About 212 million people are infected with malaria each year. It is caused by a parasite that is spread by blood-sucking mosquitoes and is a major killer of children.
The first choice treatment for malaria is artemisinin in combination with piperaquine.
But as artemisinin has become less effective, the parasite has now evolved to resist piperaquine too.
There have now been “alarming rates of failure”, the letter says.
Prof Dondorp said the treatment was failing around a third of the time in Vietnam while in some regions of Cambodia the failure rate was closer to 60%.
Resistance to the drugs would be catastrophic in Africa, where 92% of all malaria cases happen.
‘Against the clock’
There is a push to eliminate malaria in the Greater Mekong sub-region before it is too late.
Prof Dondorp added: “It’s a race against the clock – we have to eliminate it before malaria becomes untreatable again and we see a lot of deaths.
“If I’m honest, I’m quite worried.”
Michael Chew, from the Wellcome Trust medical research charity, said: “The spread of this malaria ‘superbug’ strain, resistant to the most effective drug we have, is alarming and has major implications for public health globally.
“Around 700,000 people a year die from drug-resistant infections, including malaria.
“If nothing is done, this could increase to millions of people every year by 2050.”
The number of NHS mental health staff who have had to take sick leave because of their own mental health issues has risen by 22% in the past five years.
Those taking long-term leave of a month or more rose from 7,580 in 2012-13 to 9,285 in 2016-17, BBC freedom of information requests found.
The union Unite said cuts to staff and services were putting extra pressure on front-line mental health workers.
The Department of Health said it was transforming mental health care.
Out of 81 mental health authorities in England, Scotland, Wales and Northern Ireland, 58 provided the BBC with comparable information.
Looking after ourselves
One mental health doctor who had to take mental health leave told 5 live anonymously: “I don’t think I realised it was happening until quite a long way down the road.”
She explained that she was getting irritable with her partner, her sleep was disturbed and she couldn’t switch off from work.
“In the end, I went to my GP who offered me a sick note. I was quite taken aback that it was quite so obvious to my GP that I needed to be off work.” she said.
“As mental health practitioners, we are pretty rubbish at putting our own mental health first. You need to put your own oxygen mask on first before putting it on to someone else.”
5 live also spoke to a group of community mental health nurses at the Leeds and York Partnership NHS Foundation Trust about how they cope with the pressure of the role.
“I think when you’re so passionate about something it’s very easy to overlook just how much you are taking on,” said Kate Ward, an occupational therapist working as a care co-ordinator in the team.
She said it was important for staff to understand what their thresholds are, recognising the early signs of their resilience getting chipped away.
“We think we are this person that can help everybody, but we have to remember that we have to help ourselves sometimes,” Julie Poole, a community mental health nurse, explained.
Dave Munday, mental health professional lead at union Unite, which represents 100,000 health workers across the UK, said: “These figures are of real concern and they only tell part of the story.
“We know that many more mental health professionals will feel unwell but try to ‘soldier on’ or mask the real reason they’re taking leave.
“Our members tell us workplace stress is increasing and that cuts to staff and services mean they’re working longer hours with fewer resources.
“Staff themselves are feeling the impact of austerity and there’s a lack of trust in the often repeated but not fulfilled promises of the current government.”
Not good enough
A spokesman for the Royal College of Nursing said: “Mental health staff face unique challenges. The pressure to make the right decision and provide care for extremely vulnerable people against a backdrop of staff shortages, can take its toll on their health and wellbeing.
“More than 40,000 mental health staff are assaulted every year, and too often violence is seen as ‘part of the job’ by employers, and the authorities.
“This isn’t good enough. We want to see action on work-related stress, including violence at work which, as well as physical injuries, adds to burnout stress, and depression.”
The Department of Health said: “We are transforming mental health care for everyone in this country, including NHS employees, with record amounts of investment.
“There is more to do – that is why we are undertaking one of the largest expansions of mental health services in Europe, so that all staff have the time to look after themselves as well as others.”
Aimee Leigh Smith worked as a mental health nurse for 17 years. Earlier this year she left her job. She told BBC 5 live that the “stress and burnout” was taking its toll on her family life and her mental health.
“I came home and sat on my couch, I fell to the side and I felt like I couldn’t get back up again” she said.
BBC 5 live have found that NHS mental health staff taking long-term sick leave because of their own mental health issues has risen by 24% in the past five years.
