Artemisinin: Worthy of Nobel Prize, but Growing Concerns About Resistance

Artemisinin, a drug used to treat malaria, has been a recent topic of public discussion after its discovery was recognized with the Nobel Prize in Physiology or Medicine on October 5. The 2015 prize was awarded to three researchers who developed treatments for parasite-caused diseases, with half the award going to Youyou Tu, who is credited with the discovery of artemisinin. Artemisinin has benefited hundreds of millions of people around the world. Yet the recognition for artemisinin’s discovery comes at a time when public health officials are becoming more concerned about its ongoing effectiveness and struggling to implement policies to slow the spread of artemisinin resistance.

Malaria used to be treated primarily with chloroquine and quinine. In 1967, as these two treatments were becoming increasingly ineffective due to parasites’ resistance, Tu and other Chinese researchers began to evaluate traditional Chinese remedies as possible new treatments for malaria. Initial screens of thousands of herbs suggested wormwood as a promising treatment, and eventually Tu and the other researchers isolated pure artemisinin by 1972. Artemisinin has subsequently been used across the world as one of the most effective treatments for malaria.

But over time, artemisinin, like the earlier drugs, has gradually become less effective. Due to a combination of several factors, including poor treatment practices and widespread nonconforming use, artemisinin-resistant parasites have emerged in five countries in the Greater Mekong subregion of southeast Asia. In some areas along the Cambodia-Thailand border, multidrug-resistant malaria has become a problem. The World Health Organization is also actively monitoring for signs of artemisinin resistance in Africa and South America.

Public health officials and researchers have proactively responded to these concerning developments. Since 2013, the WHO has highlighted the importance of containing artemisinin-resistant malaria and actively sought to prevent its spread through a regional framework in the Greater Mekong subregion. More globally, the WHO’s 2015 Guidelines for the Treatment of Malaria explicitly address artemisinin-resistant malaria and emphasize the urgent need for studies to determine the best treatment regimens to combine artemisinin with other drugs to prevent resistance. Genomic research is providing crucial insights into the mechanisms of artemisinin resistance, although these discoveries are currently being used primarily to track the locations of artemisinin resistance.

Ultimately, the WHO says, the elimination of the threat of artemisinin-resistant malaria will “require considerable financial resources, long-term political commitment, and strong cross-border cooperation.” Specific regulatory, legal, and policy changes are needed, such as stronger regulation of artemisinin-based therapies, more widespread compliance with treatment recommendations, greater access to effective treatments, and increased funding for malaria treatment and prevention. Unless sufficient changes can be made to successfully prevent or slow the spread of artemisinin resistance, policymakers and scientists worry that this breakthrough drug might follow in the unfortunate footsteps of chloroquine and quinine.

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