Artemisia annua L, used in Chinese traditional medicine for centuries, is today considered part of the solution where malaria has become resistant to other medicines. Artemisinin-based combination therapies (ACTs) have been recommended by WHO since 2,001 in all countries where falciparum malaria - the most resistant form of the disease - is endemic.
Since then, the world market for products containing artemisinin derivatives has grown rapidly. However, not all artemisinin meets the required standards to produce quality medicines, making it all the more urgent to promote best practices in the cultivation and collection of the raw material used to make the combination therapy.
About 40% of the world's population is at risk of contracting malaria which is resistant to other medicines. Of the 76 countries needing artemisinin-based treatment today, 69 have adopted the WHO recommendation to use this therapy.
The availability of these treatments still falls short of what is needed. Of an estimated 600 million people needing ACTs worldwide, only about 82 million are receiving the treatment through public sector distribution systems (which constitute 90% of antimalarial distribution in developing countries).
The "WHO monograph on good agricultural and collection practices for Artemisia annua L." provides a detailed description of the cultivation and collection techniques and measures required for a harvest to meet quality requirements. The information is based on research data and the practical experience of several countries where successful cultivation practices have led to a high yield of good quality Artemisia annua L.
As with most medicinal herbs, artemisinin's contents and efficacy are subject to climatic, geographical and environmental conditions. Not all Artemisia annua plants necessarily contain artemisinin and in some places, depending on the quality of the soil and rainfall, the content may be very low and without industrial value. These factors make it necessary to run pilot tests of cultivation on small areas of land to ensure that the land selected is suitable for growing high-yield plants before large-scale cultivation begins.
Cultivation of Artemisia annua requires a minimum of 6 months and extraction, processing and manufacturing of the final product require at least 2--5 months depending on the product formulation. High temperatures during post-harvest handling can damage the quality of the plant. After harvesting or collection, the artemisinin content of the leaves will gradually decrease. The value of the raw material for extraction can be lost after six to twelve months' storage.