Every year, thousands of workers arrive at the sapphire and ruby mines of Pailin, Cambodia, risking their lives to unearth gems in the landmine-ridden territory. Soon, however, they could be the ones to put millions of others at risk. On the Thai-Cambodian border, a rogue strain of malaria has started to resist artemisinin, the only remaining effective drug in the world’s arsenal against malaria’s most deadly strain, Plasmodium falciparum. For six decades, malaria drugs like chloroquine and mefloquine have fallen impotent in this Southeast Asian border area, allowing stronger strains to spread to Burma, India and Africa. But this time there’s no new wonder drug waiting in the wings. “It would be unspeakably dire if resistance formed to artemisinin,” says Amir Attaran, a professor of law and medicine at the University of Ottawa who has written extensively on malaria issues.
Malaria strikes about 250 million people around the world every year and kills nearly a million. The mosquito-borne parasite is the third deadliest infectious disease in the world, after HIV/AIDS and tuberculosis, and most of its victims are children. With the help of tens of millions of dollars from the Bill and Melinda Gates Foundation and various governments, the global health community from biochemical engineers in Berkeley, Calif., to village volunteers in Battambang, Cambodia is racing to eliminate the increasingly resistant parasite before it’s too late. This week, the Global Fund signed off on a $220 millionplus project called the Affordable Medicines Facility for malaria , a controversial two-year program that will drop the price of the recommended malaria treatment in nine malarial countries. In Cambodia, the only country in Asia participating in the program, the price of malaria medication will fall to only $0.05 per dose for distributors. Even with markups down the supply chain, the best malaria medicine will, for the first time in Cambodia, also be the cheapest.