Artemisia annua – the plant of hope

China is the most populated country on Earth with over 1.4 billion people. In the Lancet article (1) Xiao-Nong Zhon describes how China achieved malaria eradication. He then says “We hope similar tools can be used by other countries approaching elimination”. The article continues to state that “China intends to establish a collaborative platform for malaria control with around 65 countries” (1). In China, Artemisia annua is called ‘the plant of hope’.

It is a sad fact that malaria still kills over 3000 people every day. Every day! One child dies of malaria every minute. Most of these deaths occur in Sub Saharan Africa. Another fact is that 85 percent of all malaria deaths occur in the poorest 20 percent of the population (2) who either cannot afford anti-malaria medication or do not have avenues of ready available access. This is a disheartening phenomenon in that malaria is both a direct cause and consequence of poverty.

Those with malaria cannot work, and therefore, their loss of income translates to even greater depths of despair. Malaria eats away at the public health budget, with nearly 40 percent of public health money spent on treating malaria in the worst affected areas.

Chinese scientist Tu Youyou received the Nobel Prize in 2015 in the field of Physiology and Medicine for her 1971 exploration of sweet wormwood (Artemisia annua) that was traditionally used to treat intermittent fevers and malaria. Tu Youyou extracted the ‘active ingredient’ or artemisinin. Tu Youyou’s research yielded remarkable results, in that this work led to the acceptance of sweet wormwood (Artemisia annua) as a medicinal agent, and soon it began to be commercially grown on a large scale. The extract or derivative from the whole plant, artemisinin, is used to produce the pharmaceutical drug artesunate.

Sweet wormwood (Artemisia annua) has been used in Chinese Traditional Medicine for over 2000 years. “Xu Zhengdong ..... describes the folk remedy for fever. The 62-year-old remembers 'the bitter grass', as they called it, from when he was a child. 'We boiled it and drank it from a cup, to bring down a fever. You use about this much to make tea,' he says, extending a cupped hand as if cradling a small bird. 'A handful. It's very bitter” (3).

Subsequent to her initial analysis of the extracted form of Artemisia annua, Tu Youyou presented artemisinin to the WHO at the Beijing conference in 1982, where she proposed that the Chinese government begin production of the plant’s extract so that its use could be extended to the malaria-ridden regions of Africa.

The WHO rejected the offer’ (4). Interestingly, the same ANAMED document cites that 12 years later, in 1994, the Swiss pharmaceutical company “Novartis signed a licensing agreement with Chinese partners and was granted exclusive rights to develop, register and market the drug artesunate. (4). How many African people could have been saved and their suffering alleviated if the herb, or any form of its extracted medicinal parts had been offered and distributed to them in those earlier days and years?

In 2001, the WHO shifted their position and openly declared “sweet wormwood (Artemisia annua) represents the greatest hope in the world against malaria”.

Shortly thereafter, artemisinin-containing anti-malaria medication was produced and distributed in many countries. However, by 2012, the WHO changed its stance again and advised against the use of artemisinin-based medication because research studies of the time showed that the parasite Plasmodium falciparum (that causes malaria) developed resistance to artemisinin. Just as chloroquine became ineffective as malaria treatment years ago, the same ‘law of nature’ came into force. It is a common biological occurrence that parasites and microorganisms are able to develop resistance to monotherapy, i.e. to the form of a single (or simple) chemical compounds. This effect is observed with antibiotics and with antiviral medications. More and more of these compounds are losing effectiveness in treating bacterial and viral infections. One explanation for this resistance is that there is an essential difference between using a whole plant versus using an isolated ‘active ingredient’. Parasitic microorganisms can develop resistance towards artemisinin (monotherapy) but not towards sweet wormwood (Artemisia annua) taken as the whole plant (polytherapy).

“There is no evidence of resistance because of the plant’s synergistic action of several constituents representing the great potential of plant extract against malaria resistance. Herbal medicine may also contribute to reduce the risks of disease without removing the continued exposure to infection necessary to retain immunity, which is critical in the management and eradication of malaria particularly in Africa” (5).

