What If You Could Cure Malaria?
The fields of Senegal are at the centre of a controversial battle against deadly malaria. With mosquitoes increasingly resistant to insecticides, and the parasite’s developing resistance to conventional remedies, the humanitarian emergency becomes ever more pressing worldwide. A plant genus could be the answer: Artemisia. But that goes against the wishes of the WHO…
What’s at Stake?
Malaria is a parasitic disease, spread by infected female Anopheles mosquitoes that carry the parasite, and can transmit it to humans with one bite.
Malaria infects 200 to 500 million people each year, and 1 in 5 die.
Globally, malaria claims over 500,000 lives each year. That’s over half a million people!
Africa is the worst affected continent. Sub-Saharan Africa accounts for the vast majority of cases and 90% of mortality.
“The WHO did not act fast enough.”
Let’s be very clear…
Due to the complexity of the disease, no vaccine is available.
Research is urgent as millions of lives have been lost.
And most of the victims are children.
Malaria: A Plasmodium Infection
Malaria is classified into either “severe” or “uncomplicated”, because there are several forms of malaria parasites.
Four main types of Plasmodium (P) species can infect humans:
- Plasmodium vivax and Plasmodium ovale, which both cause a relapsing form of the disease, and
- Plasmodium malariae and Plasmodium falciparum, which do not cause relapses.
Microscopy (through morphologic analysis of the parasites in the blood) continues to be the “gold standard” for malaria diagnosis. Parasites can be visualised on both thick and thin blood smears stained with Giemsa, Wright, or Wright-Giemsa stains. Note Giemsa is the preferred stain, as it allows for detection of certain morphologic features (e.g. Schüffner’s dots, Maurer’s clefts, etc.) that may not be seen with the other two.
The Malaria Parasite Under the Microscope
Microscopy (through morphologic analysis of the parasites in the blood) continues to be the “gold standard” for malaria diagnosis. Parasites can be visualised on both thick and thin blood smears stained with Giemsa, Wright, or Wright-Giemsa stains.
Note Giemsa is the preferred stain, as it allows for detection of certain morphologic features (e.g. Schüffner’s dots, Maurer’s clefts, etc.) that may not be seen with the other two.
The most severe type of malaria is caused by the Plasmodium falsiparum parasite.
The symptoms are severe fever and sweats that can degenerate into a coma.
In severely affected areas, 1 in 5 children die.
Artemisia annua as a Prophylactic?
In 2016, the first published reports of malaria occurring in European travellers who had used Artemisia annua (A. annua) for prophylactic purposes were published in the Journal of Travel Medicine.
For the researchers, these two cases highlighted the ‘absolute necessity’ to promote the use of authorised medicines and issue warnings against the use of non-pharmaceutical forms of A. annua for malaria prophylaxis.
“No institution is capable of running studies and promoting this therapy.“
The truth is less straightforward.
War against Malaria
For centuries, humanity has been fighting malaria on two fronts:
- the war on the parasite,
- the war on the mosquito.
Insecticides such as DDT were broadly used to combat the Anopheles mosquito and get rid of the disease in industrialised countries. Everything (and everyone) got sprayed with the dangerous chemical!
At the same time as the battle against the mosquito started, so did the battle against the parasite.
Quinine, an extract from the bark of the Cinchona Tree, was the first substance used to treat malaria. Although bark extracts have been used to treat malaria since the 1630s, the compound was first isolated in 1820, subsequently synthesised, and sold under the name Chloroquine.
So began the malaria business.
In 1964, malaria ceased to exist in Europe.
Then, the problem about resistance gradually started to emerge…
During the 1970s, resistance to Chloroquine was observed in South East Asia, and shortly after in South America.
According to Pascal Ringwald of the Global Malaria Programme,
Resistance spread and reached Africa in the late 70s early 80s.
