Back to All Events

A Tale of Two Treatments: Animalarials and the pursuit of legitimacy

Place: Salle J322, University of Paris Descartes

Seminar Series: Produire et inventer au sud

Abstract: Artemisinin-based combination therapies (ACTs) are the current front-line treatment for uncomplicated malaria recommended by the World Health Organization. Due to fears about the spread of artemisinin resistance in Sub-Saharan Africa, where the majority of malaria cases and deaths occur, the WHO and the Global Fund to Fight AIDS, TB, and Malaria mandate the use of combination therapies rather than monotherapies to protect the usefulness of the pharmaceutical agent. The WHO prequalifies pharmaceutical products and the Global Fund subsidizes only ant-imalarials that use different versions of the agent artemisinin (including artesunate, dihydroartemisinin (DHA or artenimol), and artemether) combined with other anti-malarial agents (like lumefantrine, amodiaquine, and mefloquine). In this global public health space where fear of losing pharmaceutical effectiveness drives much of the recommendations that the WHO promotes to fight malaria, I wish to investigate the modes of legitimization behind two “alternative” forms of producing anti-malarial treatments. 

First, I will discuss the semisynthetic production of an artemisinin derivative (artesunate) by biologically engineered yeast through a public-private partnership funded by the Bill and Melinda Gates Foundation, which has been called The Artemisinin Project. Although the project ultimately “failed,” the processes that set it in motion and the regulations that allowed it to come to fruition raise interesting questions about the WHO’s prequalification process and bioequivalence. Second, I will turn to an international network of pharmacologists and plant biologists that aims to legitimize the use of whole plant therapy of Artemisia annua, the plant from which artemisinin was first isolated by Chinese pharmacologists in the 1970s. The WHO’s stance on whole plant therapy is one of discouragement, and this network has attempted to produce the kind of evidence that would overturn this stance. They wield the concept of synergy and argue that the fear of the spread of artemisinin resistance, on the heels of chloroquine resistance, should be a lesson to global health decision-makers that they should look for new ways of fighting malaria that do not put an isolated pharmaceutical agent at the foundation of their strategies. In this sense, these two cases of seeking legitimacy for anti-malarial treatment provide two very different definitions of “innovation” and lay bare the politics at the heart of global health.