Parasites and other microorganisms are not able to easily develop resistance to whole plants because of the plant’s chemical complexity and because of slight variances depending on where they grew, in what kind of soils etc. Another immense benefit is that people can grow the plant themselves and then self treat. Give a man a fish and he will eat for a day. Teach a man how to fish and you feed him for a lifetime.

As a result of artemisinin resistance, pharmaceutical companies have developed a ‘new’ drug where artemisinin is being combined with the pharmaceutical antimalaria compound Lumefantrin. In other words, two old drugs were combined to form a ‘new’ drug. Novartis is selling this drug called ACT (artemisinin combination therapy) as Coartem in Africa and as Riamet in Europe. Novartis received a 10 year contract from the WHO to sell this ‘new’ drug as the sole company to the African market at cost. Coartem costs $2.5 in Africa, while the same drug sold as Riamet costs up to CHF 63.60 (or approx $66) in Switzerland.

In the 1990s the herb sweet wormwood (Artemisia annua) was introduced to many Sub Saharan countries by a Christian organisation called ANAMED (action for natural medicine in the tropics). Their goal is to “help people to help themselves” (6). ANAMED has organised seminars and trained people on how to use the herb, how to grow it and also on how to process it to make an effective anti-malaria treatment. Members of ANAMED work with local organisations, including churches and local healers. They have achieved astounding results not just with preventing and healing malaria but also in treating people suffering with HIV and AIDS. Sweet wormwood (Artemisia annua) does not cure people from HIV and AIDS but it does enables them to become stronger again and able to cope better with their antiretroviral medication. This equates to a much higher quality of life.

Sweet wormwood (Artemisia annua) is a herb with anti-parasitic properties. How does it work? Dr Martin Hirt, one of the founders of ANAMED with a PhD in Pharmacy explains: “Artemisia tea contains at least 46 medicinally active substances that are helpful in fighting malaria. Artemisinin is a “sesquiterpene lactone peroxide..... Its lethal effect on the plasmodium is due to its two oxygen atoms in the peroxide bond. The plasmodia attack and digest the red blood cells, but because they cannot excrete the iron this accumulates within the plasmodium.

When this iron comes into contact with the peroxide in the artemisinin, it breaks the peroxide bond; the oxygen atoms become charged and as such are called free radicals. These free radicals immediately attack the protein in the plasmodium, and the plasmodia are killed.” (7)

Apart from ANAMED there are several organisations with the very similar goals of helping people in malaria-prone areas to help themselves. This effort represents true help, whereas anything else has the potential to create dependency.

The first example is the Austrian organisation ‘Fight the Fever’ whose motto is supporting “people to heal and protect themselves from malaria in a self determined way and to work towards abolishing unjust power structures in the public health system” (8). They have produced the outstanding and prize-winning documentary “The Fever” (directed by Katharina Weingartner), which had its world premiere in 2019.

The Belgian/Luxembourg organisation IFBV- BELHERB aims to discuss and exchange research results on working with herbs, specifically with Artemisia annua. IFBV-BELHERB has “established a working relationship with African and South American universities, in close cooperation with other European research institutions. Several of these partners have run clinical trials with Artemisia annua tea. In all these trials a therapeutic effect of 95 % or higher was confirmed by the use over 7 days of whole leaf infusion, capsules or tablets”. (9) Dr Pierre Lutgen worked tirelessly in promoting Artemisia, organising clinical trials and working groups to grow and harvest and process the herb. And of course he published many results. Very sadly, he recently died.

The French organisation ‘Maisons de l’Artemisia’ (The Houses of Artemisia) are multidisciplinary centres of expertise that oversee the sustainable spread of Artemisia annua in many malaria-endemic countries by adhering to an ethical charter focussing on ecological, economic and social responsibility practices.

Another prominent authority is biologist Prof Pamela Weathers from Worcester Polytechnic Institute (USA). She has spent over 25 years studying Artemisia annua. This herb is the source of the primary drug used to treat malaria. Pamela Weathers shows that the whole leaves of the plant can be processed and dispensed in tablet form and these tablets appear to be more effective at knocking out the malaria-causing parasite than the pharmaceutical drug which uses only one active ingredient.

