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As the second largest international donor, the UK has been at the forefront of efforts to reduce the number of cases for many years by investing in treatment, prevention and research, including the fight against the threat of drug resistance. The UK has announced further support for the fight against malaria to save more than 120,000 lives ahead of a Malaria Summit tomorrow with Commonwealth leaders.

Bed net apr18 Photo by Alexander Kumar © MORU 2018

18 April 2018 (London) – The United Kingdom’s Department for International Development (DFID) announced that it will commit £9.2 million (USD 13.15 million) of research funding to DeTACT (Development of Triple Artemisinin Combination Therapies), a large multi-centre trial in 5 Asian and 10 African countries that aims to develop two new safe and effective malaria treatments using combinations of existing antimalarial drugs.

The issue is particularly urgent: In September 2017, scientists warned in The Lancet Infectious Diseases that a very artemisinin drug resistant P falciparum malaria “superbug” had spread from western Cambodia to north-eastern Thailand, southern Laos and into southern Vietnam, causing a large increase in treatment failures in malaria patients across the entire Mekong Sub-region and posing a serious threat to malaria control and eradication efforts.

Led by the Bangkok-based Mahidol Oxford Tropical Medicine Research Unit (MORU), a collaboration between Mahidol University, Thailand, and the University of Oxford and Wellcome from the UK, DeTACT will use a comprehensive approach to develop and study in Asia and in African children the safety, efficacy, ethics, economics and acceptability of two co-formulated and co-blistered Triple Artemisinin Combination Therapies (TACTs) – artemether-lumefantrine+amodiaquine and DHA-piperaquine+mefloquine. 

DeTACT arises from the recently completed DFID-supported TRACII (Targeting Resistance to Artemisinin Collaboration II) study, which found that both of the TACTs were well tolerated and safe.

Importantly, TRAC II found that the two TACTs were highly effective against artemisinin combination therapy (ACT)-resistant falciparum malaria, even in Cambodia, Thailand and Vietnam, where antimalarial resistance has led to high failure rates of the DHA-piperaquine ACTs.

“DeTACT is a very important study: Increasing drug resistance in Southeast Asia jeopardizes the treatment of falciparum malaria, a potential fatal disease, and malaria elimination is only possible if we have effective drugs to treat the disease,” said Oxford Prof. Arjen Dondorp, Head of Malaria at MORU and principal investigator for DeTACT.

A young Cambodian man, under a bed net, at home near the woods and fields outside Pailin, where he makes his living. Located in western Cambodia, Pailin is in the area where the latest highly resistant P. falciparum malaria strain originated. Photo by Alexander Kumar/Global Health Photography © 2018 MORU.

“These triple artemisinin combinations therapies (TACTs) can provide an effective and safe malaria treatment, using a combination of already available antimalarial drugs,” said Prof. Dondorp. “We thank DFID and UK Aid for supporting this important work.”

MORU Research Physician Dr Rob van der Pluijm, who coordinated the TRACII study, explained why the TACTs are so important: “Antimalarial resistance is causing great difficulty in treating falciparum malaria in South-East Asia, yet new antimalarials are not expected within the next 4-5 years. TACTs could be a viable way to treat multi-drug resistant malaria and prevent or at least delay the emergence of antimalarial resistance in other parts of Asia and in Africa.”

Announced by UK International Development Secretary Penny Mordaunt ahead of the 18 April 2018 Malaria Summit with Commonwealth leaders in London, the DeTACT funding is part of a £100 million (USD 142.9 million) UK fund to be matched pound for pound by the private sector that will be used to support priority countries with mosquito nets, indoor sprays and strengthening of health systems.