The ability of the malaria parasite to shrug off the effects of artemisinin has been spreading since it emerged in South East Asia.
Tests, published in Lancet Infectious Diseases, now show this resistance on the verge of entering India.
Experts said the development was “alarming”.
Deaths from malaria have nearly halved since 2000, and the infection now kills about 584,000 people each year.
But resistance to artemisinin threatens to undo all that hard work, and it has been detected in:
- Myanmar, also known as Burma
Blood samples from 940 people with malaria from 55 sites across Myanmar showed this resistance was widespread across the country.
One site, in the Sagaing region, showed that resistant parasites were just 25km (15 miles) from the Indian border.
One of the researchers, Dr Charles Woodrow, from the Mahidol-Oxford Tropical Medicine Research Unit, in Thailand, told the BBC News website: “We can see artemisinin resistance is clearly present quite close to the Indian border, that’s clearly a threat and in the future is likely to lead to extension of the problem to neighbouring areas.”
Artemisinin is normally given as part of combination therapy.
Initially the other drug will pick up the slack to keep the combination effective, but Dr Woodrow says this resistance will “inevitably” lead to it failing.
“If this were to spread into India, malaria will continue to affect rural populations there, but there may not be an immediate effect on cure-rate,” he said.
“But beyond the short term, there is very likely to be a problem, and there are very few [other] drugs on the table.”