Resistance to first-line treatments for Plasmodium falciparum malaria and the insecticides used for Anopheles vector control are threatening malaria elimination efforts. Suboptimal responses to drugs and insecticides are both spreading geographically and emerging independently and are being seen at increasing intensities. Whilst resistance is unavoidable, its effects can be mitigated through resistance management practices, such as exposing the parasite or vector to more than one selective agent. Resistance contributed to the failure of the 20th century Global Malaria Eradication Programme, and yet the global response to this issue continues to be slow and poorly coordinated—too often, too little, too late. The Malaria Eradication Research Agenda (malERA) Refresh process convened a panel on resistance of both insecticides and antimalarial drugs. This paper outlines developments in the field over the past 5 years, highlights gaps in knowledge, and proposes a research agenda focused on managing resistance. A deeper understanding of the complex biological processes involved and how resistance is selected is needed, together with evidence of its public health impact. Resistance management will require improved use of entomological and parasitological data in decision making, and optimisation of the useful life of new and existing products through careful implementation, combination, and evaluation. A proactive, collaborative approach is needed from basic science and the development of new tools to programme and policy interventions that will ensure that the armamentarium of drugs and insecticides is sufficient to deal with the challenges of malaria control and its elimination.

对恶性疟原虫疟疾一线治疗和用于控制按蚊病媒的杀虫剂的耐药性正在威胁着消除疟疾的努力。对药物和杀虫剂的次优反应既在地理上蔓延，又独立出现，而且越来越严重。虽然耐药性是不可避免的，但可以通过耐药性管理实践来减轻其影响，例如将寄生虫或媒介暴露于一种以上的选择剂。耐药性导致了 20 世纪全球根除疟疾计划的失败，但全球对这一问题的反应仍然缓慢且缺乏协调——经常、太少、太晚。根除疟疾研究议程（malERA）刷新过程召集了一个关于杀虫剂和抗疟药物耐药性的小组。本文概述了过去 5 年该领域的发展，强调了知识差距，并提出了一个专注于管理阻力的研究议程。需要更深入地了解所涉及的复杂生物过程以及如何选择耐药性，以及其公共卫生影响的证据。抗性管理需要在决策中更好地利用昆虫学和寄生虫学数据，并通过仔细实施、组合和评估来优化新产品和现有产品的使用寿命。需要采取积极主动的合作方法，从基础科学和新工具的开发到规划和政策干预，以确保药物和杀虫剂的储备足以应对控制和消除疟疾的挑战。