Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

No one knows exactly why resistance to malaria drugs always emerges first in this remote western province of Cambodia, nestled in the Cardamom Mountains. “The reasons are as much social as biological,” says malariologist Tom Peto, who is here in this dusty, unremarkable-looking town battling the latest threat to global malaria control: multiple drug–resistant (MDR) malaria.

Young man behing a mosquito nest, in Southeast Asia
Migrant workers such as this man in Pailin, Cambodia, near the border with Thailand, are at especially high risk of contracting malaria. Jeffrey Lau

PAILIN, CAMBODIA—Whatever the reason, this is where it starts. Resistance to chloroquine surfaced here in the 1950s before sweeping through the wider Mekong region and then into India and Africa, causing millions of deaths. Sulfadoxine-pyrimethamine went next, in the 1960s. Mefloquine failed in the 1970s.

Then in late 2008 and 2009 came reports that rocked the malaria world: Artemisinin, the so-called wonder drug that has sent malaria deaths plummeting across the globe over the past decade, was losing its effectiveness here. That sparked global alarm and prompted an ultimately futile emergency plan to contain resistance in Cambodia before the last, best drug was lost.

Now, Pailin is the epicenter of what some say is the greatest threat yet to malaria control: the deadliest malaria parasite, Plasmodium falciparum, has become resistant not only to artemisinin, but to a key partner drug, piperaquine, or PPQ, that is used in combination with artemisinin and is critical to its success. The emergence of this MDR parasite is raising the specter of untreatable malaria in the Mekong region and perhaps beyond.

Similar stories

Global Research on AntiMicrobial resistance (GRAM) project

Antimicrobial resistance (AMR) is responsible for at least 1.27 million deaths per year — with over 97,000 deaths in 2019 in SE Asia alone, according to a study published in The Lancet by the Global Research on AntiMicrobial resistance (GRAM) project, who urged urgent action from policymakers and health communities to avoid further preventable deaths.

Susie, Phaik Yeong, Richard and Paul among new full Oxford professors!

In the 2021 Oxford Recognition of Distinction round, four MORU colleagues were awarded Full Professor title.

All-nighter: staying up to fight malaria

Featured in Nature, Victor Chaumeau collects mosquitoes in Myanmar to better understand how to control malaria.

Antibiotic accountability: how countries and companies perform

Patients in north Africa and the Middle East are using antibiotics in sharply rising quantities far beyond the global average, raising concerns over the escalating risks of resistance to medicines to treat bacterial infections. Estimated antibiotic consumption for 204 countries between 2000 and 2018 shows a 46 per cent increase in global antibiotic usage, with a surge in nations including India and Vietnam.

New! A learning framework about antimicrobial resistance for children and young people

A downloadable resource for educators, health & research professionals to help develop young peoples’ understanding of AMR and positive actions they can take to mitigate it.

Overusing antibiotics? Find out with Antibiotic Footprint Calculator

To mark WHO World Antimicrobial Awareness Week, 18-24 Nov 2021, and help reduce the overuse of antibiotics, MORU researchers have released a new, easy to use online tool – Antibiotic Footprint Calculator – that could make an important contribution in the fight against antimicrobial resistance (AMR), one of the world’s most significant emerging threats to public health.