Global investments have had great impact on malaria—these are now at risk of being reversed. Cambodia is where drug resistance historically emerges and spreads globally to drive resulting pandemics—we are currently watching history repeat itself. Despite large investments and recent success in driving down overall rates of malaria, high levels of resistance to nearly all antimalarial drugs are now widespread in Cambodia. Malaria cases are again rising in both Cambodia and Vietnam. Nearly incurable malaria in this region is a real and present threat. Critical actions to prevent further spread of the emerging incurable parasites are: (1) Commitment and real sense of urgency through declaration of a “Public Health Emergency of International Concern” or a similar set of directives; (2) Establish leadership with sufficient authority, respect, expertise and operational funding; (3) Engage affected security forces to stop disease transmission and support elimination operations; (4) Utilize surveillance as a core intervention with result-based funding targeting malaria transmission foci with rapid and effective action. Immediate decisive action is needed in Southeast Asia to prevent the next malaria pandemic. This chapter highlights persistent gaps in the region with methods to address them. In 2015–2016, our collaboration with NIMPE pilot tested tools to intervene in actual forest transmission foci. Our study district saw a 96% decrease in malaria from 2014 to 2017, with the entire province seeing the largest decrease in Central Vietnam in this same timeframe. We describe methods to tackle transmission foci, with both an integrated prevention and treatment package. We call on all stakeholders to make changes to current investments to address this critical challenge.
Part of the book: Towards Malaria Elimination