A Beacon of Hope
Thailand’s data-driven fight against drug-resistant malaria
As a park ranger, Chokchai Phichitpatapee patrols Thailand’s Salawin National Park both day and night, often sleeping in the forest. If he forgets to bring a mosquito net or apply his mosquito repellent, he’s vulnerable to malaria. He has already been infected twice.
In both cases, health workers diagnosed and treated him, following up four times to take blood samples and checking the stickers on his medicine pack to ensure he took the complete course of medicine. They also took blood samples from villagers surrounding the park to find any additional malaria cases in the area.
“We didn’t know that malaria medicine needs to be taken completely even if symptoms are gone,” said Chokchai. “If the malaria worker had not followed up with me and the people around here, we would not have been cured.”
These follow-ups and testing are part of Thailand’s integrated drug efficacy surveillance (iDES) system, which expanded into national policy with USAID’s support in 2017. Through the U.S. President’s Malaria Initiative (PMI), USAID has been helping Thailand’s Division of Vector-Borne Diseases (DVBD) develop innovative methods for early detection of drug resistance and response that serve as a beacon of hope in the fight against malaria.
Thailand is the first country in the Greater Mekong Subregion to pilot and implement this approach, which incorporates drug resistance monitoring as part of routine malaria surveillance and response.
The end goal? Every single person that gets malaria is treated, monitored, and cured.
Ensuring Effective Drugs to Get to Zero Malaria
Thailand has made incredible progress against malaria over the past decade. With an 88% decline in malaria cases since 2012 and a 75% decline in the number of villages with malaria transmission, the country is well on its way to reaching its goal of eliminating malaria by 2024.
However, Thailand faces a constant threat on this journey: waning efficacy of the drugs used to treat malaria (namely, artesunate-mefloquine and dihydroartemisinin-piperaquine). The region has been the epicenter of emerging resistance to malaria drugs since the 1950s, with resistance first detected along Thailand’s border with Cambodia then spreading to other countries. Even as countries have adjusted and developed new drugs, the malaria parasite continues to mutate and develop resistance to the latest front-line treatments, threatening global health security and putting millions at risk.
Through iDES, Thailand’s national malaria program can capture and monitor data on drug efficacy all over the country during regular diagnoses and treatment processes — as opposed to only being able to access limited data from certain areas.
This is a big win for being able to quickly identify potential drug-resistant malaria and halt the spread in its tracks.
“Reaching patients like Chokchai to ensure they take all of their medicine and their blood is tested is essential in obtaining the most accurate data we possibly can,” says Dr. Aungkana Saejeng, who leads a team of scientists devoted to studying and monitoring drug-resistant malaria at DVBD’s national lab outside of Bangkok.
USAID has supported drug efficacy monitoring in Thailand and the region since 2000, and the iDES approach is now being trialed in neighboring Cambodia, Laos, and Vietnam.
A Strong Surveillance System is Key
Thailand’s comprehensive case-based malaria surveillance system is the backbone of combating drug resistance and eliminating malaria in the country. It supports a resilient health system that can quickly detect and respond to infectious disease threats, including COVID-19.
PMI supported the launch of Thailand’s 1–3–7 surveillance strategy to help ensure that every single malaria case triggers a complete set of actions to prevent further spread.
PMI also supported Thailand’s national malaria program in collating both patient data and drug resistance data into Malaria Online, a single national database. Now health workers from the national to village level can access information and user-friendly dashboards to monitor changes and interpret trends in their specific region.
From Dashboards to Policy
Recently, Thailand was able to use its wealth of surveillance data to develop evidence-based policy.
Between 2018 and 2019, two provinces in Eastern Thailand accounted for just 14% of the deadliest strain of malaria cases but 67% of patients still testing positive after treatment. This analysis led the DVBD, with support from the World Health Organization, to change the recommended treatment in these provinces; patients started receiving a more effective drug, pyronaridine–artesunate, in 2020. Since then, the provinces have seen very few cases — just three in 2020 and zero in 2021.
Going forward, PMI continues to partner with the DVBD to improve the quality and completeness of drug resistance data, simplify and harmonize processes, and train public health staff to take full ownership of the system — ensuring they have the tools they need to carry their country across the malaria elimination finish line.
“I am proud of the work we have done to study and contain the spread of drug-resistant malaria in my country, and hope that others can learn from our experience,” says Dr. Saejeng. “Nobody should have to die from this treatable disease.”
A version of this story originally appeared on pmi.gov.
About the Author
Funded by the U.S President’s Malaria Initiative, Inform Asia supports Thailand in its goal of reaching zero malaria by strengthening malaria surveillance systems, evaluating strategies and tools for malaria elimination, and supporting the national malaria program to generate, analyze, and use strategic information to inform decision-making and policy development.
