Opportunities for drug research and development in low- and middle-income countries: accelerating traditional medicine through systematic use and global synergy | Infectious diseases of poverty

Like other LRICs, China has started R&D of new drugs in low-resource settings. China discovered Artemisinin not only based on the valuable experiential wisdom of TCM, but also relied on a government-led R&D model. Based on the accumulated experience of TCM and the productive synergy between several departments, China has discovered the incredible effectiveness of Artemisinin as a new cure for malaria. Three key success factors still inspire today, including the scientific use of traditional medicine, the overall synergy of all research units, and an effective information sharing mechanism.

Targeting potential medicines from traditional medicine by modern methods

In the pharmaceutical industry, the drug discovery process was recognized as expensive, risky and inefficient. Under the oversight of the national drug regulatory agency and WHO, all R&D of new drugs must follow the standard drug development and approval process, including preclinical studies and 3-phase trials experimental clinics [12]. However, cases from China and other countries have proven that traditional medicine can speed up the R&D process and save investment. In the case of the discovery of artemisinin, Chinese scientists quickly targeted drug candidates based on TCM resources and adhered to modern drug research and development procedures to rapidly develop drug candidates (such as shown in Figure 1).

Fig. 1

Exploration flow of antimalarial drugs based on TCM. TCM Traditional Chinese Medicine.

With extensive knowledge of traditional medicine, Chinese scientists have examined more than 40,000 herbs and compounds from TCM books and collected folk remedies. After concluding current evidence, 10 key herbs including Qinghao (Chinese name of Artemisia annual Linn, artemisinin raw material) were selected for further research. Qinghao has been used for over 2,000 years in China and its antimalarial effects were first recorded around 1,600 years ago in Ge Hong’s “A Handbook of Prescriptions for Emergencies”. [13]. When extracting the purified ingredient from Qinghao extraction, Youyou Tu took inspiration from TCM literature and used low temperature ethyl ether extraction instead of boiling extraction methods to protect the active ingredient. Additionally, animal experiments have been used for safety and efficacy testing. Qinghao low temperature ethyl ether extract showed 100% inhibition against mouse malaria, Plasmodium berghei.

Many PRITI have gradually realized the value of traditional medicine. To effectively use traditional medicine, other LRICs could apply the artemisinin exploration stream in their drug discovery process. It should be noted that documented documents, folk practices and interviews with TCM doctors were equally valuable and could provide evidence from different angles including efficacy and safety.

Establish a system of interdepartmental and interregional collaboration

The inspirations of traditional medicine provided a good basis for the R&D process of new drugs. However, the inadequate social and economic development of the LRICs has resulted in a shortage of funds and talent in related industries and has greatly hampered the R&D process. A comprehensive system of collaboration should be put in place to mobilize resources, while the government should play a leading role in promoting synergy among all parties.

In the 1970s, China had extremely limited R&D resources and adopted a collaborative method to develop antimalarial products, which motivated almost all national research units at different levels and departments. The National Leadership Group for Drug Research for Malaria Control and Prevention (established May 23, 1967, hence called National Office 523) was established to support the implementation of the research plan and collaboration between regions and departments. National Office 523 was composed of six sectors, including the State Science and Technology Commission, the General Logistics Department of the Chinese People’s Liberation Army, the Science, Technology and Industry Commission for the National Defense, the Ministry of Health, the Ministry of Chemical Industry and the Academy of Sciences. Each sector would designate focal points responsible for communicating with the 523 Country Offices and implementing all tasks in their subordinate units in a timely manner. Dozens of research institutions have been organized by the national 523 office and provincial 523 offices, including scientific research centers, medical schools and pharmaceutical manufacturing facilities.

Traditional medicine was considered as one of the avenues of research and a public-private partnership was set up to promote its development and industrialization. To overcome the challenge of artemisinin production, the National 523 Office has organized further cooperation between institutions, medical schools and private companies. [14]. In the chain of industry-university-research cooperation, universities have conducted clinical trials and provided compelling observational data on the effects of artemisinin against falciparum malaria; research institutes engaged in the structural analysis of artemisinin and proposed that its possible structural formula contained lactone peroxide; while pharmaceutical manufacturing facilities conducted surveys on raw materials and quality standards, etc.

In the process, government departments collected research information from all sectors and served the entire industry chain by providing clear division and guidance. This government-led, mission-driven R&D model could be used to establish a comprehensive and effective R&D system for resource-limited environments. This collaboration system has also been observed during the COVID-19 period at the national and global level to speed up the R&D process.

Promote synergy through effective information sharing mechanisms

A productive collaboration system would not only rely on government commitment, but would also rely on effective information-sharing mechanisms to promote synergy. Cross-regional collaboration required regular communications to avoid duplication of work and share recent advances. Chinese artemisinin research set a good example in the 1970s. After Youyou Tu reported the discovery from Qinghao, the National 523 Office of China and professional groups attached great importance to and promoted the sharing of information between all research units and adjusted research orientations. The exchange of information between the provinces has enabled all research centers to progress based on the latest advances and the synergy has increased the efficiency of all research.

Nowadays, with the development of communication technologies, information and progress could be exchanged online rather than through offline meetings, which was much faster and more convenient. With the help of emerging communication tools, LRICs could establish more effective information sharing mechanisms to promote R&D collaborations.

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