Monitoring Drug Resistant Strains of Malaria Utilizing Genomic Sequencing

We are continuing our new series, Media Day, where we spotlight individual medical institutions and infectious disease (ID) programs. We are highlighting clinicians and researchers from the University of North Carolina (UNC)’s Institute for Global Health and Infectious Diseases (IGHID).

The Democratic Republic of Congo (DRC) has one of the highest infection rates of malaria in the world. “The World Health Organization estimated there were more than 30 million malaria cases and over 80,000 deaths in the DRC in 2021, mostly in young children,” Jonathan Parr, MD, MPH, assistant professor of medicine in infectious diseases, UNC, said in a news release.¹

In 2023 the sub-Saharan African region accounted for 94% of all malaria cases and 95% of deaths. And children under 5 years of age accounted for about 76% of all malaria deaths in this part of the world. Over half of these deaths occurred in 4 countries: Nigeria (30.9%), the Democratic Republic of the Congo (11.3%), Niger (5.9%) and United Republic of Tanzania (4.3%).²

Compounding this major public health issue is the increasing number of drug-resistant strains of the vector-borne disease.

With this ongoing serious disease burden, Parr and his UNC team has been involved in a project sequencing genomes of drug-resistant malaria parasites in the DRC.

In 2023, the UNC School of Medicine’s Institute for Global Health and Infectious Diseases received a $2.9 million grant for malaria surveillance for its DRC séquençage du paludisme (PaluSeq) Program, a state-of-the-art country-wide monitoring program for antimalarial drug-resistance mutations. The grant also builds capacity for ongoing research in the DRC.¹

“Unfortunately, now we're seeing pockets of parasites emerge in multiple countries with resistance mutations to these very important drugs,” Parr told Contagion. “So with that in mind, and working with our partners in the Congo, we were able to establish this PaluSeq project, which is intended to establish a monitoring system for these drug-resistant strains. This work is complex but really satisfying, because we are taking cutting edge methods in the lab and not only attempting to use them here in the United States, but also apply them on the ground in the Congo.”

“We are now scaling up sequencing of malaria parasites and generating report cards for the malaria control program that show exactly where parasites with these mutations are found at what frequency, and allowing them to use that information to make smart decisions,” Parr said. “Right now, we don't have alternative therapies for these strains of malaria, but there are new drugs in development, and there are some creative ways that programs can respond to try to push these parasite strains down and keep them from spreading.”

And as mentioned in previous Media Day interviews with UNC clinicians and researchers, what happens globally can impact surveillance and public health approaches to disease states here in the US. Malaria is a good example of this. Although most US cases of malaria are in individuals who have traveled overseas and contracted the disease in other countries, there are handful of locally-acquired cases emerging in the US the last few years.

“I would say that we don't need to panic,” Parr said of malaria in the US. “We have seen increasing cases of malaria in the far south of the United States. All of us are monitoring this closely, but I think very close public health monitoring and awareness of these cases, especially in the context of changes in temperature, changes in climate, changes in mosquito populations, is very important to be aware of —what threats are out there and to be prepared to respond to them.”

In terms of his career path, Parr was attracted to UNC because it offered him this hybrid of combining field work and the latest lab technology.

“One of the reasons I moved to UNC was actually to join a group like this, where I could do a combination of field work or epidemiology, where we're collecting data on communities and people, how they suffer from infectious diseases, how our treatments work, and combine that with cutting edge work in the lab,” Parr said. “I'm constantly looking for projects where we can do high impact work, specifically in the molecular epidemiology space, and by that I mean high throughput PCR sequencing, cutting edge technologies that allow us to study how pathogens evolve, how pathogens move, and how they respond to control measures that we put in place.”

In the next episode, UNC's David Margolis, MD, discusses his team’s work on HIV cure treatments.

References
1. UNC School of Medicine’s Institute for Global Health and Infectious Diseases Receives $2.9 Million Capacity Building Grant for Malaria Surveillance in the Democratic Republic of the Congo. UNC. April 25, 2023. Accessed September 2, 2025.
https://globalhealth.unc.edu/2023/04/unc-school-of-medicines-institute-for-global-health-and-infectious-diseases-receives-2-9-million-capacity-buildig-grant-for-malaria-surveillance-in-the-democratic-republic-of-the-congo/
2. Malaria. WHO. December 11, 2024. Accessed September 2, 2025. https://www.who.int/news-room/fact-sheets/detail/malaria