Page 14 - GHES-3-3

Global Health Economics and
Sustainability
Sustainable therapeutic Artemisia

not clear. Nevertheless, newer technologies such as converted into ART (Paddon & Keasling, 2014). The
supercritical CO (scCO ) extraction offer the potential process was scaled up and commercial production of
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to reduce overall costs with a reduction in energy and WHO-approved ART was initiated by Sanofi in 2013.
hazardous waste (de Vries et al., 1999). In a 2006 review Despite a stellar technical achievement, the microbial
(Lapkin et al., 2006), various extraction technologies production of ART was met with a huge socioeconomic
were compared and assessed for their ART recovery backlash resulting in the closure of the Sanofi production
efficiency and cost. Although deemed a “green” solvent, facilities in the West. African growers realized that
ethanol was less efficient than hexane extraction, but they would be put out of business with this production
scCO , ionic liquids (IL), and hydrofluorocarbon (HFC) scheme, so they planted huge amounts of A. annua for
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offered promising improvements for extraction. IF and eART. That significantly reduced the price of ART such
HFC, however, have high capital costs with potentially that the sbART was no longer cost-effective for Sanofi
harmful greenhouse gas emissions and higher energy (Peplow, 2013; 2016). In 2009 (News, 2009), over 4,000
costs. While slightly less efficient, scCO was cited as small stakeholder farmers were growing A. annua,
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a mature off-the-shelf processing technology, having potentially representing more than 4,000 families whose
already been developed for applications such as livelihoods depended on the cultivation of A. annua.
decaffeinating coffee (Lapkin et al., 2006). Interestingly, Indeed, ethical concerns regarding sbART were raised,
Babacan et al. (2022) recently showed that using ethanol particularly due to its impact on farmer livelihoods. In
as the extraction solvent was as efficient as hexane and addition, the cost of sbART was consistently higher than
six other solvents at extracting ART when coupled with that of eART, and sbART represented a shift of wealth
1.5% (w/v) of powdered charcoal. Charcoal optimized from the global South to the global North (Dalziell
chlorophyll removal and facilitated the desorption & Rogers, 2022). Considering the massive financial
of ART, and, after drying, yielded a white crystalline input (>US$ 50 million from the Gates Foundation and
powder consisting of ART, suggesting that a more collaborating institutions) into producing sbART in
sustainable production process may be possible. Efforts significant quantities, the anticipated long-term impact
are afoot to use more environmentally friendly solvents on malaria has not been realized. Indeed, ART resistance
for ART extraction. For example, Cao et al. (2017) is now spreading throughout Africa and there is urgency
used deep eutectic solvents, e.g., N81Cl-NBA, that can in addressing this pending disaster (Dhorda et al., 2024;
be reused several times and are thus notably “greener” Ishengoma et al., 2024). There also is no reason why the
for extracting ART. Interestingly, Triemer et al. (2018) use of sbART, extraction, and production of eART/AA,
exploited the presence of chlorophyll in a toluene crude and traditional A. annua (pART) approaches cannot
extract of A. annua that along with trifluoracetic acid co-exist (Brisibe & Chukwurah, 2013).
(TFA) in an LED photobioreactor converted DHAA to
ART at lower than typical unit op temperature. DHAA is 3.4. The whole plant is the most sustainable
quite labile and often lost in the extraction process so this solution: Efficacy and production options
was a significant improvement. The resulting ART still Unfortunately, the production of eART focuses solely
requires final purification, but using powdered charcoal on ART, missing the synergistic potential of the plant
as suggested by Babacan et al. (2022) could yield an even in its entirety. Only powdered, encapsulated dried
“greener” process. Unfortunately, the environmental leaves of the plant offer the full therapeutic potential
cost of charcoal production (Chidumayo & Gumbo, of its phytochemicals, along with the crucial benefit
2013) was not considered. There are also efforts aimed of pART resilience against the evolution of ART drug
at minimizing other wastes and to also add value to the resistance. The key concerns for using any drug are
process, such as using discarded A. annua stems – very threefold: efficacy, consistency, and safety. As already
woody and thick – as a source for the production of noted in Section 1.0, pART from A. annua is highly
high-quality cellulose derivatives (Risite et al., 2022). efficacious when produced and used in a consistent form.
Furthermore, when A. annua is grown in the same locale,
3.3. ART produced through synthetic biology it yields phytochemically consistent crops with consistent
approach: Boon or bust? ART and total flavonoid content (Gruessner et al., 2019).
A major scientific breakthrough in synthetic biology ART Traditional medicines remain the norm, particularly in
(sbART) production was achieved by the Keasling group low- and middle-income countries, with the controlled
who engineered both yeast and E. coli to produce a late use of traditional tea proving successful and continuing
precursor of ART, ultimately enabling yeast production of to expand, as discussed later in Section 4.0. Another
25 g/L AA that could be extracted and semi-synthetically option with minimal capital input is the encapsulation

Volume 3 Issue 3 (2025) 6 https://doi.org/10.36922/ghes.4927