According to German Velasquez, Former Director of the PHI Team, WHO:
As far as malaria was concerned, the WHO did not act fast enough when they started seeing resistance to Chloroquine. Replacement products often arrived very late.
In the early 1980s, malaria started to kill again.
This catastrophic situation contributed to the return in favour of a plant: A. annua.
Artemisia and the Vietnam War
The Vietnam War had revealed an alternative treatment.
While American soldiers took Chloroquine to avoid catching malaria, on the opposite side, the communist troops who lacked treatment, were wiped out by the disease.
Veterans said mosquitoes were more feared than the G.I.s.
When Ho Chi Min asked for help from China, the country was sent tonnes of Artemisia annua, a traditional remedy against malaria that had been known in China for centuries. Taken in the form of a herbal tea, A. annua acted as a magic potion and helped the communist troops secure victory.
It was the plant’s first victory over conventional medicine.
“This is a bombshell!”
Under Mao’s regime, research was done to isolate the substance from the plant. Chinese Project 523 isolated a molecule which was named artemisinin, supposedly the active ingredient in A. annua.
Artemisia annua (A. annua) (or sweet wormwood), a medicinal plant, has been used in China to treat malaria for 2,000 years.
Artemisia is a large, diverse genus of plants with between 200 and 400 species, including the mugwort, sagebrush and wormwood. It belongs to the daisy family Asteraceae.
Artemisia species comprise hardy herbaceous plants and shrubs, that grow in the temperate climates of both hemispheres, usually in dry or semiarid habitats. The plants are well known locally for the powerful chemical constituents in their essential oils.
Artemisia is neither a drug nor a poison. In fact, Artemisia annua only seems to be dangerous to the malaria parasite… AND the WHO.
Initially, the West took little notice. The scientific results were confined to history and largely forgotten.
Evolution trumps Everything…
As the parasite-carrying mosquitoes become increasingly resistant to known insecticides, the effectiveness of Chloroquine against P. falciparum has declined as resistant strains of the parasite evolved.
Although the WHO continues to recommend Chloroquine to push back the disease, resistance to the drug has been well documented.
Since the 1950s, Chloroquine-resistant P. falciparum strains have appeared throughout East and West Africa, Southeast Asia, and South America.
Evolution trumps Chloroquine.
Artemisinin and its semi-synthetic derivatives are a group of drugs used against Plasmodium falciparum malaria.
Artemisinin was discovered in 1972 by Tu Youyou, a Chinese scientist, who was later awarded half of the 2015 Nobel Prize in Medicine for her discovery.
Now, Chinese artemisinin medicines are very good at destroying the vast majority of the malarial parasites within a few hours. But some will survive.
So, a combination of the medicine with another molecule was urgently required. And this was the start of Artemisinin-Combination Therapies (ACTs).
Artemisinin (from A. annua) and its derivatives are a group of compounds with the most rapid action of all current drugs used to treat malaria.
The five currently recommended ACTs are listed in the WHO Guidelines for the treatment of (uncomplicated) malaria, 2015:
- artemether and lumefantrine,
- artesunate and amodiaquine,
- artesunate and mefloquine,
- dihydroartemisinin and piperaquine, and
- artesunate and sulfadoxine-pyrimethamine (SP).
Pharmaceutical drugs containing artemisinin derivatives or ACTs are now standard treatment worldwide for malaria caused by Plasmodium falciparum.
The WHO imposed ACTs on all malaria-infected countries, and ACT medicines appear on the WHO Model List of Essential Medicines (EML).
But ACTs do not cure malaria.
In the early 2000s, Chinese artemisinin tablets started to appear in Africa.
Although artemisinins can be used alone, this often leads to a high rate of recrudescence of parasites, and other drugs are required to clear the body of all parasites and prevent a future recurrence of the symptoms.
The WHO is now pressuring manufacturers to stop making the uncompounded drug available to the medical community at large, aware of the humanitarian catastrophe that would result if the malaria parasite developed resistance to artemisinin.
