Malaria is on the rise in northeastern Cambodia — and it’s becoming increasingly drug-resistant. Although Southeast Asia accounts for just 7% of malaria cases worldwide, it has a notorious history as the breeding ground for strains of malaria parasites that survive every drug thrown at them — and spread. If resistance to the latest gold-standard cure for malaria hits Africa, deaths will skyrocket. Already, the disease kills roughly half a billion people every year. In 2015, the governments of Cambodia, Thailand, Vietnam, Laos and Myanmar pledged to eliminate the malaria parasite Plasmodium falciparum from the region by 2025.
I traveled to three of these countries to see how the effort is going. What I found worried me. Researchers had recently discovered that diagnostic tests only detect a small fraction of symptomatic cases. More sensitive tests revealed that entire populations carried parasites in their blood. Finding and treating these asymptomatic cases will be logistically difficult and expensive.
That’s even truer in separatist states that have long resisted Burmese rule, where health systems are virtually non-existent. The situation in Cambodia is fraught as well. Health workers stationed in rural villages expanding into lush forests where told me they frequently stock out of malaria drugs. This contributed to the rise in cases last year. My feature for Nature explores how researchers in the region are trying to approach political and financial hurdles through science. For instance, in different parts of Myanmar, research teams are documenting different ways to treat people with asymptomatic malaria. They are pushing ahead, despite the odds, because not doing so threatens the world.