Tell me a bit about yourself.
I’m trained as an infectious diseases and intensive care physician, and developing ICU [intensive care unit] care in developing countries is an interest of mine. I’ve been living here, in Bangkok, for the last 15 years. During that time, I’ve mainly been doing research on both uncomplicated and severe falciparum malaria, a disease that requires intensive care in hospital. Over the last ten years or so, I’ve developed a strong interest in antimalarial drug resistance, which is an increasing problem here in the region – again.
Despite recent declines in the number of cases worldwide, malaria remains a public health concern with 3.2 billion people still at risk of infection globally.  Fortunately, malaria is a treatable disease - artemisinin is an effective and potent drug recommended for treatment of uncomplicated malaria cases in most parts of the world. However, the success of this frontline drug is threatened by emerging resistance.
Despite huge efforts to treat and eradicate the disease, in 2015, 214 million people were infected with malaria. 438,000 died. More than 292,000 of those deaths were African children aged under five. Treatment is complicated by the fact the malaria parasite develops resistance to antimalarial drugs.
Despite huge efforts to treat and eradicate the disease, in 2015, more than 200 million people were infected with malaria. Nearly half a million people died. The current frontline treatment for malaria is a drug called artemisinin but treatment is complicated by the fact that the malaria-causing parasite Plasmodium falciparum is exceptionally good at developing resistance to antimalarial drugs.
Can you tell us a bit about the malaria situation in Sri Lanka and how it has changed?
When I joined the University of Colombo as a Lecturer in 1989, malaria was a major problem with around 400,000 cases per year. But there’s been a drastic reduction since 2000 with no evidence of local transmission in Sri Lanka since 2012. So, according to the World Health Organization criteria, Sri Lanka has fulfilled the requirements to be certified as a malaria-free country.
About the crosses
Resistance to the widely used antimalarial drug artemisinin is spreading in Southeast Asia and is likely to be around the corner for Africa. It could reach us very quickly or it could emerge locally.
We don’t want to be surprised by it and we don’t want to be banging our heads against the wall trying to figure out how to deal with it when it comes. We need to be prepared.
Can you tell us a bit about the Plasmodium Diversity Network Africa? What made you want to get involved?
Malaria causes one in ten of all deaths among children in sub-Saharan Africa, with more than 600,000 dying each year from over 200 million reported cases.
Although the number of deaths is staggeringly high, this is a mortality rate of only 0.3%. Early diagnosis and proper treatment are crucial to prevent death, but it is known that some individuals naturally resist malaria severity.