Over the past 15 years, there has been an unprecedented 40% reduction in malaria morbidity and mortality, predominantly attributed to the wide-scale introduction of bed nets and the artemisinin-based combination therapies, re-invigorating goals of malaria elimination [1]. Artemisinin-based drugs are now the mainstay for malaria treatment globally, and hundreds of millions of clinical treatments for malaria rely on these drugs. A recent alarming development has been the emergence and spread of artemisinin drug resistance in the Greater Mekong Subregion and concern that resistance will spread globally. In response, the World Health Organization’s (WHO) priority strategic goal is to eliminate malaria in the Greater Mekong Subregion by 2030, in order to stop the spread of artemisinin drug resistance from the region to South-east Asia, Africa, and beyond.
The level of naturally acquired immunity in a population has the potential to mask and drive the emergence of antimalarial drug resistance in populations. In this talk I will present immunological, clinical and epidemiological data demonstrating the key role of immunity in the transmission and spread of malaria and drug resistance in the Greater Mekong Subregion and discuss implications on strategies to achieve malaria elimination in this region.