Ediorial – Revolutionary therapies

The Nobel Prize in Physiology or Medicine 2015 has been awarded to three scientists for the “revolutionary treatments” they developed for devastating diseases that predominantly affect people in the developing countries. The discovery of the drug ivermectin, a derivative of avermectin, by William Campbell of Drew University in Madison, New Jersey, and by Satoshi Ômura of Kitasato University in Tokyo, nearly eradicated river blindness and radically reduced the incidence of lymphatic filariasis. The discovery of artemisinin by Tu Youyou of the China Academy of Chinese Medical Sciences in Beijing in the early-1970s was a decisive step in the battle against severe cases of malaria. Unlike the quest by the two Laureates for a remedy for roundworm infestation, Dr. Tu’s hunt for a potent anti-malarial drug turned out to be as dramatic as the drug itself. “In keeping with Mao Zedong’s urgings to explore and further improve the great treasure house” of Chinese medicine, she pored through ancient texts for leads. The secret operation, named Project 523 and announced on May 23, 1967, investigated more than 2,000 preparations before an extract from Artemisia annua (sweet wormwood) showed promise. Deftly combining traditional knowledge with modern science, she redesigned the extraction process, and purified the extract to make it both potent and safe. She was involved in isolating the active ingredient, conducting clinical trials and publishing the results. In 1973, she modified artemisinin to generate a powerful drug.

The miracle drug has prevented millions of malarial deaths. Yet, in 2013 there were 198 million cases of malaria and an estimated 584,000 deaths worldwide, over 90 per cent of them in Africa. As in the case of many other wonder drugs, resistance to artemisinin is fast emerging. As of February 2015, artemisinin resistance has been confirmed in five countries of the Greater Mekong subregion — Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Vietnam. What is alarming is that artemisinin-resistant Plasmodium falciparum has been found to occur across much of Upper Myanmar “including regions close to the Indian border in the Northwest”. In fact, the zone where resistance to artemisinin exists has come to within 25 km of the Indian border. Since the Myanmar-India boundary was a “path followed by resistance to chloroquine” to spread from South East Asia to the Indian subcontinent, a recurrence in the case of artemisinin-resistant malaria has to be averted at any cost. Already over 40,000 people in India die each year, and according to the World Malaria Report 2011, over 70 per cent of India’s population is at risk of malaria infection. The tasks and the challenges thus remain.

Published in The Hindu on October 7, 2015