Africa's malaria miracle growing in the wilds of Yunnan
Africa, the usually forgotten continent, is again front and centre in the world's conscience, thanks to an unlikely alliance of well-meaning pop stars and rich-world politicians. Not even the terrorist bombings in London could distract the G8 summit from its core agenda: a pledge to increase annual aid to the continent from US$25 billion to US$50 billion by 2010.
But such high-profile efforts - including the 'Global 8' series of rock concerts that preceded the summit - overshadow smaller miracles that, too, have the potential to work wonders in Africa. These often occur far from the international limelight, in unlikely places such as China's Yunnan province.
There, Kunming Pharmaceuticals Corp extracts artemisinin from the dried leaves of sweet wormwood, which grows wild in southwest China. From artemisinin, a substance Chinese medical practitioners have used for centuries to relieve fevers, the company derives more potent artemether and supplies it to manufacturers such as Novartis, the Swiss-based pharmaceutical group, for use in a new anti-malarial treatment.
What sets this drug apart from others used against malaria is not just its ability to kill the parasite that causes the disease extremely quickly. Chinese scientists have also found that when artemether is used in combination with slower acting drugs, the parasite is unable to build up resistance to them.
The benefits of an effective malaria remedy are hard to exaggerate. The mosquito-borne disease kills more than 350 Africans a day and strikes down countless others with unbearable fevers that prevent them from working, providing for their families and attending school.
Resistance is the bane of anti-malarial efforts. Having been exposed to treatments such as chloroquine for years, in many regions the malaria parasite is now immune to them.
Artemisinin-based medication, however, does not stay in the body long enough for the parasite to strengthen against it. When taken together with less potent drugs in an artemisinin-based combination therapy (ACT), it's especially effective, as any surviving parasites that may have become resistant are killed before they can be passed on by mosquitoes.
Until last year, the raw plant material Kunming Pharmaceutical needs was picked wild in the mountainous regions of Yunnan. But following a decision last year by the World Health Organisation (WHO) to encourage African governments to switch to ACTs, demand for the plant and its derivatives surged and it became clear production needed to be increased.
According to the company's director of research and development, Ma Weipeng, Kunming Pharmaceutical was first contracted to supply the active ingredient to Novartis 10 years ago and has recently been asked by the central government to co-operate with the WHO by producing as much of the substance as possible.
Last year, the company produced six tonnes of artemether, two-thirds of which was sold to Novartis for use in four million treatments. This year, Novartis hopes to make 30 million treatments, placing massive demand on the nascent industry.
Novartis makes quality assurance engineers available to Kunming Pharmaceutical, once sending an entire technical team from Switzerland to help the company prepare for certification by international health authorities. 'There has been fantastic progress in China in developing the chemical and pharmacological capability [of sweet wormwood],' says Hans Rietveld, Novartis' global marketing manager for tropical diseases.
To cope with the additional demand and ensure it meets its obligations, last year Kunming Pharmaceutical planted its first sweet wormwood crop across 405 hectares of land. Mr Ma believes that the company will harvest about 200,000 tonnes of leaves next month, as well as pick an unpredictable amount of wild plants. This will, however, still fall far short of African demand this year.
The first successful African deployment of artemether was carried out in 2001 in the South African province of KwaZulu-Natal. Used in combination with DDT, it reduced the number of hospital admissions for malaria by 82 per cent, while notified malaria deaths fell 87 per cent.
Soon afterwards, Zambia realised that using chloroquine as its frontline defence against the disease was failing hopelessly and sought approval to switch to ACTs from the Global Fund, a body that finances the treatment of Aids, tuberculosis and malaria. The result was a dramatic improvement, and so late last year Zambia ordered another three million treatments from Novartis.
Fearing an outbreak of the disease within its borders, Ethiopia then bought a significant quantity of the drug. This year Nigeria, Uganda, Mozambique, Angola and Zanzibar are also expected to roll out the treatment, and Mr Ma expects demand will continue to increase with the rate dependant on WHO policies.
Kunming Pharmaceutical has spent US$10 million on a new factory to extract and derive artemether, which should allow it to supply Novartis with the quantities needed next year. Strong demand will continue for at least another three years beyond that, Mr Ma believes.
Until last year, ACTs were not among the drugs strongly recommended by the WHO or approved for grants by the Global Fund. According to Mr Rietveld, only when the scientific community demanded that health authorities review traditional remedies' success rates did they realise a drastic change was needed. 'The WHO and Global fund were put on the spot,' he says.
Novartis produces an ACT called Coartem which it supplies to the WHO at cost for use in malaria endemic countries. The Swiss company became involved in the project to develop the combination therapy after being approached by the Chinese Academy of Military Medical Science (Camms), which had isolated artemisinin and discovered the value of combining it with other anti-malarials.
They did not, however, know how to formulate two drugs into one treatment and needed Novartis' help to see the drug through international testing trials.
Even so, the cruel reality of ACTs is that they're significantly more expensive than more traditional medications. Coartem, for example, can be 10 to 20 times more expensive than chloroquine.
'[ACTs] have hugely increased the price of controlling malaria,' says Dr Kamini Mendis at the WHO. She says that because the active ingredient must be extracted from plants, there are limits to how much production costs can be reduced.
Unlike Asia, where the likelihood of being bitten by a malarial mosquito is once a year, in some places in Africa the transmission rate is so high that people can be bitten once a day. As a result, people can require treatments many times a year, the costs for which soon exceed the US$4-5 African countries can afford to spend each year on health care per person.
According to Mr Ma at Kunming Pharmaceutical, the central government appreciates that artemisinin could be the most effective drug to help African countries tackle malaria and has asked the company to scale up production.
For Kunming Pharmaceutical, however, producing artemether does not provide substantial financial rewards. 'It is not a good investment for my company,' says Mr Ma, 'because malaria plagues poor countries where people cannot pay high prices.'
Mr Ma nonetheless speaks enthusiastically of the 10 years he's spent working on Kunming Pharmaceutical's artemisinin projects, noting that 'African people really need our help'.
