Stopping malaria in Africa :For a new strategy

IDAY’S HONORARY COMMITTEE Hauwa Ibrahim (Sakharov Prize 2005) – Baaba Maal (Ambassador UNDP – Senegal) – Luisa Morgantini (Vice-President of the European Parliament 2007/2009) – Dr Denis Mukwege (Sakharov Prize 2014, King Baudouin Prize 2011, Director of Panzi Hospital) – Mampe Ntsedi (Nelson Mandela Children Center) – Ousmane Sy (King Baudouin Prize 2005 and founder of CEPIA) – Pamela Weathers (Professor at Worcester Polytechnic Institute) – Hendrina Doroba (Executive Director of FAWE) – Ole Dibba-Wadda (Executive Secretary of ADEA)

Raising voices foreducation in Africa

The last report of the World Health Organization (WHO) on malaria acknowledges the growing

threat of resistances to the latest drugs based on an extract of Artemisia annua.It also expresses concerns about te persistence of deaths due to the disease in Africa, the slowing of the pace of progress, its effects on poverty and social inequality, the inadequacy of global response and the financial means to achieve a world-wide response, the need to scale up research on vector control tools and the effect on the most vulnerable groups (young children and pregnant women) as well as the need for more accessible preventive and curative therapies.

Resistances affect the Artemisinin Combined Therapy (ACTs) suggesting that such dual combination therapies

fall to the same problem as the single pharmaceutical therapies of the past. These resistances, also reported in the media (Le Monde, The Guardian, The Financial Times,…) affect particularly some Asian regions but are feared to pass-over to Africa. In fact, similar treatments are applied on a large scale in Africa and resistance has already been reported.

This situation begs the question : are we on the verge of a new medical catastrophy in Africa ?

DiagnosisIn the meantime, two important developments deserve attention.

The first is the latest in vivo research by Professor Pamela Weathers and her team who showed that the intake of

the whole plant of Artemisia annua offers greater protection against the threat of emergence of artemisinin drug resistance than the pharmaceutical drugs. These results confirm a vast body of research conducted by several African and other

researchers. Together they suggest that the plant provides a natural combined therapy that mutants find more difficult to circumvent. These results seem to confirm that the Chinese experience with the plant for over 2 000 years without resistance could well be applicable also to Africa.

The second is that the plant finds a growing use in Africa by local population since it is more easily accessible than

drugs and covers those populations that precisely the official channels find more difficult to reach. Plantations or use of plant extracts in the form of capsules or tea are now found on a more or less wide scale in the following countries known by IDAY : Senegal, Gambia, Mali, Guinea, Benin, Togo, DRC, Burundi, Rwanda and Kenya as well as in Cameroun and Uganda where the plant is officially recognized as an efficient way to combat malaria.

In fact, the plant is known in many African countries where it was introduced by the pharmaceutical companies to extract

artemisinin, and naturally, the local producers have become aware of the plant’s healing capacities and have adopted it as a natural cure.

It has considerable advantages compared to the classical methods : it is a repellent, several plant components are

effective against the disease, very low concentrations of the toxic artemisinin are adequate and hence it can be used prophylactically, it is presented as effective against other neglected tropical diseases and, finally, it is easily accessible to all because plant varieties adapted to African conditions can be grown by poor and remote populations. The latter advantage is particularly important, considering WHO’s reported lack of resources to tackle malaria in the whole of Africa (shortfall of 3 billion $/year).

RecommendationsWhat is then the solution ?The growing difficulties reported by WHO and the media about the current strategy call for a new approach that pulls all available means together to tackle malaria in Africa.

Confirmation by appropriate clinical tests of the efficacy of Artemisia annua observed in the field would :- give a complementary treatment in case of development of resistance against the pharmaceutical products in Africa ;- offer a cheap complementary tool to fight malaria among the least accessible populations, giving WHO

a breakthrough in its goal to stop malaria in Africa ;- induce significant health savings that would then become available to tackle the other so-called

Neglected Tropical Diseases (NTD).

Considering :- the spread of resistance to the currently available pharmaceutical drugs that confirm

historical trends using this sort of medication ;- the gap in resources to pay for the spreading of the current means across the whole of Africa;- the need to reach out to remote and poor populations with a mean to stop malaria that is

both physically and financially accessible to them ;- the critical importance of ridding Africa of malaria to raise the income per inhabitant ;- the recent results of in vivo research indicating a greater protection against drug resistance

by the plant itself than by pure chemicals (even under combined form) confirming the polytherapeutic feature of the plants and the relative importance of artemisinin against malaria ;

- the extent of spontaneous plantations of Artemisia annua in Africa ;- the field evidence suggesting considerable benefits from less aggressive prophylactic approach to

combating malaria in terms of saving in health costs and higher education quality ;

Recent Bibliography 1. Artemisia annua produces artemisinin and is a generally recognized as safe (GRAS) effective herb used for thousands of years in Chinafor malaria

(Duke, 2001 ; Chinese Pharmacopoeia).2. Artemisinin delivered via orally consumed dried leaves in animal models was more bioavailable than when delivered as a pure compound

(Weathers et al. 2011, 2014a).3. “Dried whole-plant Artemisia annua slows evolution of malaria drug resistance and overcomes resistance to artemisinin »

Mostafa A. Elfawal et al. 2015.4. Artemisinin delivered once a week as a pACT tea infusion also reduced incidence of malaria, acting prophylactically (Ogwang et al. 2011, 2012).5. Based on agricultural field trials and the ICIPE (2005) study it was estimated that use of therapeutic pACT is highly economical at $0.10-35/cure (Weathers et al., 2014b).6. Analysis of multiple crops of A. annua showed that artemisinin content is consistent when clonal propagation is used (Weathers and Towler, 2014).7. Artemisinin and other key phytochemicals are maximally produced during the floral budding stage (Towler and Weathers, 2015)

IDAY-International aisbl19, rue des Jambes � 1420 Braine l’Alleud � Belgium

L+(32)2 385 44 13 � 3info@iday.orgIBAN BE 93 5230 8026 6767 � BIC TRIOBEBB (Triodos)

www.iday.org

ConclusionsIDAY recommends conducting human clinical trials on the use of the plant against malaria in Africa. The purpose of the research, carried out according to WHO criteria, should consist mainly in verifying the impact, - including in terms of obviating emergence of drug resistance - of the extended use of Artemisia annua against malaria and provide the basis for a continuing control carried out by several African universities and US/European research centers.These researches would allow African States to understand better a traditional medicine already used by their people and develop policies, regulations and guidelines for the use of Artemisia annua, according to WHO Traditional Medicine Strategy 2014-2023.

A colloquium could be organized to facilitate discussions among political decision makers, researchers and practitioners with Artemisia annua experience to examine this strategy.