In 2002 Dr Gro Harlem Brundtland, the former director-general of the World Health Organization (1998 to 2003) and former prime minister of Norway gave the group ANAMED a Prize of Excellency for their work in Bukavu D R Congo for successfully treating malaria patients using sweet wormwood (Artemisia annua).

In addition to Western-based organisations there is the African organisation PROMETRA (Promotion of medicine and treatment from Africa) whose mission statement reads: “We are dedicated to the preservation and restoration of African traditional medicine and indigenous science. It is an institution of scientific and cultural research, medical practice and is an instrument for African integration and international relations. Our purpose is to preserve African traditional medicine, culture and indigenous science through research, education, advocacy and traditional medical practice” (10).

The work of all these organisations gives hope to the possibility of improving the health for many people who suffer from malaria and many other diseases. Their commitment to honouring traditional and native medicines expands not only the definition of treatment, but has the potential to offer treatment to a greater number of individuals.

In Katharina Weingartner’s documentary ‘The Fever’ an African scientist expresses his frustration by saying “We have the problem, we want to sort it out!” This attitude is echoed in the WHO recognition of the importance of traditional medicine in their publication which states: “The WHO defines traditional medicine as the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”. (WHO Traditional Medicine Strategy 2014 -2023).

We all should have the right to choose preventative and curative measures to maintain health by using pharmaceuticals or natural remedies, or both.

In her very detailed research on malaria in Tanzania Caroline Meier zu Biesen (11) sums up the dilemma: “The discovery and isolation of artemisinin led to the transformation of Artemisia annua from a herbal tea to a patented global pharmaceutical drug with far-reaching consequences.” One of these consequences is that the WHO does not recommend the use of the herb Artemisia annua claiming it is monotherapy and will lead to resistance. The WHO even advises against the use of the herb. During the 2000 years of Artemisia use in China the parasite Plasmodium did not develop resistance to the herb. It is the isolated active ingredient artemisinin that has led to resistance in the parasite. In some areas in Southeast Asia resistance to ACTs is already appearing which will have disastrous consequences when it reaches Africa. The use of the whole plant is polytherapy because of the plants many constituents that work together synergistically. An immense benefit in encouraging the use of the herb Artemisia annua consists in its very low to zero cost and its availability to people in rural and remote areas.

Of course sweet wormwood (Artemisia annua) is not the only plant with anti-malarial properties. Being an annual plant, it needs to be sown every year and it requires plenty of watering. Africa has its own indigenous anti-malaria herb, African wormwood,: (Artemisia afra), that grows from South Africa to Ethiopia. It does not contain artemisinin and is still as effective as Artemisia annua because its many other constituents also have anti-parasitic properties. Additionally, it is a perennial plant. It has the potential as an indigenous anti-parasitic herb to rid African countries of malaria. Therein lies a great example of how using herbs grown locally and within native habitats can sometimes yield the best results.

References

1. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00491-6/fulltext

2. Caroline Meier zu Biesen, Globale Epidemien – Lokale Antworten, campus

3. https://www.echocommunity.org/en/resources/e3b0227c-4927-44f6-9604-b0a003d4f9b5

4. ANAMED international e.V. ‘ANAMED encourager’ 01/2020

5. Plants as sources of natural and recombinant antimalaria agents. Peyman Habibi et al, Molecular Biology 92022) 64:1177-1197

6. www.anamed.org

7. https://www.scmp.com/magazines/post-magazine/article/1864835/how-west-waited-20-years-use-tu-youyous-nobel-prize-winning

8. https://www.fightthefever.org/

9. 4th International Conference and Exhibition on Pharmacognosy, Phytochemistry & Natural Products in Sao Paulo, Brazil August 29-31, 2016

10. https://prometra.org/about

11. Caroline Meier zu Biesen, The rise to prominence of Artemisia annua L. – the transformation of a Chinese plant to a global pharmaceutical.

Luzia Barclay DBTh MIRCH

Registered Medical Herbalist - UK

email Luzia for more information