ACTs—artemisinin-combination therapies—are the current standards in first-line malaria treatment for all but severe cases.  Since the loss of chloroquine—after nearly 50 years of effectiveness—to the spread of drug resistant strains of the malaria parasite, the message has come home that the artemisinins—the backbones of ACTs—must be protected from resistance development.  That has led to the now-accepted dictum that artemisinins only be used when combined in a single pill (or liquid) with another effective antimalarial.  
CDDEP researchers have contributed to understanding the degree of protection that ACTs would provide in comparison with artemisinin monotherapy.  They also have been intimately involved with the establishment of a financing mechanism—the Affordable Medicines Facility-malaria (AMFm)—to expand financial access to ACTs, unique because it acknowledges and builds on the role of the private sector in supplying malaria drugs.  


This article examines what is known about how resistance to antimalarial drugs emerges and spreads, and reviews various strategies for controlling the spread of resistance.