The World Health Organization and Artemisia annuaSarah Staub

University of Florida, Department of Anthropology

Abstract

For nearly 100 years we have fought to control and eradicate malaria, with limited success in Sub-Saharan Africa. In 2007, the Bill & Melinda Gates Foundation stated that anything less than the eradication of malaria was morally unacceptable, a position immediately echoed by the then Director General of World Health Organization (WHO). A number of obstacles to malaria control and eradication have been identified by the WHO, governments and organizations and they have stated that new, sustainable, and innovative approaches are necessary for success; yet the WHO continues to opt for standardized ‘development’ packages that resonate with their discourse. Artemisia annua is a widely studied, sustainable, safe and effective method to both prevent and treat uncomplicated and resistant malaria. Artemisia annua is currently being grown and used for malaria in at least 14 African countries and its use is growing (Weathers et al., 2014a). At a time of apparent failures of current programs and methods, increased resistance of Artemisinin combination therapy (ACT) medicine and insecticides, low ACT usage and accessibility issues, and an increased push for effective and sustainable development, I question why the WHO main office has continued to actively discouraged the use of the whole plant and their stated refusal to even discuss their 2012 position statement on Artemisia annua or discuss the use of this plant in any meetings related to malaria; while the WHO Africa office states that “The Chinese herb Artemisia annua has been found to be effective against resistant malaria and could create a breakthrough in preventing almost 1 million deaths annually,” (WHO 2017). In 2005 the WHO changed its financial policy to allow private money into the system, which resulted in strong ties to the pharmaceutical industry (Ventegodt, 2015). They have repeatedly been accused of biased recommendations, failure to disclose financial ties with the pharmaceutical industry and negotiating medicines with governments on behalf of the pharmaceutical companies. By not addressing the scientific literature, and the growing use of Artemisia annua in Africa the WHO is straying from their initial objective of allowing people the highest possible level of health and their motives should be questioned. It is my belief that the peer-reviewed research regarding Artemisia annua for malaria addresses the WHO’s stated concerns, their claim of a lack of evidence on the plant is unsubstantiated and their true opposition to the use of this plant lies in financial and political reasons.

Background

Malaria• Nearly half of the world's population is at risk of malaria. • In 2015, there were roughly 212 million malaria cases and an estimated

429,000 malaria deaths, with more than 90% of these cases and deaths occurring in sub-Saharan Africa (WHO, 2016).

Artemisia annua L. (Asteraceae) • commonly known as sweet wormwood • native to Southeast Asia and China.• Artemisinin extraction in 1972 • The plant has been naturalized

and grown in over 75 countries.

World Health Organization (WHO)• Created by the United Nations in 1948. • The objective of WHO is the attainment by all peoples of the highest

possible level of health. Health, as defined in the WHO Constitution, is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

WHO opposition to Artemisia annua

Discussion and Conclusion

• The WHO has cited a number of reasons for their opposition of Artemisia annua and while more research is needed, particularly regarding its prophylaxis use and the recrudescence of malaria in patients, their concerns have been largely addressed and disproven in the peer-reviewed research. With over 10,600 peer reviewed studies on the use of the Artemisia annua plant for malaria it appears that their simple claim of a lack of peer-reviewed clinical evidence is not valid.

• While the WHO has stated that African governments need to take more ownership and control of their programs and identify those that will be sustainable, they concurrently deny countries the right to use any malaria funding for the promotion of Artemisia annua.

• Governments, NGO’s, academics and experts have identified a history of corruption within the WHO, have deplored this neo-colonialist rule and have called upon African researchers and governments to seek their own solutions to malaria control and go against the WHO in promoting Artemisia annua (Weathers et al., 2017).

• The WHO has repeatedly been accused of corruption, ties to the pharmaceutical industry, failure to disclose conflicts of interest, biased recommendations, and negotiating medicines with governments on behalf of the pharmaceutical companies.

• A review of WHO’s financial records, MPAC meeting reports, declarations of interest, ERG’s, and submitted reports supports the notion that they formulated their position statement on the effectiveness of Artemisia annua for malaria without any official discussion or review of evidence and financial and political motivations may be behind the WHO’s true opposition to the use of Artemisia annua.

