ARTEMISIA ANNUA against malaria: corrections to the article in Le Figaro of 22 November 2018

We read with great interest the article on the subject of Artemisia annua and whether it raises with reason some delicate points concerning the use of herbal tea against malaria, others, however, seem to us to deserve some clarification in order to reach a more balanced conclusion.

The affirmation of the efficacy of this plant does not come from a single French association but from many researchers and the experiences of several other African, German, Luxembourg and Belgian associations that confirm these statements.

Physicians’ claims that the merits of this herbal tea are unfounded deserve clarification. We therefore repeat below, step by step, the various statements in the article in order to give them another perspective to which we believe the reader is entitled to form an objective opinion on the issue.

The interest of the drug is to give a precise dose of active ingredient. With an infusion you can’t control anything

IDAY’s lighting: the associations that use the plant against malaria in Africa have adopted different dosages. IDAY is interested in this specific point and intends to launch a large-scale survey that will make it possible to identify practices among the many users of the plant and relate them to the results of medical tests (thick drop). The fact that the plant is used in a different way (we have identified 3 different effective dosages to date) and still obtain positive results is an argument in favour of its efficacy. Africans have an ancestral knowledge of herbal medicine and practice it properly.

So the plant has many antimalarial powers. But its use in the form of herbal tea is a problem for the medical community. As early as 2012, the WHO took a stand against it

IDAY lighting: In 2012, WHO declared that it was opposed to the use of the plant against malaria. Since then, the associations that use the plant in Africa have been in regular contact with WHO (Geneva and Brazzaville).

From now on, reference treatments are no longer based on a single molecule

IDAY’s lighting: The main problem with the approach taken in your article is that only doctors have the right to speak. However, Western doctors have great difficulty seeing anything in medicinal plants other than the component or components they take out of them to produce their medicines. However, plants rarely act from a single component. In the case of Artemisia annua, which is effective against several tropical infectious diseases, there are many components that act against malaria in particular. Researchers believe that this plant is a real combination therapy with about ten (one researcher even has 20) effective components against malaria. There is a lot of evidence: (1) Research has identified several of these components that act either independently or in synergy; (2) other varieties of Artemisia, such as Artemisia afra, which do not have artemisinin, are just as effective against malaria as annua; (2) an experiment in Uganda where an Artemisia annua-based product from which artemisinin has been extracted has been used effectively against malaria for several years; (3) Pamela Weathers of the American Association for the Advancement of Sciences has demonstrated in the laboratory the lower sensitivity to plant resistance compared to conventional drugs, artemisinin-based combination therapy (ACT). These results can only be explained by its polytherapeutic nature. This discovery is confirmed in the field by the still effective protection against malaria of nearly 1,000 Ugandan cooperators with Artemisia herbal teas that have been available for more than 10 years without any incidence of resistance.

From one plant to another, the content of active ingredient varies greatly depending on weather conditions, geographical location, storage conditions …

IDAY lighting: this is absolutely correct except that the words “active principle” must be conjugated in the plural. Indeed, as explained above, the plant is composed of several active ingredients whose content varies from one crop to another and it is therefore the taking of the plant in its entirety ( in totum) that ensures the effectiveness of the treatment, the different components being balanced. Field tests show that while one principle is found at a lower concentration in the plant, others are found at higher concentrations, thus providing sufficient overall impact.

Another argument put forward by the WHO: it would require drinking huge amounts of herbal tea to obtain the dose of curative active ingredient

IDAY lighting: This is therefore in contradiction with field observations and is only justified if the other active components are ignored in addition to artemisinin, which reinforces its impact

In addition, in herbal tea infuses another threat: that of creating artemisinin-resistant parasites

IDAY lighting: This danger is real and does not exempt the promoters of the plant from constant attention to resistance, because there is no such thing as zero risk with a disease as complex as malaria. However, it must be recognized that at the current stage of knowledge, the risk is much higher with dual ACT therapy than with the true combination therapy that is Artemisia annua. This is probably why WHO is waiting for the results of research carried out in accordance with their standards.

It is indeed to drugs that resistance has appeared, whereas no indication of resistance has been reported so far in relation to the plant. In addition to the results of the above-mentioned research, American researcher Pamela Weathers published a study that shows that patients suspected of having a severe malaria attack who no longer respond to official treatment were cured within 5 days by taking the plant in the form of dried leaves.

