Abstract:
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Resistance to first-line treatments for Plasmodium falciparum
malaria and the insecticides used for Anopheles vector control
are threatening malaria elimination efforts. Suboptimal
responses to drugs and insecticides are both spreading
geographically and emerging independently and are being seen at
increasing intensities. Whilst resistance is unavoidable, its
effects can be mitigated through resistance management
practices, such as exposing the parasite or vector to more than
one selective agent. Resistance contributed to the failure of
the 20th century Global Malaria Eradication Programme, and yet
the global response to this issue continues to be slow and
poorly coordinated-too often, too little, too late. The Malaria
Eradication Research Agenda (malERA) Refresh process convened a
panel on resistance of both insecticides and antimalarial drugs.
This paper outlines developments in the field over the past 5
years, highlights gaps in knowledge, and proposes a research
agenda focused on managing resistance. A deeper understanding of
the complex biological processes involved and how resistance is
selected is needed, together with evidence of its public health
impact. Resistance management will require improved use of
entomological and parasitological data in decision making, and
optimisation of the useful life of new and existing products
through careful implementation, combination, and evaluation. A
proactive, collaborative approach is needed from basic science
and the development of new tools to programme and policy
interventions that will ensure that the armamentarium of drugs
and insecticides is sufficient to deal with the challenges of
malaria control and its elimination. |