A top secret project, an ancient Chinese text, and a violent war. It sounds like the makings of a spy movie, but it's actually the foundation that led to one of the most influential discoveries in modern medicine—a treatment for malaria—and just earned Youyou Tu a Nobel Prize in science, making her the first Chinese national woman to win the award.
On Monday, the Nobel Assembly announced the winners of this year's prizes in physiology or medicine, one of which was awarded to Tu, an 86-year-old Chinese pharmacologist. In the 1970s, Tu discovered that an ancient Chinese remedy for malaria, sweet wormwood, could be used to create a highly effective modern treatment. By studying thousand-year-old texts, Tu uncovered a process for extracting artemisinin—an organic compound—from the sweet wormwood in order to create a malaria-fighting drug, which has saved millions of people around the globe.
"Medicines come from lots of interesting sources. They're not all discovered from microorganisms," said Dr. Peter Agre, the directory of the Johns Hopkins Malaria Research Institute, and the Nobel Prize winner in Chemistry for 2003. "But the story behind the discovery of artemisinin is fascinating."
Born in the city of Ningbo, China in 1930, Tu earned her pharmacology degree in 1955, according to a 2011 profile in the Journal of Clinical Investigation. After graduation, she was assigned to work at the China Academy of Chinese Medical Research, where she would spend the rest of her career.
When Tu graduated, a drug called chloroquine was the predominant treatment for malaria, and it was very effective. But even in the 1950s, there were signs that the malaria-causing parasites were starting to develop resistance to the drug, and a new option needed to be found.
"During the Vietnam War, the North Vietnamese asked China for help when malarious soldiers along the Ho Chi Minh Trail stopped responding to chloroquine," explained Dr. Christopher Plowe, a malaria expert at the University of Maryland School of Medicine. "This was during the Cultural Revolution when most Chinese intellectuals were hauled off to re-education camps. Malariologists like Youyou Tu were spared and tasked with finding a new drug to treat chloroquine-resistant malaria."
The secret assignment was called Project 523. Tu and her team pored over 2,000 records of traditional Chinese remedies to look for anything that had anti-malarial properties. After years of studying and testing out possible concoctions in the lab, Tu and her team finally discovered an effective treatment: artemisinin. Due to government restrictions during the Cultural Revolution, drug trials weren't an option, so Tu and her peers acted as guinea pigs themselves, participating in the first human trials of the drug.
"We were in danger of running out of effective drugs."
They continued to develop the drug over the next few years, with the circle of scientists, doctors, and researchers in the know gradually widening until 1979, when the results were published in English for the first time. In the decades to follow, artemisinin combination therapies (a combination of an artemisinin-based drug and other antimalarial drugs) would become the most widely-used malaria treatment on the planet, preventing six million people from dying of the disease.
"These drugs have had a huge impact. We were in danger of running out of effective drugs to use in Southeast Asia—the artemisinins have been a life-saver there," said Dr. Terrie Taylor, a malaria expert and researcher at Michigan State University. "In sub-saharan Africa, the artemisinin combination therapies are affordable and safe, and when used in combination with rapid diagnostic tests for malaria, make rapid and effective diagnosis and treatment more widely available than ever before."
What makes artemisinin so effective is how broadly it attacks malaria. It can be used to treat severe or uncomplicated malaria, can kill off the parasite more quickly than other drugs, and stops the disease from spreading. Exactly how it kills off the parasite, though, is still unknown, according to Agre.
"It's not always clear how medicines work and artemisinin is a good example of that," Agre said. "But it definitely works and it works differently from the way chloroquine worked."
Unfortunately, there are already signs of artemisinin-resistant malaria in southeast Asia, and the risk of it spreading to Africa are very real. Right now, researchers are concerned about finding another treatment (or prevention method) effective enough to replace artemisinin—and it's not an easy feat.
"We don't have the next line drug, yet, and so the specter of artemisinin resistance spreading west and then going to Africa is a truly terrifying thought considering 3 billion people are at risk for malaria each year," Josh Blumenfeld, the managing director of policy and advocacy for the nonprofit group Malaria No More, told me over the phone. But Blumenfeld said the attention from the Nobel Prize will hopefully make people realize it's possible to find solutions, even in the most unlikely places, and that this a disease we can beat.
"Here in this country, no one worries about sending their kid out into the backyard and them dying from a mosquito bite," Blumenfeld said. "But for half of the world's population, when their children play outside or walk to school, a mosquito bite could mean the end of their life."