Drug resistance can be fought by engineering methods.
I share the concern of WHO and others about preventing the spread of drug resistance from Burma (or Myanmar as it is called by a few dictators) to the rest of the world (See Oped piece of 29 March in International Herald Tribune). But there is a better way to prevent it, by using environmental management of mosquito habitats and reducing the dependency on drugs and their increasing use. However the response of the malaria people in Burma and in WHO Geneva to growing drug resistance of the malaria parasite has simply been "More of the Same." It is incredible that the failure of malaria control in Burma is occurring right next door to the success of malaria control in Malaysia, but WHO is not exploring the reason for this huge difference. The reason for the difference in these two countries is that the base for the fight against malaria in Malaysia has always been environmental management of the malaria mosquito habitats, whereas in Burma the malaria people don’t even know which mosquito is causing their problem; they simply look for another combination of drugs. I call it chemical dependency, and it weakens not only the fight against malaria in Burma, but also in Africa.
Malaysia started their long history of successful suppression of malaria in the 1920’s when they discovered that the responsible mosquitoes lived along the edge of small streams, needed shade, and could breed in coastal swamps. So they developed ways to flush the streams with permanent siphon structures, remove the shade manually, and control the salinity in coastal swamps with tide gates. I visited the island of Penang in Malaysia a few years ago and saw that these measures are still in place and still working, after decades. Penang is just south of Burma. They also pioneered the use of underground drainage channels, filled with coconut husks to maintain the flow channel. This eliminates the problem of "hoofprint" breeding sites by lowering the local water table. I have covered these engineering approaches to mosquito control in my book "A realistic strategy to fight malaria in Africa" by Boston Harbor Publishers 2011. But Please check out the Malaysia vector control website, especially the last section, on environmental management of mosquito habitats. Note that the current number of cases of malaria in Malaysia is down to a few thousand per year. http://www.actmalaria.net/IRW/IRW_Malaysia.pdf Or simply look up malaysia and malaria.
I was interested to see this successful program in Malaysia because I have worked on environmental management of tropical disease transmission for about 50 years. I learned that long before chloroquine or DDT came on the scene, the malaria had been reduced to a manageable prevalence in Malaysia by these kinds of environmental measures. Their success has endured. Currently only a few thousand cases of malaria are found in Malaysia in an average year, whereas in Burma the number is in the millions, and growing. But in Burma you have been swamped by drug resistance, first to chloroquine, and now to the supposed answer to chloroquine resistance; artemisinin in combination therapy. So in 2011 WHO proposed the strategy to fight drug resistance which is basically more of the same, adding more drugs to the mix and looking for new ones. What do they call it when you keep doing the same thing over and over but expect different results?
The way to get out of the treadmill of drug resistance is to broaden the fight in Burma to add environmental mangagement of mosquito habitats, and to get off the dependency on drugs. It is a fairly simple process.
The first step is to find out which mosquitoes are transmitting malaria locally and where they live.
The second step is to modify their habitats so that the habitats and mosquitoes are drastically reduced in numbers. As transmission is reduced by control of mosquito breeding, then limited and careful use of drugs can help to achieve suppression of malaria prevalence for generations, without causing more drug resistance.
William Jobin Director of Blue Nile Associates