Malaria remedy proves a tonic for remote China

By Howard W. French
The New York Times
May 12, 2005 

ZHUOSHUI, China Every five days, a country market converges in a horn-honking, pig-squealing clamor on the old arching stone bridge that spans the river coursing through here.

For as long as anyone can remember, the biggest crop in this valley has been the corn that grows tall and thick by the river's edge. But in the past two years, a new crop, qinghao, or sweet wormwood, has been crowned king, driven by a desperate need in the tropical world for new malaria treatments.

The rugged valleys and steep gorges along the Apeng River, in central China, have long been a metaphor for idyllic remoteness. Even China's dazzling economic takeoff did little to change that, until the World Health Organization approved a malaria treatment using artemisinin, the active ingredient of the qinghao plant, in 2001.

Since then, the plant's market value has nearly quadrupled. And in the process, qinghao has become an unlikely driver of globalization in these parts, sending peasants scouring the mountainsides to harvest the wild bush.

Just as eager to cash in, farmers are replacing plots of corn, tobacco and potato with the herb, which is bought and sold from bulging burlap sacks amid frenzied market-day crowds by dealers wielding brass hand-held scales.

Despite China's long history and ancient medical traditions, artemisinin is the first Chinese pharmaceutical product to be broadly distributed internationally.

In antiquity, it was written that parts of this southeastern region of Chongqing Province were so isolated that the people here did not know what dynasty they lived under. Today, mounting a full-court press driven in part by demand for the drug, the government is rushing to remedy that, building the first highways into the area, along with a rail line and a small airport.

Confusion about dynasties seems to have given way to confusion about all the fuss being made over sweet wormwood, an ancient folk remedy for colds and fevers, even as trading the herb begins to line pockets.

"I don't know what medicine this makes," said Sun Lingui, 23, a qinghao dealer who staked out a prime position on the bridge on a recent market day.

He sold the herb along with a bushel of dried beetles that he said were a traditional remedy for respiratory problems.

"I know it is used to extract something called artemisinin," Sun added. "Anyway, it is for some kind of medicine, and I hear that tropical countries all need it." Sun said he had gleaned the little he knew about the plant from a television program, which spoke of the herb's rapidly increasing value and alluded to its health benefits. What those benefits were, he, like the peasants around him, could not quite recall.

The fact that this traditional Chinese drug, which the villagers say is good for everything from sniffles to healing wounds, is the greatest recent hope in global efforts to fight malaria is scarcely appreciated here. Malaria kills more than one million people a year, mostly in Africa.

With established antimalarial medicines rapidly losing their effectiveness, the World Health Organization recommended in 2001 that countries afflicted by the disease switch to a combination therapy based in part on the Chinese drug. After a slow start in adopting artemisinin-based drugs, demand has skyrocketed in the past two years, with projections that 300 million doses will be needed in 2006.

Ding Derong, a scientist with China's Southwest Agriculture University, who has studied artemisinin for 30 years, said that between 30,000 and 40,000 tons of the crop would be needed to meet that demand.

"This is a very easy thing to plant and grow, but it is hard to cultivate good-quality seeds," Ding said. "At first, farmers will choose cheap seeds over good ones. The result is there will be a lot of disorder."

Jiang Yifei, spokeswoman of the Holley Corporation, the largest Chinese producer of artemisinin, said the biggest challenge in increasing production was "organizing farmers to start standardized cultivation." Holley supplies the Swiss pharmaceutical giant Novartis with artemisinin. Novartis uses the active ingredient from the herb to produce Coartem, a drug it supplies on a nonprofit basis to the World Health Organization for distribution to malaria-afflicted countries.

Holley is investing heavily in increased production of sweet wormwood, as evidenced by hectare after orderly hectare of plantations of the bushy plant draped across a sweltering valley not far from here. Particular efforts are being made to produce high-yielding seeds for distribution to peasants who agree to cultivate the plant in cooperation with the company.

Even peasants closely associated with these efforts, however, say they are being kept in the dark about the drug's uses, and they grumbled over what they said was the company's secretiveness.

Xu Qianmin, a farmer who gets his seeds from Holley, said his arrangements with the company prevented him from talking about the uses of sweet wormwood. Little by little, though, with his family gathered around in their simple farmhouse, he opened up.

"I hear there's a country in Africa with a population of 1.5 million people, and only 14 kilos of our qinghao cured all of their malaria," he said, touting his plants as a sort of miracle drug.

"Qinghao isn't only good for one disease," he added. "We've heard it can be made into 300 different medicines."

Asked for examples, he briefly acted as if he had committed an indiscretion.

"The company has found a way to make money, and they want to keep things a secret," Xu said. "They don't want others to come in and steal their business. They want it for themselves."