US experts are raising the alarm over the spread of drug-resistant malaria in several Southeast Asian countries, endangering major global gains in fighting the mosquito-borne disease that kills more than 600,000 people annually.
While the communicable disease wreaks its heaviest toll in Africa, it's in nations along the Mekong River where the most serious threat to treating it has emerged.
The availability of therapies using the drug artemisinin has helped cut global malaria deaths by a quarter in the past decade.
But resistance to it emerged on the Thai-Cambodia border in 2003 and has since been confirmed in Vietnam and Myanmar.
It has also been detected in southwest China and suspected as far away as Guyana and Suriname, according to a new report by the Center for Strategic and International Studies think tank.
The report warns that could be a health catastrophe in the making, as no alternative anti-malarial drug is on the horizon.
The UN World Health Organization, or WHO, is warning that what seems to be a localised threat could easily get out of control and have serious implications for global health.
"Absent elimination of the malaria parasite in the Mekong, it is only a matter of time before artemisinin resistance becomes the global norm, reversing the recent gains," wrote Dr. Christopher Daniel in the report for a conference at the Washington think tank.
Mosquitoes have developed resistance to antimalarial drugs before.
It happened with the drug chloroquine, which helped eliminate malaria from Europe, North America, the Caribbean and parts of Asia and South-Central America during the 1950s.
Resistance first began appearing on the Thai-Cambodia border, and by the early 1990s it was virtually useless as an antimalarial in much of the world.
The Center for Strategic and International Studies is advocating greater US involvement and aid for health and fighting malaria in the Mekong region, particularly in Myanmar, where about 70 per cent of its 55 million people live in malaria-endemic areas.
The centrist think tank argues that can increase America's profile in Southeast Asia in a way that will benefit needy people and not be viewed as threatening to strategic rival, China.
Myanmar's public health system is ill-equipped to cope, as government spending on health dwindled to the equivalent of just 60 US cents per person under military rule, although it has been increased significantly under the quasi-civilian administration that took power in 2011.
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