• Evidence is mounting for the safety and efficacy of the use of Artemisia annua, to prevent and treat malaria. We know that a vast number of people are using Artemisia annua in various forms for the prevention and treatment of malaria and they will continue to do so due to the availability, low cost, efficacy and a growing lack of trust of western based medicines (Kooy and Sullivan, 2013). The question is, will the WHO continue on this path of corruption and continue to prevent this use or will they follow their objective of allowing peoples the highest possible level of health by promoting research and discussion on this tool for malaria eradication.

WHO opposition to Artemisia annua

WHO’s History of Corruption

• 2005 financial policy change • Ties to Pharmaceutical industry

• 2002 meeting and 2004 recommendations on stockpiling • Failure of WHO to disclose financial ties and refusal to release details of declarations of interest• Presence of pharmaceutical company representatives at policy meeting

• 2009 Flu Vaccine Scandal • WHO advisor ties to pharmaceutical companies• WHO intentional hype of flu season • Change in definition of “pandemic”

• Original definition: “An influenza pandemic occurs when a new influenza virus appears against which the human population has no immunity, resulting in several simultaneous epidemics worldwide with enormous numbers of deaths and illness.”

• May 2009 definition: “An influenza pandemic occurs when a new influenza virus appears against which the human population has no immunity.”

• After this redefinition, the WHO declared H1N1 the first “pandemic” in 42 years, categorizing it a “Level 6” pandemic emergency.

• Vaccine contract stipulations required countries purchase reserves if a “pandemic” is declared.

• Criticism of WHO organization expenses • 2015 internal audit by the United Nation’s Office of Internal Oversight Services

• At the World Health Assembly meeting, health officials from around the world chastised the UN’s public health arm for creating an environment where serious violations are allowed to occur.

• Corruption and Malaria • 2015 financial records

• Pharmaceutical industry contributions- $30,275,130- $20,920,096 million of that coming from 3 pharmaceutical companies that produce the ACT malaria medicine or vaccine GSK, Novartis, Sanofi Pasteur

• 2004 and 2012 position statements• Malaria Policy Advisory Committee(MPAC)

• No reported discussion of Artemisia annua in any meeting• No Evidence Review Group (ERG) or Technical Expert Group on Artemsia annua• Conflicts of interests- Declaration of Interests (DOI)

• 117 out of 180 members over 12 MPAC meetings reported “relevant interests” • 102 DOIs reported financial interests, 22 personal, 39 specific, 2 significant • 14 members recused from part of at least 1 session.

References

Blanke, C. H., Naisabha, G. B., Balema, M. B., Mbaruku, G. M., Heide, L., & Müller, M. S. (2008). Herba Artemisiae annuae tea preparation compared to

sulfadoxine-pyrimethamine in the treatment of uncomplicated falciparum malaria in adults: a randomized double-blind clinical trial. Tropical

doctor, 38(2), 113-116.

Closser, S. (2012). “We can't give up now”: global health optimism and polio eradication in Pakistan. Medical anthropology, 31(5), 385-403.

Duke JA. (2001). Handbook of phytochemical constituents of Grass herbs and other economic plants. CRC Press LLC, Boca Raton, FL p 70.

Elfawal, M. A., Towler, M. J., Reich, N. G., Weathers, P. J., & Rich, S. M. (2015). Dried whole-plant Artemisia annua slows evolution of malaria drug

resistance and overcomes resistance to artemisinin. Proceedings of the National Academy of Sciences, 112(3), 821-826.

Mueller, M. S., Runyambo, N., Wagner, I., Borrmann, S., Dietz, K., & Heide, L. (2004). Randomized controlled trial of a traditional preparation of

Artemisia annua L. (Annual Wormwood) in the treatment of malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene, 98(5),

318-321.

Onimus, M., Carteron, S., & Lutgen, P. (2013). The surprising efficiency of Artemisia annua powder capsules. Medicin Aromat Plants, 2(3), 2167-0412.

Van der Kooy, F., & Sullivan, S. E. (2013). The complexity of medicinal plants: The traditional Artemisia annua formulation, current status and future

perspectives. Journal of ethnopharmacology, 150(1), 1-13.