“It’s more profitable to have a patient as a customer…”
When the ACT market exploded, leading to a shortage of the raw material, A. annua.
The mostly Asian growers could not keep up with the demand, and the sale price of Artemisia peaked in 2005.
Business was there to be made.
That is when a Franco-Malagasy company decided to move into large-scale A. annua production. Their business model was simple: encouraging local farmers to grow the plant in exchange for purchasing their harvest at a predetermined price.
“Funding was cut overnight.”
10,000 Malagasy farmers were tempted by the prospect of a good yield, for a higher price than rice. Artemisia is a robust plant. In one season, a grower can earn up to 700 Euros (about £600 or $800) – a godsend for the country where most farmers live on less than 1 Euro a day.
But the crop is for export, to manufacture medicines abroad. Not for treating the local population.
Some farmers have figured out a medicinal shortcut:
A pinch of Artemisia can make the fever disappear.
The Prohibition of Herbal Artemisia
Artemisia is banned in several countries, like France and Belgium. In Luxembourg though, no such ban prevented research until…
Pierre Lutgen, a retired chemist from Luxembourg, tried studying Artemisia for an NGO, until delegates from the WHO, big pharma, and the Antwerp Institute of Tropical Medicine visited his research institute for “cooperation”:
Funding was cut overnight. The Ministry bowed to pressure saying funding such research was beyond their remit.
Investigating the Virtues of Herbal Tea
More and more scientists are getting involved as they are convinced of the plant’s effectiveness in malaria treatment. Despite WHO misgivings, hundreds of researchers are currently working on Artemisia across Colombia, Cambodia and Senegal.
All wonder what can possibly justify the distrust of the medical establishment with regards to A. annua…
The most common argument is known as the “Precautionary Principle”.
The precautionary principle generally defines actions on issues considered to be uncertain, for instance applied in assessing risk management. This approach is used by policy makers to justify discretionary decisions in situations where there is the possibility of harm from making a certain decision (e.g. taking a particular course of action) when extensive scientific knowledge on the matter is lacking. The principle implies that there is a social responsibility to protect the public from exposure to harm, when scientific investigation has identified a plausible risk. The Precautionary Principle is often applied to biological fields because changes cannot be easily contained, and thus have the potential of being global. The application of the principle can be seen in the public policy of requiring pharmaceutical companies to carry out clinical trials to show that new medications are safe.
The precautionary principle generally defines actions on issues considered to be uncertain, for instance applied in assessing risk management.
This approach is used by policy makers to justify discretionary decisions in situations where there is the possibility of harm from making a certain decision (e.g. taking a particular course of action) when extensive scientific knowledge on the matter is lacking.
The principle implies that there is a social responsibility to protect the public from exposure to harm, when scientific investigation has identified a plausible risk.
The Precautionary Principle is often applied to biological fields because changes cannot be easily contained, and thus have the potential of being global. The application of the principle can be seen in the public policy of requiring pharmaceutical companies to carry out clinical trials to show that new medications are safe.
Until we understand the full properties of a plant, we must avoid using it.
But make no mistake about it.
This principle is often NOT applied to pharmaceuticals.
For example, Lariam (Méfloquine) continues to be prescribed despite its dangerous side-effects for sensitive individuals. Several non-governmental organisations are seeking to ban the molecule.
Yet the WHO still recommends Méfloquine, dubbed the “military’s suicide pill”, on its List of Essential Medicines, but refuses to recognise the benefit of the plant.
This led a bunch of charitable individuals to take things into hands.
The Artemisia Project
According to Lucile Cornet-Vernet, from La Maison de l’Artemisia:
No institution is capable of running studies and promoting this therapy. That’s how it all started. We said: “Let’s do it!”
Artemisia-promoting associations sprang up all over Europe. These initiatives were often targeted by those institutions in favour of the Precautionary Principle.
“My lab notebook was even taken away.”
