UOA01-01: Introducing Artemisinin to the World
Submitting InstitutionUniversity of Oxford
Unit of AssessmentClinical Medicine
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Medical Microbiology, Pharmacology and Pharmaceutical Sciences
Summary of the impact
The University of Oxford's Professor Nick White and his colleagues
successfully demonstrated the effectiveness of artemisinin (an ancient
Chinese remedy) in the treatment of malaria. They also pioneered
artemisinin-combination therapy (ACT), the most effective and fast-acting
malaria treatment in the world. Responsible for saving hundreds of
thousands of lives every year, ACT was recommended by the World Health
Organization (WHO) in 2006 as the primary method of malarial treatment
globally. Malaria kills more than half a million and affects over 225
million people every year.
Malaria is a deadly mosquito-borne infectious disease that has been
affecting humans for over 50,000 years. Until recently one of the most
widely used treatments for malaria was quinine, isolated from the bark of
cinchona trees. Quinine was first applied as an antimalarial in the 17th
century, but after years of use malaria parasites have developed a
resistance to quinine, as well as other antimalarial medications.
Artemisinin is a compound derived from the leaves of the annual wormwood
Artemisia annua. Chinese herbalists have used derivatives of annual
wormwood for thousands of years in the treatment of malaria and other
diseases, however, the artemisinin compound capable of treating malaria
was only officially discovered by Chinese researchers in 19721.
More than a decade after this initial discovery, the University of
Oxford's Professor Nick White and his Bangkok-based research team began
undertaking clinical trials to test the relative effectiveness of
artemisinin as an antimalarial treatment. In their first trial, they found
artemisinin compounds to be the most rapidly acting of all antimalarial
drugs2. The team then undertook a series of prospective studies
of 5,193 adults and children with acute malaria on the western border of
Thailand, between 1990 and 1995. After finding that artemisinin
derivatives reduce the transmission potential of malaria3, they
then trialed a combination treatment of mefloquine (a synthetic form of
quinine) and artemisinin. Combining artemisinin-based derivatives to
rapidly clear malaria parasites from the body, along with slower acting
partner drugs to destroy any surviving parasites, proved to be the most
effective way of treating malaria. Compared to monotherapy,
artemisinin-combination therapy (ACT) reduced the risk of treatment
failure, parasite resistance and side effects in patients4.
In a landmark paper published in 2005, the University of Oxford team
showed that in adults, intravenously administered artemisinin was a more
potent and rapid antimalarial treatment than quinine5. They
also found artemisinin to be safer, simpler to administer and more
effective, with mortality rates reduced by 34.7% in artemisinin recipients
compared to those treated with quinine5.
Since the majority of malarial mortality occurs in children under the age
of five, White and his team continued their research to prove the
effectiveness of artemisinin in the treatment of infants and children. In
a study of African children suffering from severe malaria, mortality
occurred in 297 of the 2,713 children treated with quinine, in comparison
to 230 deaths from the 2,712 children treated with artemisinin6,
a relative reduction in mortality of 22.5%. Post-treatment hypoglycaemia
was also less frequent in the artemisinin treatment group than in the
As a result of this research, the University of Oxford successfully
showed artemisinin and ACT to be the superior treatment for malaria in
both children and adults6.
References to the research
1. Antimalaria studies on Qinghaosu. Chin. Med. J. 92,
Primary paper from Chinese researchers showing that artemisinin
compounds are capable of treating malaria.
2. White, N. J. Artemisinin: current status. Trans. R. Soc. Trop.
Med. Hyg. 88 Suppl 1, S3-4 (1994).
First trial from Oxford researchers showing artemisinin compounds
to be the most rapidly acting of all antimalarial drugs.
3. Price, R. N. et al. Effects of artemisinin derivatives on
malaria transmissibility. Lancet 347, 1654-1658 (1996).
Prospective study showing artemisinin derivatives reduce the
transmission potential of malaria.
4. Nosten, F., Hien, T. T. & White, N. J. Use of artemisinin
derivatives for the control of malaria. Med Trop (Mars) 58,
Trial showing artemisinin-combination therapy (ACT) reduces the
risk of treatment failure, parasite resistance and side effects in
patients more effectively than monotherapy.
