The last decade has seen unprecedented improvements in global malaria control. Current estimates suggest that, worldwide, malaria-attributed deaths (that occur mostly in young children) have fallen by 47 % since 2000 [
1]. Therefore, many millions of today’s young people owe their lives to this progress. A key to this success has been improved availability of safe, highly effective antimalarial drugs. In particular, the rediscovery of the ancient Chinese herbal medicine, artemisinin, has been transformative since it first became widely used in the 1990s [
2]. This remarkable drug class is distinguished by affordability, an excellent safety profile, and potent parasiticidal activity that manifests as a rate of malaria parasite “log kill” an order of magnitude greater than that of previously available drugs. Very early on, artemisinins were recognized as such a precious resource that strenuous efforts were advocated to protect them from the ravages of drug resistance [
3]. This underpinned the rationale for deployment in combination with a second, longer acting partner drug, leading to artemisinin-based combination therapy (ACT). ACTs are now the cornerstone of global malaria treatment policy, being recommended by WHO as the first-line drugs of choice for most of the estimated 198 million annual global cases of malaria illness [
4]. They are recognized as vital tools for over 35 countries that have now set nationwide elimination as the explicit objective of their malaria programs [
1]. ACTs may therefore yet play a significant role in the audacious goal of eventual complete global malaria eradication [
5].
Sub-Saharan Africa carries the world’s greatest burden of
Plasmodium falciparum and has seen some of the world’s greatest gains in malaria control, including an estimated 54 % reduction in mortality since 2000 [
1]. However, optimism here has been tempered firstly by the recent advent of high-level insecticide resistance in African mosquito vectors and secondly by the alarming emergence and spread of artemisinin-resistance in South-East Asia [
1,
6]. Were artemisinin resistance to also arise in Africa, the consequences could be catastrophic. This could occur if South-East Asian
P. falciparum strains found their way to Africa, or as is perhaps more likely, if resistance were to arise
in situ in Africa as a separate independent event. The lessons from South-East Asia are sobering. Delayed early parasite clearance was first reported in the Pailin region of Western Cambodia in 2008 [
7]. By 2014, gene mutations associated with this resistant phenotype were already present in five South-East Asian countries and appeared close to encroaching on the Indian sub-continent [
6]. Resistance has also now developed in ACT partner drugs, presumably because they effectively became unprotected monotherapies once the artemisinin component had been compromised [
8,
9]. This has occurred despite unprecedented levels of international financial assistance being mobilized to attempt to contain the spread of resistance from as early as 2008. Robust mechanisms for early detection and prompt response are necessary to avert such a scenario unfolding in Africa.