Page 10 - GHES-3-3

Global Health Economics and
Sustainability
Sustainable therapeutic Artemisia

Southeastern Asia and is mainly used for the extraction of et al., 2015; Islamuddin et al., 2012; Kane et al., 2019; Mesa
its potent antimalarial compound, artemisinin (ART). The et al., 2017; Mishina et al., 2007; Naß & Efferth, 2018;
ART content of A. annua varies widely from 0.2 – 1.6% Taljaard et al., 2022). Four of these diseases are exemplified
(weight/weight; w/w) and is usually disproportionate in Table 1. Of particular recent interest is A. afra, a closely
to artemisinic acid (AA), ranging from 0 – 0.4% (w/w); related Artemisia species that lacks ART, but demonstrates
another important component is dihydroartemisinic acid efficacy against many of the same diseases, thereby
(DHAA), which ranges from 0.01 – 1.6 % (w/w) (Larson suggesting the broad therapeutic potential of the non-ART
et al., 2013). A. afra, which does not produce ART, is not phytochemicals it contains (Gruessner et al., 2019; Kane
grown as extensively or commercially as A. annua. It is et al., 2019; Snider & Weathers, 2021; Taljaard et al., 2022;
native to southern Africa and is increasingly being grown Weathers, 2023).
locally. Extracted ART (eART), AA, and DHAA are semi- A. annua also demonstrates efficacy against an emerging
synthesized and derivatized to form artesunate (AS), list of chronic ailments, such as fibrosis (Dolivo et al., 2021;
dihydroartemisinin (DHA), or artemether (AM). One of Larson et al., 2018; Larson et al., 2019; Weathers et al.,
these is then combined with another antimalarial drug, e.g., 2024), a pathology common to many diseases susceptible
lumefantrine, mefloquine, or amodiaquine, to formulate
the commercially available two-drug combination to ART/Artemisia treatment (Mutsaers et al., 2023; Nardo
therapy, ACT, to treat malaria patients. The cost of ACTs et al., 2021; Sewanan et al., 2023; Singh et al., 2023),
is still significantly subsidized by the West with the aim osteoarthritis (Hunt et al., 2016; Stebbings et al., 2016),
of reducing the global malaria burden (Goodman et al., and general inflammation (de Faveri Favero et al., 2024;
2024; White, 2008). Several clinical studies showed that the Desrosiers et al., 2020). Recently, even A. afra showed
traditional use of A. annua was effective against malaria potent antifibrotic effects (Weathers et al., 2024). Along
(Daddy et al., 2017; Munyangi et al., 2019; Räth et al., 2004; with the many in vitro and some human studies, the
Zime-Diawara et al., 2015). efficacy of A. afra suggests that phytochemicals other than
ART in both species are therapeutically efficacious (Ashraf
Beyond malaria, ART and A. annua have also shown et al., 2022; Daddy et al., 2021; Gruessner et al., 2019; Kane
great efficacy against many other infectious diseases et al., 2019; Kellogg et al., 2024; Kiani et al., 2023; Martini
including those caused by viruses (Devaraj & Roelofson, et al., 2020; Ntutela et al., 2009; Snider & Weathers, 2021).
2015; Efferth, 2018; Lubbe et al., 2012; Nair et al., 2021; Key results of the next four sections are further described
Romero et al., 2005; Zhou et al., 2021), bacteria (Daddy in four additional important areas: botanical crop
et al., 2021; Efferth, 2009; Kellogg et al., 2024; Kiani et al., consistency, safety, bioavailability of the compound, and
2023; Kim & Neiva, 2015; Martini et al., 2020; Zheng et al., resilience against the evolution of ART drug resistance.
2019), and especially parasites, including schistosomiasis,
leishmania, trypanosomiasis, and Lyme disease (Ashraf 2. Key features of Artemisia as a botanical drug
et al., 2022; Berrizbeitia de Morgado et al., 2017; Daddy
et al., 2017; Derda et al., 2016; Efferth, 2009; Elfawal et al., 2.1. Phytochemical consistency
2012; Elfawal et al., 2015; Feng et al., 2019; Feng et al., It is critical for a medicinal plant to be cultivated with a
2015; Feng et al., 2014; Ferreira et al., 2011; Ghaffarifar consistent phytochemical content to provide a reliable

Figure 1. Artemisia annua, Artemisia afra, artemisinin, and its derivatives used in the formulations of ART-based combination therapy (ACT)

Volume 3 Issue 3 (2025) 2 https://doi.org/10.36922/ghes.4927