Artemisinin has become the world’s most powerful weapon against malaria

The innovation of artemisinin is a combination of the original thinking on TCM and modern science and technology and an example of solving world’s medical problem through a Chinese approach. China is sharing the TCM resources and technology with countries along the Silk Road through innovating the cooperation mode.

A business card of China

Artemisia annua L. is reaped in August every year. The fresh Artemisia annua L. from the fields is dried, crushed, soaked, leached, concentrated and extracted, to turn into artemisinin which is then reduced and esterified to convert to the derivative artesunate that is more stable, and stronger in killing plasmodia.

In the modern production workshop of Guilin Pharmaceutical, process steps including processing, sterilization and prefilling, etc. are completed in one go. After passing the quality inspection, boxes and boxes of Artesunate for Injection marked "Made in China" are packed and transported to all parts of the world, and have become the world’s most powerful weapon against malaria.

Artemisia annua L. is cold in property and bitter in taste, and is an annual herb that widely distributes in fields and river banks across China. Such inconspicuous yellow-green grass is a gift to the world from the great and profound traditional Chinese medicine.

The falciparum malaria resistant to the then major antimalarial drug: chloroquine spread from Southeast Asia to Africa in 1950s-1960s, resulting in the global malaria incidence and mortality to largely rebound, until the emergence of the new generation of antimalarial drug: artemisinin.

Products of the member of Fosun Pharma: Guilin Pharmaceutical, the only Chinese antimalarial drug supplier that has passed the WHO medicines prequalification, have been continuously sold to Southeast Asian malaria affected areas such as Thailand, Burma, Laos and Indonesia and many African countries in the past 20 years.

Wu Yifang, President and CEO of Shanghai Fosun Pharmaceutical (Group) Co., Ltd., said, "Artemisinin antimalarial drug has years of word-of-mouth in countries on ‘Maritime Silk Road’, especially, Professor Tu Youyou’s winning of the Nobel Prize in 2015 has made such antimalarial drug continued success in overseas markets."

"It has become a business card for Chinese pharmaceutical industry to march towards the world stage", said Wu Yifang.

 A much-told story in the medical field

In fact, artemisinin’s marching towards the world also first started from Southeast Asia.

The birth of artemisinin stemmed from the antimalarial drug research Project 523 implemented by China to support Vietnam in 1960s. The Chinese government began to provide artemisinin to Cambodia to help it fight against malaria in 1970s.

According to Wu Yifang, as the malaria incidence has been very low in China in recent years, currently the international artemisinin-based antimalarial therapeutic regimens are first conducted clinical study in Southeast Asia and then popularized to the world.

A course of twists and turns

The course of artemisinin drugs’ recognition by the world was not smooth.

Nicholas White, Chairman of WHO antimalarial treatment guidelines committee and Professor at University of Oxford, aged 66 this year, is one among those promoting China’s artemisinin to the world. Professor White and his colleagues are engaging in research of artemisinin antimalarial drugs in Mahidol Oxford Tropical Medicine Research Unit in Bangkok, Thailand for decades on end.

White first heard of such antimalarial drug from China at the beginning of 1990s and hoped to verify its efficacy through test. Scientists of the Tropical Medicine Research Unit intended to carry out the first clinical trial of treating severe malaria with Artesunate for Injection in Vietnam in 1994, however, WHO did not accept the use of artemisinin drugs from China, and they had to give up the test halfway.

White and his colleagues did not give up the research in the following decade. They conducted a multicenter clinical trial in Bangladesh, Indonesia, India and Burma in 2004. "The results were shocking," White recalled, "artesunate and quinine showed a very significant difference in efficacy, so that the independent committee responsible for monitoring the trial immediately asked to stop the trial, and use Artesunate for Injection for clinical treatment ASAP, to save more patients with severe malaria."

The trial results showed that artesunate reduced the mortality rate of severe malaria patients by 34.7% compared to the traditional drugs. The results were published in the medical journal The Lancet in 2006, and in the same year, WHO published Guidelines for the treatment of malaria and adopted the trial protocol of the Tropical Medicine Research Unit. The artemisinin-based drugs thus officially obtained an "international passport".

"I am not marketing for Chinese enterprises, because the efficacy of the drug proves itself to be a good drug," White estimated that artemisinin and its combination therapies had saved the lives of over 6 million people in the world since 2000.

A "chemical reaction"

Inherence but not obstinately following tradition; innovation but not departing from the original stand.

Today, many Southeast Asian countries have established the legal status of TCMs which have become indispensable resources for local people to prevent and treat diseases. The Belt and Road Initiative even serves as a "catalyst" for China and Southeast Asia to conduct TCM innovation cooperation.

Wu Zaichi said that "The Belt and Road" drove TCM to "go out" and enabled TCM to have the chance to know more about conditions outside and explore how to integrate into the medical system of each place. This is the best interpretation of the "healthy Silk Road".