Why should the Artemisia annua herb NOT be used for malaria?

The World Health Organization (WHO) recommends against the use of Artemisia plants for malaria treatment or prevention. Artemisia annua herbal remedies have variable artemisinin content, which is often not sufficient to eradicate the malaria parasites. Additionally, artemisinin has a short half-life (1-3 hours), so it likely won’t stay in the body long enough to eradicate the malaria parasites even when given in a sufficient dose. These dosing issues increase the risk of malarial rebound disease and resistance to artemisinin. Many clinical studies testing herbal Artemisia annua remedies for malaria reported disease relapse and rebound parasitemia (parasites in the blood) after initial improvement in up to 70% of participants.^[1]

Research has also shown that Artemisia annua is less effective than other treatments for malaria. One randomized clinical trial showed that 5–9 grams of Artemisia annua consumed as 4 cups of tea daily for 7 days resulted in a cure rate of only up to 34% at 35 days, compared to a 79% cure rate with 1500 mg of quinine daily for 7 days.^[2] One randomized clinical trial comparing Artemisia annua tea to sulfadoxine-pyrimethamine, one of the standard treatments, was stopped early due to high rates of malaria recurrence in the groups taking the tea.^[3]

Artemisia annua’s constituent artemisinin is used to produce semisynthetic derivatives (artesunate, dihydroartemisinin, and artemether) with standardized dosages and longer half-lives. These derivatives are formulated in combination with other antimalarial drugs to ensure the eradication of malaria parasites and to reduce the risk of the parasites becoming resistant to artemisinin. Artemisinin-based combination therapies (ACTs) are the WHO’s preferred treatment for malaria as of October 2023. There is concern about the continued effectiveness of these treatments, as resistance of the parasites to artemisinin has been increasing.^[4][5]