Aimee Leigh said: “The managers are burnt out, the staff are burnt out.
“Mental health workers are absolutely taking on what their patients are experiencing, and starting to exhibit the same kinds of behaviours.
“Things like low mood, depression, eating disorders, shouting at each other.”
One of Europe’s leading heart and lung hospitals – Papworth – has been granted a royal title by the Queen.
The hospital near Cambridge, which carried out heart surgery on the Duke of Edinburgh in 2011, will become Royal Papworth Hospital.
The UK’s first successful heart transplant was carried out there in 1979 and the world’s first successful heart, lung and liver transplant took place there in 1986.
Its name officially changes in 2018.
Next year marks the 100th anniversary of the hospital, which opened as a tuberculosis colony in the small Cambridgeshire village of Papworth Everard in 1918.
Since then the hospital has become renowned for its pioneering cardiothoracic procedures, treating more than 100,000 patients from across the UK each year.
In 2015 its surgeons were the first in Europe to successfully perform a heart transplant using a non-beating heart.
More than 30 such operations have been carried out since then, increasing its transplant rate by more than one third.
The title will make Papworth the first “royal” hospital in the east of England, a spokesman said.
It has been bestowed “in recognition of its pioneering history and continued commitment to developing the treatments of the future”, he added.
Prof John Wallwork, chairman of Papworth Hospital NHS Foundation Trust, and the surgeon who jointly performed the first heart, lung and liver transplant, said he was “thrilled to see the hospital get this recognition from the Queen”.
The hospital is to move to Cambridge Biomedical Campus – the site which houses Addenbrooke’s Hospital – next year.
The £165m 310-bed new hospital will replace the current 276-bed facility.
It is not yet known what will happen to the old hospital site.
Researchers have put a financial price on an “epidemic of loneliness” – estimating it costs £6,000 per person in health costs and pressure on local services.
But the London School of Economics study of older people says for every £1 spent in preventing loneliness there are £3 of savings.
Deborah Moggach, author of the novel adapted for The Best Exotic Marigold Hotel films about retired people from the UK going to India, said: “Loneliness really is the last taboo.”
She said old age must not be an “inevitable descent into despair” and more efforts had to be made to stop people becoming isolated and lonely.
“We have to stop thinking of this as someone else’s problem. As a society, we need to recognise loneliness as an issue, and put something in place that enables older generations to flourish – not flounder,” said Moggach.
‘Stigma’ of loneliness
The research from the LSE has been published alongside the Campaign to End Loneliness, a group set up by charities and local authorities.
There are an estimated 1.2 million people in the UK who have “chronic” loneliness, with links to poorer physical and mental health and increased use of GPs, hospitals and social services.
The campaign says it should be seen as a problem in public health terms, like obesity and smoking.
For a decade of an older person’s life, the extra economic cost of loneliness is calculated as £6,000.
Over five years, preventing loneliness could see a saving of £3.6m, say the researchers.
Loneliness is also linked in the study to earlier death and higher risks of dementia.
The study says there have been a variety of attempts to tackle loneliness – such as befriending schemes, healthy living initiatives and better “signposting” to show the elderly where they can get help or meet other people.
This week, Guides in Manchester launched a new badge to tackle loneliness in old people, with young people visiting the elderly.
‘They’re closed off’
But the LSE research also shows that there is a “stigma” around admitting to loneliness.
“It implies that there’s something wrong with us,” said Moggach.
“We talk about everything else – death, sex and money.”
She said the proliferation of technology could make people feel even more isolated in public places.
“Everyone’s on their phones, they’re closed off.”
She said the “last bastion” for old people of chatting to people at the supermarket checkout was being taken away by the increase in automated machines.
People in later life could become “hugely cut off,” she said, describing the loss of friends and independence as “chronic, low-level bereavement”.
Laura Alcock-Ferguson, executive director of the Campaign to End Loneliness, said: “There is much to do to overcome loneliness.
“The huge stigma surrounding it is clear, which is slowing down efforts to combat it. This is isolating millions of older people – and with our ageing population, the epidemic of loneliness is growing fast.”
“It can be hard,” says June, a 76-year-old widow living near Peterborough. “I have to push myself.”
She looks forward to a tea party once a week, on a Sunday, which she says can feel “like the loneliest day of the week”.
