The Vietnamese pharmaceutical expertise in the era of drug globalization: the case of artemisinin

Overview & Synopsis

In 1975, at the time of Vietnam reunification, a new and effective antimalarial medication was much needed for the health authorities. The Chinese were at the point of finalizing a research program, started during the Vietnam War, which had led to the discovery of the high therapeutic potential of an extract from the leaves of Artemisia annua, a traditional medicinal plant, known as Qinghaosu or artemisinin. Before the end of the decade, after Chinese chemists had synthesized artemisinin derivatives - more stable than the original product - the drug could be mass produced. In Vietnam, clinical trials of the Chinese drug were conducted for the first time in a Hochiminh City hospital in 1982. However, the worsening relations between China and Vietnam, as well as the deplorable economic situation of the latter, prevented the drug mass import. In the early 1980s, the government launched the mobilization of Vietnamese scientists in several research institutes. A young chemist of the National Academy of Science was sent to Sofia, Bulgaria, to study an extraction method of artemisinin and validate it with regard to wild Artemisia plants collected in the Northern Vietnamese provinces. Most of the research was conducted in Vietnam. A good deal of the scientific work was performed by the scientists of the Institute of Materia Medica in Hanoi. Vast plantations of Artemisia were created in the delta, especially around Hanoi, as soon as an industrial scale production of artemisinin started, in the early 1990s. The research focused particularly on the plant improvement, i.e., increasing artemisinin content. In the mid-1990s, the production of the artemisinin based drug could meet the domestic needs in Vietnam. Without dethroning the Chinese drug production, Vietnam could also rapidly export it to some Southeast Asian countries. The artemisin based drug recommendation as the first line treatment in all malaria endemic countries by WHO in the beginning of the 2000s was a new challenge faced by Vietnam. The country is the second largest artemisin producer in the world after China. However, although Vietnamese pharmaceutical companies produced finished medicinal products (since 2002, ACT or Artemisinin Combined therapy as recommended by WHO), the country has conquered the artemisinin international market mainly by the export of raw material. Focusing on the problems that technological advances present for the Vietnamese pharmaceutical industry, we will discuss WHO imposed norms and the role of the Global Fund for malaria.