Page 12 - GHES-3-3

Global Health Economics and
Sustainability
Sustainable therapeutic Artemisia

digested, A. annua increases the solubility of ART four-fold preparation, and delivery stages of these medicinal plants,
(Desrosiers & Weathers, 2016), improves ART transport then therapeutic results are quite reliable. Development of
across the intestinal barrier (Desrosiers & Weathers, well-controlled use of these two medicinal plants results in
2018), and, once in the liver, inhibits the main cytochrome the empowerment of people, especially in low- and middle-
P450s, 2B6 and 3A4 (Desrosiers et al., 2020; Kane et al., income countries, and impacts the United Nation’s (UN)
2022), which metabolize ART. This results in a greater sustainability goals (No. 1, 3, 5, 8, 11, and 12) that focus
distribution of ART to organs including, the brain, heart, on reduced poverty, good health and wellbeing, gender
lungs, muscle, and liver, compared to pure ART (pART) equality, decent work and economic growth, responsible
(Desrosiers et al., 2020). consumption and production, and sustainable cities
and communities. Failure to recognize and encourage
2.4. No ART drug resistance the responsible development of these two important
With over 2,000 years of use, consumption of a more medicinal crops is a necropolitical choice made by Western
complex botanical drug such as Artemisia also obviates the biomedicine and regulating bodies, e.g., the WHO (Staub,
emergence of single-molecule drug resistance. Using two 2023). The following is a comparative discussion on the
murine malaria models, Elfawal et al. (2015) tested pART inclusion of these plants as a more sustainable part of
and A. annua at equal ART concentrations to generate therapeutic protocols for treating many diseases that afflict
ART-resistant Plasmodium parasites. While resistance was and kill millions annually, with cases and deaths from four
readily developed using pART, no resistance emerged using examples presented in Table 1.
A. annua. Others (Ataba et al., 2022) including WHO claim 3.1. Production of Artemisia versus eART
that the use of A. annua modalities to treat malaria could
increase ART-drug resistance in the parasite, but there While A. afra is not globally commercially produced yet,
is no evidence to date to substantiate this claim. Indeed, there are thousands of acres of global A. annua plantations
evidence to the contrary was provided by Elfawal et al. mainly for the extraction of ART for ACTs. The global A.
(2015), who showed that ART-induced drug resistance annua extract market size was valued at US$ 75 million in
was successfully treated with A. annua, but not with pART, 2023, growing at a compound annual growth rate of 19.8%,
even at higher doses than those from the consumed plant and is projected to reach US$ 225.3 million by 2030.
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material. Furthermore, Daddy et al. (2017) also used Traditional use of both pART and eART first involves
A. annua dried leaf tablets to successfully treat 18 patients growing the plant. In 2010, Ellman (2010) estimated the
who had severe malaria and were not responding either costs of agricultural production of the plant, many steps of
to ACT or intravenous AS. Two of the pediatric patients which are common to both traditional use of A. annua and
were successfully revived from coma after treatment. These eART production. These estimates are shown in Table 2;
human results correlate well with the rodent studies of while similar for commercial and smallholder growers, the
Elfawal et al., showing that A. annua could treat malaria estimates were nevertheless 40% lower for the smallholder
that is not responsive to the standard drugs. grower, mainly due to lower costs of plants, fertilizer,
irrigation, and harvesting.
3. Comparisons between Artemisia and For eART, additional costs are incurred by extraction
eART production: Current and emerging and purification of ART and other artemisinic compounds
prospects from the plant, a process that involves many steps,

Use of A. annua through more traditional means, or with a commonly known as unit operations (unit ops). While exact
simple Western biomedical approach such as encapsulated production steps and costs are often proprietary secrets,
powdered dried leaves or emulsions, is much more de Vries et al. (de Vries et al., 1999) described the general
sustainable than the extraction and purification of the active process in 1999. It is briefly described with cost estimates in
molecules, or the chemical synthesis of such molecules. 1998 shown in Table 3. After the leaves are threshed from
The plant in its entirety also requires no solvents other plants, they are then milled and homogenized to yield a
than water, so there are no excess energy consumption and relatively uniform material for extraction. Extraction
capital costs associated with processing operations. The is via an organic solvent with various heating steps
use of locally-guided, protocol-driven agriculture has a included to yield eART, which is then analyzed for purity.
significant impact on many women, who represent about eART is then derivatized via a semi-synthetic process to
40% of the agricultural labor force in low- and middle- yield AS, DHA, or AM, which are required to formulate
income countries (Palacios-Lopez et al., 2017). In addition,
local jobs are created when based on locally grown crops. If 1 https://www.verifiedmarketresearch.com/product/sweet-
well-established protocols are followed for all production, wormwood-artemisia-annua-extract-market/.

Volume 3 Issue 3 (2025) 4 https://doi.org/10.36922/ghes.4927