The birth of artemisinin, a drug responsible for saving millions of lives across the globe, began oddly enough in the midst of the Vietnam War. Among the battlefields of Vietnam, malaria epidemics ravaged the ranks of North Vietnamese troops, often inflicting casualties more numerous than those due to warfare itself. In 1967, North Vietnamese Prime Minister Ho Chi Minh turned to communist China, for a treatment, enlisting the help of Zhou Enlai. Although Chairman Mao Zhedong and Premier Zhou Enlai of the People’s Republic of China supported the effort to combat the parasite, Mao had previously began reforms under the Cultural Revolution, resulting in the shutdown of universities nationwide and banishment of its scientists. In response, Project 523 was initiated, a secret government program that enlisted more than five hundred Chinese scientists with the sole purpose of developing a treatment for malaria.
When scientists under Project 523 failed to come up with an effective synthetic treatment for malaria, researchers began to look at traditional Chinese herbal medicines for the answer. In 1971, a team led by Tu Youyou investigated extracts from a plant called qinghao (now known as Artemisia annua), a treatment for malarial fever described in an ancient Chinese fourth century book called The Handbook of Prescriptions for Emergencies. After initial attempts to extract a viable compound using high temperature laboratory techniques failed, Tu developed a cold-water extraction technique modeled after the recipe described in the handbook. This subtle change proved to be vital in extracting the active compound, which was called qinghaosu. After Tu successfully demonstrated that the compound could effectively eradicate malaria in mice, the compound, now known as artemisinin, became the treatment of choice for Project 523. Although artemisinin was quickly discovered to be far more potent than existing antimalarials like quinine and chloroquinine, results of the studies were not published until 1979, after the end of the Cultural Revolution.
To this day, artemisinin and its synthetic derivatives remain as the first line of defense against malarial infection by Plasmodium falciparum, and are listed on the World Health Organization’s List of Essential Medicines. Currently, artemisinin derivatives are often used in combination with other antimalarial drugs in treatments called artemisinin-combination therapies (ACTs) in an effort to prevent the development of parasitic resistance to artemisinin. Widespread use of ACTs in Africa has led to more than a twenty percent reduction in mortality due to malaria, which still kills more than five hundred thousand people per year. For her role in the discovery and development of artemisinin, Tu Youyou was awarded the 2015 Nobel Prize in Physiology or Medicine.