Ventegodt S. Why the Corruption of the World Health Organization (WHO) is the Biggest Threat to the World’s Public Health of Our Time. J Integrative

Med Ther. 2015;2(1):

Weathers, P. J., Arsenault, P. R., Covello, P. S., McMickle, A., Teoh, K. H., & Reed, D. W. (2011). Artemisinin production in Artemisia annua: studies in

planta and results of a novel delivery method for treating malaria and other neglected diseases. Phytochemistry Reviews, 10(2), 173-183.

Weathers, P. J., Elfawal, M. A., Towler, M. J., Acquaah-Mensah, G. K., & Rich, S. M. (2014). Pharmacokinetics of artemisinin delivered by oral

consumption of Artemisia annua dried leaves in healthy vs. Plasmodium chabaudi-infected mice. Journal of ethnopharmacology, 153(3), 732-736.

Weathers, Pamela, Lucile Cornet-Vernet, Ahmed Hassanali, and Jean-Jacques Schul Letter to World Health Organization (2017). Note to World Health

Organization on Integration of Artemisia annua into the Strategy Against Malaria in Africa.

WHO. (2016). World Malaria Report 2015 Summary. Report. Geneva, 2016.

“WHO is infested by corruption. There is big

corruption, like the management of H1N1, and

there is small corruption; and between the big

and the small corruption there is [corruption] in

all imaginable forms” anonymous high-level, long-

term WHO employee (Kyriakou, 2010).

“We are also aware that we are making high level claims for a

traditional medicine which means we are entering the

playground of the pharmaceutical industry. The main problem

or limitations might therefore not only be scientific but also

economic or political. Is the answer to the lack of interest in the

traditional use of the Artemisia annua formulation that we

should maybe first come up with a decent business plan?”

( Van der Kooy and Sullivan 2013, 12). Source: Van der Kooy and Sullivan (2013)

Acknowledgements

I would like to thank Dr. Kevin Bardosh and Dr. Marit Østebø for their input and guidance on this project.

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WHO Objection s Aga inst the Use of Artemisia annua

Objection WHO pos ition Counter ar~ument

Artem isinin The WHO cited t hat substanda rd doses of • Artemisia anrwa is a Resistance Artem is inin has le d to a rtemis in in resistance Polytherapy

but have yet t o cite any studies co nnecting the • No scientific proof that t he use of the Artemisia annua plant to integration of the pla nt into artemisinin resistance the overal l global st rategy

agai nst ma la ri;;i would resu lt

in artemisinin res istan ce (Weathe rs et a l., 2017;

Weathe rs e t al., 2014; Elfawal et al. 2015)

The WHO did not specifically address the • "Generally regarded as Safety safety of the plant itself in e it her the 2004 or safe" (GRAS) status by the

2012 statements except to say that more FDA

clinical resea rch was required to demonstrate • No low o r high-dose t oxicity t hat non-pha rmaceutica l fo rms of A. annua, be ing found (Weathers et. including tea bags, are safe and effective to Al., 2011; J. Duke, 2001; t reat malaria, Onimus et a l. 2013)

• No significant negative side

effects Variable WHO fea rs that different soil types, climatic • A3 ANAMED hy brid Content of cond itions and cultivation methods gene rate • Post-harvest Artemisinin Artem isinin d ifferent plant composit ion thc1t stability

could dimin ish the effectiveness of the plant • Syne rgism by reducing t he artemisinin content • ACT a rtemisin in content and

co unterfeits Proper Dosage The WHO has stated that th e varia ble content • Packaged tea bags and

of artemisinin cou ld affect dosage and tablets uncontro ll ed treatments may result in • Concern for ACT med icines incor rect dos.es..

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WHO position

Efficacy and The WHO has stated that they cannot be sure

Recrudescence if Artem isia annua is an effective treatment for malaria but has fa iled to reference a s ingle

study that addresses the supposed

ineffect iveness of t he plant on the treatment

of ma laria . Instead, their cla ims o f ineffect iveness have focused on rates of

reoccur rence, citing Muel ler MS et al., (2004)

and Blanke CH et a l., (2008),

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observed high

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