5. Dondorp, A. et al. Artesunate versus quinine for treatment of
severe falciparum malaria: a randomised trial. Lancet 366,
A landmark paper showing that intravenously administered
artemisinin was a more potent, rapid, safer, simpler to administer and
more effective antimalarial treatment than quinine in adults.
6. Dondorp, A. M. et al. Artesunate versus quinine in the
treatment of severe falciparum malaria in African children (AQUAMAT): an
open-label, randomised trial. Lancet 376, 1647-1657
(2010). doi: 10.1016/S0140-6736(10)61924-1.
Trial successfully showing artemisinin and ACT to be the superior
treatment for malaria in children.
This research was funded by the Wellcome Trust.
Details of the impact
The University of Oxford's research showing artemisinin and ACT to be the
superior treatment for malaria in both children and adults, led the World
Health Organization (WHO) to recommend ACT as the preferred antimalarial
in 20067. As a result, this research has led directly to the
successful cure of millions of malaria sufferers worldwide.
Since 2000 an increasing number of countries in which malaria is endemic
have adopted ACT in the treatment of malaria, with the number of ACT
treatment courses surging from 500,000 in 2001 to 31.3 million in 20058
- more than 80% of these orders were placed through the WHO8.
This number increased to 76 million in 2006 and reached 158 million people
in 20099. By the end of 2009, 11 African countries had provided
sufficient courses of ACT to cover more than 100% of malaria cases seen in
the public sector, while a further 8 African countries delivered enough
courses to treat between 50-100% of cases9.
In 2008, 78 countries reported a policy of treatment with ACT for malaria10.
In 2009, of the 108 countries in which malaria is endemic, 77 were using
ACT for the treatment of malaria and 52 were offering ACT free of charge
in the public sector for children under 5 years10. Due to the
availability of ACT along with other malarial control measures, such as
insecticide-treated nets and indoor-residual spraying, there has been a
50% reduction in confirmed malaria cases and malaria caused deaths in 13
WHO guidelines recommending the use of ACT7 along with other
control measures, such as insecticide-treated nets and indoor-residual
spraying, effectively saved the lives of 736,700 children in 34 African
countries between 2001 and 201012. A recent news release
circulated by the WHO on World Malaria Day 2012, showed that the number of
ACT courses distributed worldwide by government health departments had
"increased exponentially", from 11 million in 2005 to 181 million in 2010.
Along with long-lasting insecticidal nets, sprays, and better diagnostic
tests, this increased coverage has led to more than 1 million lives saved
over the past 10 years13.
Sources to corroborate the impact
- Guidelines For The Treatment Of Malaria. World Health Organization
WHO guidelines recommending the use of ACT as preferred
antimalarial. These guidelines directly reference a number of
Professor White's publications, including AQUAMAT, for
recommendations for ACT use in children.
- Bosman, A. & Mendis, K. N. A major transition in malaria
treatment: the adoption and deployment of artemisinin-based combination
therapies. Am. J. Trop. Med. Hyg. 77, 193-197 (2007).
Paper reporting the increasing number of countries adopting ACTs
as the preferred treatment for malaria.
- Global Health Observatory (GHO). World Health Organization at
WHO report showing 100% coverage of sufficient courses of ACTs in
11 African countries.
- World Malaria Report 2009. World Health Organization at
WHO malaria report, showing uptake of ACT treatment policy in 78
countries between 2008 and 2009.
- World Malaria Report Summary 2010. World Health Organization
WHO report showing a 50% reduction in confirmed malaria cases and
malaria caused deaths in 13 African nations in 2010.
- Roll Back Malaria Progress & Impact Series: Saving Lives with
Malaria Control: Counting Down to the Millennium Development Goals. Roll
Back Malaria at
Report showing that the introduction of ACTs between 2001 and
2010, (along with other interventions) have effectively saved the
lives of 736,700 children in 34 African countries.
- World Malaria Day 2012: Media Release and Report. World Health
WHO malaria day 2012 report showing the enormous increase in the
number of ACTs distributed worldwide between 2005-2010. This has
contributed to more than 1 million lives saved over the past 10