**9. Conclusions**

Artemisinin resistance in *P. falciparum* has emerged 10 years ago in SEA and spread in the entire GMS. Parasite populations resistant to all ACTs are now circulating in Cambodia, triggering a resurgence of the disease. Current gains in malaria control/elimination program are heavily relying upon the efficacy of ACTs. The emergence of artemisinin and partner drug resistance is a serious threat to the global prospect of malaria elimination. The recent decline in the number of clinical cases in the region is encouraging but by no means a victory. Current resurgence of malaria in Cambodia and the existence of large reservoirs of sub-microscopic infections must be seen as warnings that malaria could make a devastating comeback. Efforts must continue and accelerate to eliminate the parasite and this will only be possible with stronger political will and sustained financial support. The three main programmatic components are EDT, elimination of the reservoirs and adapted vector control measures. The few antimalarials in the development pipeline are promising, though these compounds will not be ready on time to replace the ACTs [120]. The spread of the ACT-resistant malaria has so far outpaced the malaria containment measures and time is running out. There are not many options but to accelerate the current malaria elimination efforts.

LLINs long-lasting impregnated nets

MDA mass drug administration

MSAT mass screening and treatment

Pgh1 P-glycoprotein homologue 1

SNP single nucleotide polymorphism

SP sulfadoxine-pyrimethamine

WHO World Health Organisation

Aung Pyae Phyo1,2\* and François Nosten1,3

University of Oxford, Oxford, UK

Pfcrt *P. falciparum* chloroquine resistance transporter

The Artemisinin Resistance in Southeast Asia: An Imminent Global Threat to Malaria Elimination

http://dx.doi.org/10.5772/intechopen.76519

27

Pfmdr-1 *P. falciparum* multi-drug resistant gene-1

PfPI3K *P. falciparum* phosphatidylinositol-3-kinase

UPR unfolded protein response pathway (UPR)

WWARN Worldwide Antimalarial Resistance Network

\*Address all correspondence to: aungpyaephyo@shoklo-unit.com

of Tropical Medicine, Mahidol University, Mae Sot, Thailand 2 Myanmar Oxford Clinical Research Unit, Yangon, Myanmar

1 Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty

[1] Plowe CV, Wellems TE. Molecular approaches to the spreading problem of drug resistant malaria. In: Jungkind DL, Mortensen JE, Fraimow HS, Calandra GB, editors. Antimicrobial

Resistance: A Crisis in Health Care. Boston, MA, USA: Springer; 1995. pp. 197-209

3 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine,

LMF lumefantrine

MFQ mefloquine

RBC red blood cell

SEA Southeast Asia

**Author details**

**References**
