**Acronyms**

identify asymptomatic malaria carriers through active case detection (ACD). The BMGF funded the development of a highly sensitive rapid diagnostics test (hsRDT), which is specific for Pf [83]. It is much more sensitive than standard rapid diagnostic tests (RDT), but not as sensitive as PCR (which is probably not necessary) [84, 85]. Alere (www.alere.com, now Abbott) has made these hsRDTs commercially available for \$0.95/each; approvals in GMS are in process. The same company also markets a malaria antibody-based RDT for both Pf and Pv [86]. The usefulness of these new tools can be rapidly demonstrated during scale-up; the hsRDT will hopefully obviate the need for mass drug administration [87]. Both of these new RDTs should facilitate defining risk populations.

If the package of available tools does not rapidly stop malaria transmission, other more aggressive tools can be added as they become available [85]. Currently available drugs are problematic for prophylaxis—primaquine and doxycycline require daily dosing; doxycycline has already been widely used along the Vietnam border—its current efficacy is unknown. Mefloquine is poorly tolerated and its use for prophylaxis may accelerate its demise. Tafenoquine [88, 89] and RTS,S malaria vaccine [90] should be accelerated to play a role for prevention in the region.

The last remaining parasites will be the most drug-resistant—alternative regimens are urgently needed. Tafenoquine [91] (unpublished observations for Pf), azithromycin and methylene blue [92–95] are currently under recognized, but could also play a role in combination treatment when no alternatives remain, which may be very soon. New regimens should be urgently evaluated; all should be seven days, as some or all of the drugs will have short half-lives. With sevenday regimens, adherence will be very challenging. Hospitalization with appropriate incentives should become the norm to achieve very high treatment adherence in the near future, including the current three-day regimens in areas where outpatient treatment monitoring is not successful.

Emerging incurable malaria in the GMS is a grave public health threat. We call for targeted, immediate decisive action by international and host country governments to establish mission leadership, enough authority, respect, and expertise at each operational level. Security forces must be engaged. Commitment and a real sense of urgency will be most effectively achieved with a PHEIC. We call on the major donors (BMGF, United States Agency for International Development, ADB, the US military) and other philanthropists/donors to fulfill the need for efficient funding. In this chapter, we have proposed the methodology to achieve elimination of the nearly incurable malaria parasites "East of Bangkok" near the WHO target of 2020 [24]. With the currently available tools, each partially effective, but when used together with smart phone-based quality monitoring of appropriate use in the actual transmission areas—we believe the mission can be accomplished near the target date. We call for the critical actions, focusing resources to where they will have most impact to help prevent the next pandemic.

We wish to thank NIMPE and Phu Yen Provincial Health leadership and staff for planning executing the work described in Vietnam (especially Professor Duong Thanh Tran, Dung

**6. Conclusion/call to action**

66 Towards Malaria Elimination - A Leap Forward

**Acknowledgements**



[2] Alonso P, Noor AM. The global fight against malaria is at crossroads. The Lancet.

Preparing for the Next Global Threat: A Call for Targeted, Immediate Decisive Action…

http://dx.doi.org/10.5772/intechopen.78261

69

[3] Garcia R, Hewitt S, Tulloch J. Report of the Mid-Term Review of the Global Fund

[4] Ives M, McNeil D. As malaria resists treatment, experts warn of global crisis. In: The

[5] Imwong M, Hien TT, Thuy-Nhien NT, Dondorp AM, White NJ. Spread of a single multidrug resistant malaria parasite lineage (PfPailin) to Vietnam. The Lancet Infectious

[6] Plowe CV. The Danger of Untreatable Malaria Is Real and Present. In: CfSaI S, editor.

[8] Ohrt C, Ngo TD, Bui PQ, Bertrand W, Pham HQ, Nguyen ND, et al. Emerging incurable malaria in Southeast Asia–A call for targeted, decisive action in the region. American

[9] Ohrt C. Preparing for the next global threat–A call for targeted, decisive action now in Southeast Asia to prevent the next pandemic in Africa. Joint International Tropical

[10] Houston S, Houston A. Screening and treating UN peacekeepers to prevent the introduction of artemisinin-resistant malaria into Africa. PLoS Medicine. 2015;**12**:e1001822.

[11] Cambodia marks 10th anniversary of peacekeeper deployment Royal Embassy of Cambodia to UK, Denmark, Finland, Ireland, Norway, Sweden, Ethiopia and African Union; 2016

[13] Van Hong N, Amambua-Ngwa A, Tuan NQ, Cuong Do D, Giang NT, Van Dung N, et al. Severe malaria not responsive to artemisinin derivatives in man returning from Angola to Vietnam. Emerging Infectious Diseases. 2014;**20**:1199-1202. DOI: 10.3201/eid2007.140155

[14] Trape JF. The public health impact of chloroquine resistance in Africa. The American

[15] Verdrager J. Localized permanent epidemics: The genesis of chloroquine resistance in *Plasmodium falciparum*. The Southeast Asian Journal of Tropical Medicine and Public

[16] malERA refresh consultative panel on insecticide and drug resistance. malERA: An updated research agenda for insecticide and drug resistance in malaria elimination and eradication. PLoS Medicine. 2017;**14**:e1002450. DOI: 10.1371/journal.pmed.1002450 [17] Greenwood BM, Fidock DA, Kyle DE, Kappe SH, Alonso PL, Collins FH, et al. Malaria: Progress, perils, and prospects for eradication. The Journal of Clinical Investigation.

[12] Sovuthy K. Peacekeeper dies from malaria in Mali. In: Cambodia Daily. 2015

Journal of Tropical Medicine and Hygiene. 2001;**64**:12-17

2008;**118**:1266-1276. DOI: 10.1172/JCI33996

Society of Tropical Medicine and Hygiene Annual Meeting, Abstract 1561. 2016

2017;**390**:2532-2534. DOI: 10.1016/S0140-6736(17)33080-5

New York Times. 2017

Regional Artemisinin Initiative (RAI). Geneva: Global Fund; 2015

Diseases. 2017;**17**:1022-1023. DOI: 10.1016/S1473-3099(17)30524-8

[7] Gates B. What it takes to wipe out malaria. In: Gatesnotes. 2014

Medicine Meeting, Bangkok, Thailand; 2016

DOI: 10.1371/journal.pmed.1001822

Health. 1995;**26**:23-28

Washington, DC: Center for Strategic and International Studies; 2014
