Use of marker classification to guide surveillance and research

Supporting decision making in molecular surveillance

The "Compendium of molecular markers for antimalarial drug resistance" is designed to support decision-making in both routine molecular surveillance and targeted research activities.

Each classification level reflects the types of evidence linking a genetic alteration to antimalarial drug resistance. Prioritization for monitoring should also consider the antimalarial medicines currently in use or under review in each country to ensure national relevance.

Validated markers

These markers are supported by laboratory and clinical evidence, and in some cases, by genetic epidemiological data. They represent the strongest case for an association with drug resistance and should be given the highest priority in molecular surveillance.

Candidate markers

Candidate markers are supported by a demonstrated laboratory or clinical association with resistance and epidemiological evidence on their presence and potential for spread. They are suitable for enhanced surveillance and should be prioritized for validation studies to confirm causality and monitor their spread.

Potential markers

These are supported by a single domain of evidence (laboratory, clinical, or epidemiological) and represent early warning signals. They are important targets for further research, including functional assays, clinical evaluations and population-level monitoring.

An evolving system

The classification system is intended to evolve. As new data become available from field studies, therapeutic efficacy trials, and laboratory investigations, new markers may be added, and existing markers may be reclassified to reflect improved understanding of their role in resistance. This evidence-based and adaptive framework for reviewing new studies allows ongoing integration of the most recent data to support molecular marker surveillance and informed decision-making.