In Africa, researchers are conducting full studies to prove that Artemisia is safe and effective.
According to Jérôme Munyangi, a young Congolese doctor:
I first came into contact with Artemisia following a malaria attack I suffered in Kinshasa. It was a resistant strain and I had already taken anti-malarial treatment to no effect.
A friend who’d already worked with Artemisia offered me the plant. I said I didn’t believe in quacks who use plants. My friend insisted.
On the 3rd day, I felt much better. Headaches and fever had gone. At the end of the treatment, on the 7th day, I went to have some tests done in a laboratory.
Everything was great. No more Plasmodium!
That was my first experience of Artemisia…
Impressed by the result, the doctor decided to involve the rest of his study to this plant. He began a Masters Degree in Paris:
After three weeks of analysis, we were astounded by the result of our lab tests. The teacher working with me was also surprised.
I remember one of my teachers saying: “This is a bombshell! And we don’t want that bombshell exploding in our lab because our funding comes from pharmaceutical companies.”
The research was halted.
My lab notebook was even taken away from me. The Artemisia samples I had brought were confiscated and taken to the laboratory director.
Virtually expelled from university with no grant, Dr Munyangi refused to give up. He contacted Lucile Cornet-Vernet who helped him continue his research:
We decided to launch a large study on a significant population following WHO standards. We studied a thousand patients.
At this point, I started fundraising. These studies were financed by friends, foundations, companies because they truly believed the plant is the answer to the evil scourge of malaria in Africa.
Once funding was secured, the doctor returned to his native province of Maniema, D.R. Congo to launch his study.
1,000 Falciparum-infected patients were involved.
500 took Artemisia and a placebo medicine.
500 took ACT and a placebo herbal tea.
According to Dr Michel Idumbo, the main study investigator:
We diagnosed malaria from blood samples taken before treatment, tested in a top laboratory to determine the parasite count.
Patients were split into two groups: one taking herbal tea, one taking ACTs.
We collected data everyday for four months.
Both groups (ACTs and Artemisia herbal tea) showed good clinical results. However, parasitology showed the parasite can disappear in patients taking herbal tea, whereas patients with ACT treatment still had parasites in their blood, even though their conditions had improved.
The results were spectacular.
While ACT medicines are considered 80% effective, the Artemisia herbal tea scored 97% with no side-effects contrary to the medicines!
The result was surprising in a positive way. And that’s where the trouble started with conventional medicine.
“We were banned from holding a conference!”
First, we were banned from holding a conference at the end of the study. When we submitted the results to the doctor in charge of the area, he immediately blocked us. He said: “I will not allow this conference. I want Jérôme [Munyangi] to keep quiet and not communicate his findings to the public.”
They realised the herbal tea had better results than ACTs. And we were given to understand that the pharmaceutical companies could withdraw support. They accused us of arrogance, and I was dismissed, said Jérôme Munyangi.
In my opinion, pharmaceutical firms were behind this. After the results were published, we told patients that the herbal tea was more effective. And they too had observed this. So, patients stopped buying ACTs. We were starting to get in the way. I was contacted by a large pharmaceutical depot in Kindu. They said: “We can’t sell ACTs anymore because of your study. You, Sir, are messing with our business!”
At the end of the study, villagers adopted the herbal tea they had trialled.
In 2016, a new experiment was run for 6 months at the local village school. The children drank Artemisia twice a week as a preventative measure. Not one child caught malaria during this period.
Research needs to be carried out on thousands of children to validate these findings. In the meantime, the school teacher is more enthusiastic than ever.
Artemisinin is not the only active substance
Dr Munyangi took advantage of this study to begin another one where the patients receiving herbal tea were divided into two subgroups: 250 took A. annua and 250 took A. afra – the African species.
A. afra does not contain artemisinin – the supposed active ingredient in anti-malarial treatment. The results were perfectly identical in the two sub-groups, which showed that artemisinin used by labs in their medicines is not the only active substance. This caused a huge stir.
