Many witnesses have warned us that, although in the United Kingdom prudent use, infection control and surveillance are established to high standards, these efforts are constantly being undermined by the arrival of infections from other lands where standards are lower. The most dangerous type is P. falciparum , the cause of cerebral malaria. There followed a policy gap, during which malaria increased again. The leading first-line drug is chloroquine, which is cheap, easy to take and fast to act. Newer and more expensive drugs are also encountering resistance.
Medicines are available in an uncontrolled way in many developing countries.
High-cost unnecessary drugs are often aggressively marketed in the private sector when they are not yet needed for case management. Consequently, resistance to them may be established by the time that they are really needed. It is difficult to develop an effective licensing policy and to enforce it. Bradley and Warhurst also call for enhanced surveillance of travellers' malaria, with which they are already involved as co-directors of the PHLS Malaria Reference Laboratory. At present, the Laboratory merely confirms the standard diagnosis.