboration on issues of freedom of religion or belief.”
Bruce, Alton and Shannon did not respond to requests for comment.
Following the highly controversial FBI raid on the property of Donald Trump, many US conservatives and members of the Republican Party expressed their indignation on social media, reiterating claims that the former president had been unfairly targeted by the agency for political purposes.And while the White House said it had no idea about the raid, and President Joe Biden refused to comment on what happened at all, many noted law enforcement officers have never visited either Biden’s son Hunter or his partners regarding his purportedly rather dubious international business dealings.But here’s the mystery, why did the FBI need to take the unprecedented step of invading the home of the former president? Reports say the agency took documents and boxes in the raid, likely the same ones the National Archives were looking for that Trump’s team allegedly took from Washington last year. Conservatives, on the other hand, recalled another scandal involving the misuse of confidential data and recklessness by a high-ranking official – Hillary Clinton when she was secretary of state – and her infamous lost and leaked emails. Back then, Clinton set up her own email server instead of using the government-issued one because it allegedly offered her complete control over her correspondence. And, not surprisingly, her staffers purportedly deleted some emails that, by law, were supposed to go to the archives.A 2016 FBI inquiry found that while Clinton and her staffers handled sensitive information with “extreme carelessness,” no “reasonable prosecutor” would pursue a criminal case against her.Well, while they’re looking into the former president’s boxes at Mar-a-Lago, we can all hope that maybe the FBI will soon be able to find the time to not only recover Hillary’s lost emails, but also determine the coordinates of Jimmy Hoffa’s burial site – that is if they’re not too busy, of course.
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On Monday, the FBI, for the first time in history, conducted a search of the home of a former president, which took place at Donald Trump’s Mar-a-Lago residence in Florida. After the raid, Trump issued a statement denouncing the incident and accusing the US court system of using it as a weapon against him.
Following the highly controversial FBI raid on the property of Donald Trump, many US conservatives and members of the Republican Party expressed their indignation on social media, reiterating claims that the former president had been unfairly targeted by the agency for political purposes.
And while the White House said it had no idea about the raid, and President Joe Biden refused to comment on what happened at all, many noted law enforcement officers have never visited either Biden’s son Hunter or his partners regarding his purportedly rather dubious international business dealings.
But here’s the mystery, why did the FBI need to take the unprecedented step of invading the home of the former president? Reports say the agency took documents and boxes in the raid, likely the same ones the National Archives were looking for that Trump’s team allegedly took from Washington last year.
Conservatives, on the other hand, recalled another scandal involving the misuse of confidential data and recklessness by a high-ranking official – Hillary Clinton when she was secretary of state – and her infamous lost and leaked emails. Back then, Clinton set up her own email server instead of using the government-issued one because it allegedly offered her complete control over her correspondence. And, not surprisingly, her staffers purportedly deleted some emails that, by law, were supposed to go to the archives.
A 2016 FBI inquiry found that while Clinton and her staffers handled sensitive information with “extreme carelessness,” no “reasonable prosecutor” would pursue a criminal case against her.
Well, while they’re looking into the former president’s boxes at Mar-a-Lago, we can all hope that maybe the FBI will soon be able to find the time to not only recover Hillary’s lost emails, but also determine the coordinates of Jimmy Hoffa’s burial site – that is if they’re not too busy, of course.