It’s hard to see what the risk to individual patients is, since many Ugandans are already using other, unproven herbs from their backyards, and the Artemisia programs have been in place for years. The tea has become widespread enough that last year the WHO published a statement opposing it for either treatment or prevention of malaria, and an online survey of malaria experts found that 72 percent were opposed to its use in prevention. Their view is that low-dose, persistent use could breed resistance, which would be disastrous. But we’re not talking about pumping pigs full of unnecessary antibiotics. We’re talking about desperate people trying to live normal lives. And, in Wagagai, after years of preventive use, resistance has not sprung up.
Ogwang says that may be because the tea, like other herbal products, contains multiple active compounds besides artemisinin. Cinchona bark is still effective after hundreds of years even though chloroquine (a derivative) is not. The Chinese have been using wormwood for more than 1,500 years for a variety of ailments, but the only place where we’ve seen signs of artemisinin resistance is on the Thai-Cambodian border, where conventional artemisinin drugs are used with abandon. If the goal is really to reserve these last-resort drugs for treatment rather than for prevention, then why do American and European doctors gladly prescribe Malarone—the only effective artemisinin alternative in some areas—for a romp around Southeast Asia? Nevertheless, Ogwang is now trying to test whether the tea remains effective for prevention even if the artemisinin is eliminated, an idea that sounds crazy but that could eliminate the objection that the tea could stimulate resistance.
It’s tempting to envision a future Africa with all the technology and resources of the Western world, and it’s demeaning to imagine anything else. You could say that herbal drugs are a second-rate health system, and, indeed, it would be irresponsible to recommend an herbal therapy where a conventional alternative exists and is readily available. The fact is that most traditional herbal remedies are probably useless, potentially dangerous, and will only delay a person’s efforts to seek proper medical treatment. But some herbs do have medically active compounds, albeit with varying levels of efficacy, and Africans are choosing to go that route because they know that drug supply won’t be cut off by war or corruption or bureaucratic incompetence. Herbs are not always going to be the right strategy, but the data about these unconventional interventions should be shared and discussed.
In the case of malaria, Anamed and others also argue that it makes sense to preserve stocks of conventional drugs for children and severe cases. One reason ACTs have been so expensive is the cost of isolating artemisinin, but there have long been indications that using a cruder, cheaper whole-plant extract could potentially be more effective and cheaper. In a study conducted in rats last year, University of Massachusetts researchers compared a single dose of pure artemisinin to dried whole leaves, and found that the whole plant was better at killing malaria parasites. And while millions have been spent bioengineering bacteria to crank out pure artemisinin on a budget, you still have to get it to the people who need it.
When you’re just brewing tea on a flower farm, all that means is a short bike ride from the kitchen to the chrysanthemums. “Doctor, doctor!” yells a tall man named Bob Muteso. He takes a plastic cup from Robert Watsusi and tosses it back. Then, he looks over at me and smiles. “He is our African doctor,” he says.