Dr Munyangi’s study was completed in 2015. In order to impact the scientific community, it needs to be published in a recognised medical journal. And editors are wary of plant-based remedies and studies carried out in Africa.
But Africans are not alone in discovering the virtues of Artemisia.
According to Professor Pamela Weathers of the WPI Life Science Bioengineering Centre, near Boston U.S.A:
We’ve always been interested in artemisinin. We’re still studying its biosynthesis, but now we know that because the whole plant material is so efficacious at getting the drug artemisinin into the body. We’ve also seen the evidence that there are so many of the antimalarial compounds in the plant that we now have a much more holistic perspective on our research. The plant material is very nice, because it has more than one drug, it has more than two, more than three. It probably has about ten. Actually, we were able to show that we could use the plant material to combat rogue malaria that was resistant to artemisinin. And as a result, one would consider that this has great potential to be used against resistant malarial parasites. And also, in patients, to prevent the emergence of resistance.
The question of resistance has split those involved in two groups: For or Against Artemisia.
Sceptics in WHO experts believe widespread use of the herbal tea could generate resistance and be prejudicial to ACT drugs.
For those in favour of Artemisia, this argument is flawed. Herbal tea has been used for over 2,000 years in China without any signs of resistance. History seems to have proved what science can’t yet show.
Perhaps the answer lies in Nature. A. annua and A. afra are polytherapies: it’s the combination of their various components that give the plants their therapeutic power. It should therefore be used whole, rather than trying to isolate a particular active ingredient.
Why the WHO stands Against Herbal Artemisia
The WHO is seen today as the main obstacle to the spread of Artemisia annua herbal tea therapy, officially because of the Precautionary Principle, but maybe also for political and financial reasons.
Publication of more successful clinical trials would force the WHO to review its position. Years of silence would come to an end.
Now 2019. Our rogue team of researchers published a paper on the treatment of malaria in Phytomedicine: International Journal of Phytotherapy and Phytopharmacy.
The study, headed by Jérôme Munyangi, was conducted on a large scale in a double blind randomised trial according to the research criteria of the WHO.
Artemisia vs ASAQ
Artemisia annua and Artemisia afra tea infusions vs. artesunate-amodiaquine (ASAQ) in treating Plasmodium falciparum malaria in a large scale, double blind, randomized clinical trial (2019)
Background and objective
Prior small-scale clinical trials showed that Artemisia annua and Artemisia afra infusions, decoctions, capsules, or tablets were low cost, easy to use, and efficient in curing malaria infections.
In a larger-scale trial in Kalima district, Democratic Republic of Congo, we aimed to show A. annua and/or A. afra infusions were superior or at least equivalent to artesunate-amodiaquine (ASAQ) against malaria.
A double blind, randomized clinical trial with 957 malaria-infected patients had two treatment arms: 472 patients for ASAQ and 471 for Artemisia (248 A. annua, 223 A. afra) remained at end of the trial. ASAQ-treated patients were treated per manufacturer posology, and Artemisia-treated patients received 1 l/d of dry leaf/twig infusions for 7 d; both arms had 28 d follow-up. Parasitemia and gametocytes were measured microscopically with results statistically compared among arms for age and gender.
Artemisinin content of A. afra was negligible, but therapeutic responses of patients were similar to A. annua-treated patients; trophozoites cleared after 24 h, but took up to 14 d to clear in ASAQ-treated patients. D28 cure rates defined as absence of parasitemia were for pediatrics 82, 91, and 50% for A. afra, A. annua and ASAQ; while for adults cure rates were 91, 100, and 30%, respectively. Fever clearance took 48 h for ASAQ, but 24 h for Artemisia. From D14-28 no Artemisia-treated patients had microscopically detectable gametocytes, while 10 ASAQ-treated patients remained gametocyte carriers at D28. More females than males were gametocyte carriers in the ASAQ arm but were unaffected in the Artemisia arms. Hemoglobin remained constant at 11 g/dl for A. afra after D1, while for A. annua and ASAQ it decreased to 9–9.5 g/dl. Only 5.0% of Artemisia-treated patients reported adverse effects, vs. 42.8% for ASAQ.
