Malaria control and the evolution of drug resistance: an intriguing link

Abstract

Does antimalarial drug resistance evolve faster in areas of high or low transmission? Suggestions that resistance evolves faster in areas of low transmission cast a cloud over control measures, such as bednet provision and insecticide spraying, by implying that their impact could be offset by the enhanced evolution of drug resistance. Theoretical analyses are ambivalent on this question, but a recent field study has attempted to measure the relationship empirically, and has generated some intriguing data: antimalarial drug resistance could be inhibited in the early stages of control programmes, only starting to resurge as the disease nears eradication.