- health cooperation and the building of a community of common health for mankind. TCM has now spread to 183 countries and regions, and 86 cooperation agreements on it have been signed between China and foreign countries, as well as international organizations. The discovery of Artemisinin, drug derived from traditional Chinese medicine, has led to the winning of the Noble prize in Physiology or Medicine by a Chinese scientist in 2015, and TCM has once again returned on the international spotlight. This big step is not only amilestone for the internalization of it, but also a recognition of those Chinese scientists and research experts.
Malaria is one of the three major communicable diseases in the world. The understanding of malaria by Chinese goes back to ancient time where the malaria was already carved on the Yinxu oracle bone script. The pathogenesis, symptoms and acupuncture treatment of malaria were also recorded systematically on ancient Chinese medicine books like Su Wen, Theory of Malaria and Theory of Piercing Malaria. TCM believes that malaria is caused by the attack of the Evil Qi on the Healthy Qi, and the symptoms of malaria are fever, chills, headache, and sweating. Most of the malaria cases in China happened during summer and autumn. The concept of malaria treatment with Artemisinin is based on the ancient Chinesemedicine book, the Handbook of Prescriptions for Emergency by Ge Hong. The handbook mentioned that consuming the strained “Juice” of Qinghao plant immersed in cool water can cure malaria; this process is actually equivalent to extracting the colourless crystal of sesquiterpene lactone with peroxide bridge out of the sweet wormwood plant.
The Chinese experience in malaria control and prevention proves that during the malaria peak season or malaria pandemic, if the testing capacity of local malaria laboratory is poor, curing positive malaria cases is not enough to timely control the transmission. In 1970s, during the malaria pandemic period, Chinese government has implemented large scale mass treatment to control malaria in the central region of China. The annual malaria cases dropped from 30 million in 1971 to less than 30 thousand in 2007, achieving a remarkable result.
To eliminate malaria as soon as possible is the consensus among countries.
According to the WHO Global Malaria Report 2020, in 2019, there were a total of 229 million malaria cases and 409 thousand people died from malaria. Malaria is the major constraint factor to the social economic development of African countries. The antimalaria team from Guangzhou University of Chinese Medicine is one of the practitioners promoting the Chinese experience in malaria control and prevention and artemisinin-based combination therapies (ACTs) to the world. The team has been working in the front line for many years. It has established malaria research centres in Cambodia, Comoros, Sao Tome and Principe, Togo and Papua New Guinea, implemented mass drug administration (MDA) with ACTs in those countries and achieved remarkable results. Malaria prevalence and mortality were significantly reduced after implementation of the MDA project.
In order to promote Chinese ACTs globally and let more Asian and African countries benefit from the drug, Guangzhou University of Chinese Medicine and Guangdong New South jointly established an antimalaria team. Based on the Chinese experience in malaria control and prevention, after analysing the malaria setting and characteristics in Asian and African countries, the team followed the traditional Chinese medicine theory and guidance of holism and treatment differentiation between syndromes to innovate the malaria control strategy. The new strategy is focusing on mass treatment rather than individual treatment, and focus on eliminating the gametophyte and plasmodium asexual bodies. MDAs with Artemisinin- Piperaquine tablets (Artequick ® ) were implemented in the islands of Anjouan, Grande Comore and Moheli, the 3 islands of the Comoros, a total of 800 thousand inhabitants participated in MDAs, and the outcomes were remarkable. In 2014, Comorosachieved zero malaria death, and the country’s malaria cases saw a reduction of 98%. MDAs have successfully controlled the malaria epidemic; the island went from a high endemic region to a low endemic region in a short time. This strategy slowly evolvedinto a strategy of mass treatment with mass prevention ACTs customized for African countries.
