The Independent, 29 December 2004
By Meera Selva in Chencha, Ethiopia
Tibebu Orcho holds up a packet of seven plastic bags, each filled with a
finely ground, dark green leaf, and asks us to inhale its head-clearing
scent.
Artemisia annua, or sweet wormwood, has become his main source of
income, and a life-saver for his community. Artemisia is an ancient cure
for malaria; the Masai in Kenya used a variation of the plant, and the
Chinese have long known about its medicinal properties. Now farmers in
Ethiopia are discovering its virtues.
Mr Orcho grows artemisia in his idyllic garden, alongside apple trees
and rows of cabbages. Once the plant is ready to be harvested, he cuts
off the leaves, dries them and crumbles them up. He then fills plastic
bags, seals them with a candle and sells them to neighbours to be made
into tea. He tells them to pour one litre of boiling water over five
grams of dried leaves. If they have no scale, he tells them five grams
is the amount that just fits into a plastic 35mm film container.
“I used to buy these leaves, at 5 birr [30 pence] for a dose when my
children got malaria,” he said. “Then people from the community project
(run by Send a Cow) told me I could grow it myself. I was hesitant at
first, but I tried and it worked.
“Before, if people couldn’t get any medicines when they shivered from
malaria, they would just sit in front of the fire and try to keep warm.
I am happy I am able to help them now.”
Mr Orcho is at the forefront of a new stage of the ongoing battle
against the disease. Artemisia, which grows wild in China and Vietnam,
is considered one of the most effective treatments against malaria in
the world.
Experiments began in China in the 1970s but Mao’s government kept it
secret for decades. Only recently has the West fully understood its
virtues; research shows that artemisia remedies cure 90 per cent of
patients in three days.
The new cure for malaria comes just in time. In the past decade,
infection has risen sharply, killing three million people worldwide,
most of them children under five. Another 300 million people who caught
the illness now regularly suffer from high fevers. Sub-Saharan Africa,
where millions have no access to reliable health care, bears the brunt:
scientists estimate the average number of cases per year in Africa has
quadrupled since the 1980s. Scientists call it the silent holocaust.
New strains of the malarial parasite which are resistant to older drugs
have spread rapidly. The World Health Organisation (WHO) and
international drug agencies now consider artemisia to be the most
cost-effective solution. It works by destroying malarial parasites in
the bloodstream.
The parasites are resistant to most existing anti-malarial drugs, but
artemisia’s structure is so different from other anti-malarial drugs
that the parasite does not recognise it.
In April, the Global Fund, the WHO, the World Bank, Unicef and the
United States Agency for International Development called on
malaria-prone countries to phase out older drugs like chloroquine and
use multi-drug combinations containing artemisia or its derivatives.
But already there are problems. The rising demand for the drug has led
to a worldwide shortage. Prices have quadrupled and the few companies
that make the medicine have cut back production. The price of artemisia
was about 60 a pound, but as soon as the international agencies made
their requests, prices shot up to around 210 a pound.
Novartis, the Swiss pharmaceutical company, now says it can produce only
half the 4.5 million courses of the Co-Artem drug it promised to make
for the WHO, because its supplier in China has not grown enough of the
plant. Drug companies in India have said they are willing to pay any
price for the plant. As a result, many countries, including Ethiopia,
which were encouraged to adopt artemisia-based drugs, will have their
supplies rationed.
All this is happening in tandem with another approach to the problem. In
Ethiopia, people working with the British charity Send a Cow began
experimenting with artemisia four years ago. They acquired seeds from a
European organisation – Action for Natural Medicines – and discovered
the plant grows well in the cool, clear air of Ethiopia’s southern
highlands. Send a Cow covered the initial costs and provided training
for farmers to grow, package and sell the medicine in the lowlands,
where malaria is a common killer. They are trying to persuade Ethiopia’s
Ministry of Health to recognise their work and to look at ways of
developing the drug, instead of buying it from European pharmaceutical
companies.
“It’s infuriating to read how Novartis cannot find enough artemisia when
our farmers are growing it in their backyards,” said Theopholus Tesfaye,
an agriculturalist working with Send a Cow Ethiopia.
“The Ethiopian government buys in expensive medicines derived from
Artemisia when the crop is growing in its own country. We need to go and
persuade them to rethink their policy.”
In the meantime, in Chencha, a town consisting of a row of shacks and
tiny farms dotted around the mountainside, an artemisia cottage industry
is growing fast. Farmers grow rows of the delicate plants in their back
gardens, and Send a Cow provides advice on when to harvest the crop and
how to process it. They use the money they gain from selling the
medicines to buy livestock, apple saplings and clothes for their
children.
The people who buy the treatments are grateful, too. Before they had
access to a regular supply of artemisia, anyone who caught malaria would
have to trek for miles to reach the nearest clinic. Even if a family
could afford to pay for it they would not be guaranteed treatment, as
the clinics often ran out of medicines.
“The artemisia plant has given this region a whole new industry,” said
Mr Tesfaye. “We may not have national recognition yet, but at least we
can help our immediate community to fight malaria.”
In Africa, a cure for malaria could provide the key to development.
Economists at Columbia University estimate that countries hit hardest by
the most severe form of malaria have economic growth rates 1.3
percentage points lower than those not seriously affected.Artemisia
could provide the springboard for development: there are indications
that it could be used to treat other diseases, from breast cancer and
leukaemia to haemorrhoids.
Most importantly, scientists are also looking at its ability to cure
HIV-Aids. Ethiopia is currently one of the most heavily affected
countries in the world, with around three million people infected with
the HIV virus at the end of 1999. The ability to grow its own
anti-malarial and HIV-Aids treatment drugs could revolutionise health
care in Ethiopia.
Mr Orcho, who retired from the Ministry of Health three years ago, is
one of the linchpins of the system.
He sells each course of seven-day treatments for 5 birr – an affordable
amount for most families. Yet he has still managed to earn 3,380 birr
[pound 203] in a year. When he worked for the government, he earned just
1,400 birr a year.