Artemisia annua is therefore attracting increasing interest from African Ministers of Health, particularly because of the growing difficulties encountered with official programmes, both in terms of resistance to distributed pharmaceutical products and in financial terms.

This molecule only works for a few hours, it is very effective but does not eliminate all parasites. The partner drug stays in the blood for several days and finishes the job

IDAY lighting: On the contrary, studies show that herbal tea cleanses gametocytes from the blood and prevents recurrences. The plant heals where the drugs heal. Once again, this means not considering the plant as a whole and forgetting the other antimalarial components.

So many arguments denied en bloc by the supporters of herbal tea, which are based on studies whose fragility is underlined by the specialists interviewed by Le Figaro (IRD, Institut Pasteur, Académie de médecine, CNRS)

IDAY’s lighting: The bibliography of in vitro research proving the effectiveness of this preventive and curative medication has nearly 120 entries (see Appendix 1). These theoretical confirmations are complemented by an abundance of evidence from the field, particularly in Africa and Latin America, not to mention the 2,000 years of effective use of Artemisia by the Chinese.
How could published scientific articles be described as fragile? Do the authorities cited have studies that demonstrate the ineffectiveness of the plant?

There is currently no properly conducted scientific study to suggest that herbal tea works better than conventional treatments and that it does not have any adverse effects

IDAY’s lighting: Indeed, research conducted according to World Health Organization (WHO) standards has yet to be published. In particular the research that Dr. Lucile Cornet-Vernet mentions. Further research is still needed to validate the widespread use of the plant as an official malaria drug. Such an international scientific study necessary to remove WHO’s reservations on the prophylactic use of Artemisia annua against malaria is indeed ready to be initiated on the basis of an agreement signed between Kenyatta University and IDAY. The protocol established according to WHO standards will be carried out in Kenya with several international partners, including Professor Pamela Weathers of the Worcester Polytechnic Institute (Ma, USA), entomologist Alexandra Hiscox of Wageningen Universiteit (Netherlands), professors Michel Frederich and Guy Mergeai of the University of Liège (Belgium).

In 2016, a study published in the Journal of Travel Medicine reported two cases of French travellers hospitalized in intensive care due to severe malaria after taking Artemisia annua preparations

IDAY lighting: It is indeed worth recalling that herbal tea is not 100% safe and that some Europeans have suffered attacks after using it for prophylaxis. It should also be remembered, for the sake of objectivity, that drugs are not either and that many people still die of malaria because they have trusted the drugs. And what about those who did not heal with the ACT and were healed by the plant? From a preventive point of view, the plant’s herbal tea has the advantage of not causing the well-known side effects of ACTs.

There remains one point on which everyone agrees: drugs are very effective but still not sufficiently accessible. A logistical problem that Artemisia’s herbal teas solved, even if they proved to be (at least partially) effective, would not solve “the problem” anyway

IDAY’s lighting: Some doctors seem to find it very difficult to take into account the practical considerations that affect African medicine. For example, they seem to ignore the problem of counterfeiting, which accounts for 50% of the antimalarial drugs available on the African market, artemisinin-based drugs sold as monotherapy, and the issue of the rapid expiry of drugs under tropical conditions. However, herbal tea is less affected by these problems. It should also be recalled that 70% of Africans still use community medicine: they are largely treated by local means, particularly because of their delicate financial conditions. Offering them the means to heal themselves with a plant that they can grow in their garden, which in addition offers them protection against the vector since it also has a repellent effect on mosquitoes, would deserve a greater openness of mind on the part of the Western medical profession.
Another key consideration is that WHO estimates that at least US$ 6.4 billion per year is now needed to meet the needs of people at risk of malaria, while only US$ 2 billion of foreign aid per year will be available in 2019 and beyond, as foreign international aid and local public funds are taken up by other emergencies. The plant is therefore an effective and inexpensive complement to current official resources and will enable vulnerable populations to cope with the upcoming health crisis.

In conclusion, Pierre Rabhi reminds us that the farmer must precede the doctor. Most drugs originate in plants. The recognition of their medical value in no way diminishes the authority of physicians, who, on the contrary, are rightly challenged when they adopt a narrow and restrictive view of the primary source of their profession. Rather than opposing doctors to the promoters of medicinal plants, it would be better to seek to reconcile positions from a service perspective to a population that has suffered for too long because of a focus on the sole Western approach to medicine, which shows its limits today.

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