Loneliness can be “hard to put in words”, particularly when she is in touch with family and neighbours.
She has ways to keep in contact – “my iPad is my friend” – and likes to talk to people in Facetime video calls.
But she says she wishes there were more places for elderly people such as herself to go to have some company.
She has volunteered with a local church project making meals for people in need, such as the homeless, and she likes the sense of giving something back.
But she misses the lack of places to go and chat to people – made worse by local shops and post offices shutting down.
And there are other older people she worries are even more isolated and who might go days and weeks without talking to anyone.
Almost 70% of women surveyed about a powerful epilepsy drug have not received new safety warnings about the dangers of taking it during pregnancy, the BBC has been told exclusively.
Sodium valproate, known as Epilim, carries a 10% risk of physical abnormalities in unborn babies.
About 20,000 children have been harmed by valproate medicines in the UK since the 1970s.
The medicines regulator said the drug had been kept under constant review.
Babies exposed to the drug in the womb have a 40% risk of developing autism, low IQ and learning disabilities.
The survey of 2,000 women and girls with epilepsy under 50 was commissioned by three charities – Epilepsy Society, Epilepsy Action and Young Epilepsy.
Of the 475 currently taking the drug, 68% said they had not received the new warnings known as the Valproate Toolkit.
The toolkit was launched in February 2016 and included printed warnings for patients in GPs’ surgeries, hospitals and pharmacies, containing up-to-date information on the risks for neuro-developmental disorders in children of women taking the drug.
The toolkit was created after the European Medicines Agency told all national watchdogs to improve information for patients.
The survey also showed that one in six women taking sodium valproate did not know the drug could “negatively affect the development and/or physical health of children born to women taking this medication”.
Twenty-one per cent said they had not had a discussion initiated by a healthcare professional about the risks of taking the drug during pregnancy.
Sodium Valproate has been prescribed since the 1970s but it was only last year that warnings were put on packets, as part of the new warning system.
Many mothers of some of the 20,000 children harmed by the drug in the UK since that time insist they were never told about the harm it could do.
Natasha Mason’s son Alfie, who is three years old, has only just learned to walk. He has been severely harmed by the drug.
Natasha said: “I wasn’t aware it could cause any problems to the unborn child.
“It wasn’t until I went to see a paediatrician with my son when he was 10 months old, that it began to click…
“He mentioned foetal valproate syndrome and that was when I started to panic.”
The Epilepsy Society is now calling on the Health Secretary Jeremy Hunt to make immediate changes to prevent GPs issuing repeat prescriptions to women for more than 12 months without face-to-face consultations with them.
It also wants routine checks at family planning clinics to include discussions about the risks of sodium valproate in pregnancy.
Its chief executive Clare Pelham, said the survey showed that the number of women who had never had a conversation with their doctor about the risks of the drug was “stubbornly high, hovering around 20%”.
She added: “Thousands of babies have been born with disabilities whose mothers were totally unaware of the risks – and will continue to be, if nothing is done.
“Politicians don’t very often get the chance to do something as important as this for mothers and babies; and even less often is it so simple and so inexpensive.”
The results of the survey will be presented next week to the European Medicines Agency, which will examine whether current warnings are adequate.
The Medicines & Healthcare Products Regulatory Agency (MHRA) in the UK says valproate had been, “kept under constant review and as new data have become available, the warnings have been updated”.
The MHRA said: “The results of the survey are important in helping us understand the effectiveness of the measures taken to date in the UK. We want to encourage all women to have access to the valproate toolkit materials that we made available in February 2016.
“We constantly monitor the safe use of valproate and support this latest review by the European Medicines Agency on the use in pregnancy and women of childbearing age.”
Its advice is that patients should not stop taking the medicine without consulting their doctor.
Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Any incidences in which valproate has been prescribed with pregnant women are a cause for concern.
“We call on all agencies to redouble efforts to ensure that the most up to date warnings are widely distributed to all healthcare professionals and patients – and the RCGP will continue to play our part in ensuring we achieve this.
“Patients should never hesitate to raise any concerns they have about valproate, or any other medication, with their GP or other health professional.”
The Association of British Neurologists said it was working closely with the MHRA to ensure that any young woman who is taking sodium valproate is fully aware of – and reminded of – the risks of becoming pregnant while taking this treatment.