Malaria in the Greater Mekong Subregion (GMS) of Southeast Asia remains an important public health
problem. There is immense spatial heterogeneity in malaria distribution, with Myanmar having the highest
regional malaria burden. Highly mobile populations crossing porous international borders are a major
contributor to parasite introduction and continued transmission. The recent emergence of resistance to the
artemisinin (ART) family of drugs as well as to their partner drugs raised global concerns. The vectorial system
is highly diverse, and increased outdoor biting and development of insecticide resistance have rendered the
two core vector control interventions – insecticide-treated nets and indoor residue spray less effective.
Furthermore, falsified and substandard ART-based combination therapies (ACTs) have become a global crisis.
Therefore, the central goal of this program is to improve our understanding of how mobile human populations,
parasite drug resistance, and mosquito biology contribute to continuous malaria transmission at international
borders so that innovative control strategies can be developed to propel the course of regional malaria
elimination. To achieve this overarching objective, we have selected study sites in the international border
regions of three GMS countries, Myanmar, China, and Thailand, with drastically different malaria epidemiology
to conduct comprehensive research on humans, vectors, and parasites in four interrelated projects. In Project
1, the foundation of the whole program, we will conduct malaria surveillance, monitor human migration and its
impact on parasite introduction, and evaluate the effectiveness of the current treatment of the predominant P.
vivax malaria. Project 2 will study how environmental changes affect mosquito community structures and
malaria transmission, identify whether behavioral changes of major vectors are genetically determined, and
determine the extent and mechanisms of insecticide resistance in malaria vectors. In Project 3, we will address
the emerging problem of resistance of P. falciparum to both the ART family of drugs and partner drugs through
molecular studies of resistance mechanisms and by tracking resistance spread in the GMS. Finally, we want to
develop monoclonal antibody-based immunoassays to detect both active ingredients in an ACT, and use our
newly developed point-of-care dipstick assays for large-scale assessment of the extent of problem of the
falsified and substandard ACTs in the GMS countries using a stratified random sampling approach. This
program, built on the scientific achievements of the current ICEMR program and the strong network of
international collaborators, aims to dissect the complex interactions between migrant human populations,
diverse mosquito vectors, MDR parasites, and falsified and substandard ACTs, which are responsible for
continued malaria transmission along international borders. These scientific questions are not only pertinent to
the GMS nations, but are also applicable to other malaria regions. Therefore, findings from these studies will
bear far-reaching impacts on global malaria elimination.