A. annua and A. afra infusions are polytherapies with better outcomes than ASAQ against malaria. In contrast to ASAQ, both Artemisias appeared to break the cycle of malaria by eliminating gametocytes.
This study merits further investigation for possible inclusion of Artemisia tea infusions as an alternative for fighting and eradicating malaria.
The Research Initiative on Traditional Antimalarial Methods (RITAM) is coordinated by Dr Merlin Willcox. In 2006, the RITAM Artemisia annua Task Force published a letter in the African Journal of Traditional, Complementary, and Alternative Medicines.
Almost identical to the story of cannabis, that is the research on Artemisia as it was published.
Now, WHY would the WHO maintain their stance against your Artemisia in the light of such clinical findings?
Is it really about protecting the public’s health or the financial interests of the pharmaceutical companies who have made it their business to combat malaria?
According to German Velasquez, Former Director of the PHI Team, WHO:
Exactly 25 years ago, over 50% of the WHO budget came from compulsory public donations from WHO member states. Today, only 18 or 20% come from public money. So the private sector with foundations, like Bill & Melinda Gates’s, have taken control of the organisation.
During the first 50 years of the pharmaceutical industry, drugs were developed to cure diseases. Over the last 20 years, the industry has produced drugs to treat, but not to cure, diseases.
Maybe it’s more profitable to have a patient as a customer. Profit comes before public health interest.
In June 2016, Bill Gates made a solemn declaration: his foundation vowed to eradicate malaria by 2040. This declaration was made in conjunction with the then-British Finance Minister: George Osborne.
To fight disease, perhaps someone from the Health Department would have been a more obvious choice for a photo opportunity. But in this case, it was the Finance Ministry as the Gates Foundation pledged to invest 4 billion Euros to eradicate malaria. Couldn’t anyone from the Health or Science Ministry make it along to the event then?!
The WHO is clearly not ready to embrace Artemisia, but the medicinal plant is popping up in many other places.
More than 40 countries worldwide produce extracts of the plant for therapeutic uses.
Artemisia is not only beneficial to health, it also creates jobs. Dozens of men and women have found work in this new sector. One of the reasons for Artemisia‘s success is its price – five times less than the recommended medicines. It’s already being sold at some markets.
According to Oumou Diakhaté, Tradeswoman,
Before we used to buy the medicines at a pharmacy, it was very expensive and it didn’t really cure the malaria. But the herbal tea is cheaper, and you get better faster.
This is the research.
You draw your own conclusions.
According to Professor Mouhamoudou Diallo,
I will tell you straight away that I have used this plant at home for several years. That’s my personal situation, and I recommend it to colleagues and scientists who also use it.
Professor Diallo has studied Artemisia for the last ten years at his bacteriological laboratory at Dakar University:
We have been looking at Artemisia afra for some time now and believe it’s a promising route forward.
In the fields of Senegal, the research is now focusing on A. afra – the African species which does not contain artemisinin, and cannot therefore induce resistance in ACT drugs. A. afra has been used in Africa for centuries, and as such is naturally recognised a medicinal plant. It’s also easier to grow than A. annua.
I dream that every African family has an Artemisia afra plant. It’s a perennial bush and they can take Artemisia cuttings every two days to make herbal tea.
No more malaria. End of story.
Truth will Triumph…
Researchers hope that Artemisia will finally be recognised, not against the view of conventional medicine professionals, but along with their approval.
If Artemisia herbal tea does turn out to be the ultimate remedy for malaria, the World might soon be left wondering why so much time has been wasted, why so many victims have suffered, and why such a huge anti-malarial pharmaceutical industry ever existed…