In the challenging landscapes of Cambodia, Lao PDR, Myanmar, Thailand and Viet Nam, an innovative project is making significant strides against malaria. The GenRe-Mekong project, launched in 2017 with support from the Global Fund, has progressed in the region, providing national malaria control programs (NMCPs) with cutting-edge genetic surveillance to guide their battle against malaria.
The main goal of the GenRe-Mekong project is collecting and analysing malaria parasite genetics to support NMCPs’ decision-making in activities relevant to malaria elimination efforts. By establishing a comprehensive surveillance network, the project collects dried blood spot samples from patients at health facilities across malaria-endemic regions. These samples are processed through the advanced SpotMalaria platform, generating crucial data that inform NMCPs about the rapid changes in the genetic landscape of malaria. This includes tracking the spread of drug-resistant strains, understanding gene flow between populations, pinpointing the geographic origins of parasites, and characterizing outbreaks.
Supporting decision-making in malaria elimination efforts
In Viet Nam, genetic surveillance results led to a significant update in national drug policy. The Ministry of Health, supported by GenRe-Mekong’s evidence, introduced artesunate–pyronaridine as the primary treatment in four provinces, including Dak Lak, where artemisinin resistance was first reported by the project in 2018. Similarly, in Lao PDR,GenRe-Mekong’s findings assisted the authorities in deciding against adopting piperaquine/dihydroartemisinin (DHA/PPQ) and instead choosing treatments better suited to local resistance patterns in the lower zone of southern Lao PDR.
These interventions have strengthened collaboration between NMCPs and GenRe-Mekong. For example, the Lao NMCP called for an investigation into a 2020 outbreak in Attapeu, highlighting the trust and reliance on the project's expertise.
Empowering local expertise
To accelerate the integration of the resulting data into public health decision-making processes and effectively translate genetic data into actionable public health strategies, GenRe-Mekong invests in building local capacity. In May 2023, the project hosted the GRC Data Analysis Training, equipping NMCP officers and scientific partners with skills to interpret genetic data using tools like the grcMalaria R software and interactive web tools. These tools transform complex genetic information into meaningful graphical visualizations, assisting NMCPs in decision-making.
Dr Nguyen Thanh Thuy Nhien, Vice Head of Malaria Research at the Oxford University Clinical Research Unit (OUCRU) said, “This was an interesting workshop that provided a fundamental introduction to NMCP officers and scientific partners to get familiar with mapping drug resistance data from Genetic Reported Cards using R.”
Moreover, a knowledge-sharing workshop in Quy Nhon, Viet Nam, in September 2023, brought together about 100 field staff, while a hybrid scientific forum in Bangkok in December 2023 gathered over 24 participants, including NMCP representatives, funders, and scientific partners from across the world. These events foster a collaborative spirit, essential for regional malaria elimination efforts.
“It was a pleasure to participate, meet the country representatives, and learn about the wonderful malaria genomic surveillance work conducted in the Greater Mekong Subregion. It was also great to hear about the work of your international collaborators,” said Dr Estee Torok, Senior Program Officer, Global Health – Malaria, The Bill & Melinda Gates Foundation (BMGF).
The GenRe-Mekong Project's ongoing support in malaria control and elimination
As the number of Plasmodium falciparum (Pf) cases decline, the malaria landscape in the Greater Mekong Subregion is evolving. The GenRe-Mekong project is adapting to these changes by exploring more flexible data collection methods, especially as the location and volume of malaria cases become increasingly unpredictable. Outbreak analysis and labelling of imported cases are becoming increasingly critical. Moreover, the project is expanding its focus to include other Plasmodium species, such as P. vivax (Pv), P. malariae (Pm), and P. knowlesi (Pk), emerging as significant threats.
GenRe-Mekong continues to commit in supporting NMCPs in their malaria elimination efforts. The project is set to start processing Pv in 2024. As the Greater Mekong Subregion is closer to eliminating malaria, the ongoing genetic surveillance and tailored support provided by GenRe-Mekong will be crucial in addressing the evolving challenges in malaria control and elimination.