The achievements of MDA project in the Comoros attracted the attention of experts from home and abroad. Former Comoros President Mohamed Sambi, former Comoros President Ikililou Dhoinine and other heads of state, health ministers from more than 10 countries including Somalia, Malawi and Cambodia, as well as the diplomatic envoys of 34 African countries have visited Guangzhou and Meizhou for investigation trip to know more about the MDA project. Somalia, South Africa, Haiti and other countries have expressed that they hope to address the threat of malaria with Artequick ® and Chinese malaria elimination strategy. Xinhua News Agency, the New York Times, Reuters, Arabian Al Jazeera Network, Kenya Television KTV, the Economist and many other domestic and foreign leading media have issued special reports on the malaria elimination project in the Comoros. International organization including the World Health Organization also gave valuable remarks to the success of the project.
Following the success of the project in the Comoros, the team extended the Artequick ® MDA to the West African country of Togo. Always guided by the holism theory of Traditional Chinese Medicine (TCM), the antimalarial team assisted the Togolese government strengthening malaria management system and capability. The team, together with the Health Bureau of the pilot region, held 58 technical trainings on the process and implementation of the project. 5 rounds of social mobilization and sensitization covering government officers to local media were organized to ensure local residents accurately understood and received the right information about the malaria project. In 2017, 3 rounds of MDA were achieved within 60 days in the 200 villages of Est-Mono Prefecture in the Région des Plateaux. About 160,000 people took Artequick ® at the same time. Data from the Togolese health authority show that malaria cases were reduced by 85% and 90%, respectively compared with the same period in 2016 and 2015.
Under the cooperation agreement between China and Papua New Guinea (PNG) on malaria control and elimination, supported by China Shenzhen Municipal Health Commission, the antimalaria team collaborated with the Department of Health of Milne Bay Province to implement 3 rounds of MDA in 3 months in Kiriwina island in 2018, which led to an outstanding result. Covering an area of 450 km 2 and 45,000 residents, Kiriwina island is situated in the Trobriand Islands of the Milne Bay Province and is composed of 92 villages. Before MDA, the average parasite carriage rate was 18%, and malaria distribution was uneven. Parts of the island are high malaria-endemic areas and the highest parasite carriage rate reached 33.68%. Four months after MDA, parasite carriage rate was reduced by 98% and dropped to 0.31%.
Under the same cooperation, supported by China Foreign Affairs Office, People’s Government of Guangdong Province and Shenzhen Municipal Health Commission, the Chinese team constructed a China-PNG Malaria Control Center and trained middle to high level technical talents and a local antimalarial technical team to improve people’s health and strengthen malaria control capability.
In the chapter “Great Theory on Yin-Yang Corresponding to Nature” of Plain Questions, it tells us “Treatment should focus on the source of a disease.” The key to interrupting malaria transmission is the plasmodium, not treatment of cases. The ultimate vision of zero malaria can be achieved only by eradicating the source of infection and that is why WHO issue malaria free certification only when the country is free from malaria for consecutive 3 years. Traditional antimalarial measures like Long Lasting Insecticidal Mosquito Nets (LLINs) and Indoor Residual Spraying (IRS) were used for years and have led to drug resistance as reported by some African countries. Besides, due to humanistic environment difference, the permanent antimalarial mode cannot deal with the complexity of the antimalarial work of today. As a result, specific and sustainable malaria control and prevention protocol shall become the new pursuit. In recent years, with the Chinese malaria control and elimination protocol being implemented in many Asian and African countries, WHO gradually recognizes the Chinese MDA strategy and issued the Mass drug administration for falciparum malaria: a practical field manual in 2017, in which acknowledgement part Professor Jianping Song of Guangzhou University of Chinese Medicine was specially mentioned. This is an acknowledgement of TCM, a beneficial attempt of breaking up cultural barrier, and even a start in building a global community of health for all.
TCM embodies traditional Chinese culture, and it is an important part of the Chinese culture. Popularizing of Chinese strategy and TCM both play an important role in the Belt and Road Initiative. Nowadays, TCM Belt and Road Initiative still faces many difficulties and challenges. However, we will continue strengthening international cooperation, building an antimalaria team with Chinese characteristics, and improving international competitiveness so to contribute to global antimalaria work and TCM development.