The Cure in the Ancient Book

In the late 1960s, malaria staged a comeback that frightened generals as much as doctors. The parasite had evolved resistance to chloroquine, the drug that had controlled it for a generation, and in the jungles of Vietnam the disease was disabling more soldiers than combat — on both sides. North Vietnam asked China for help, and on 23 May 1967 Beijing quietly launched a secret military-scale programme, named for its date: Project 523. Hundreds of scientists across dozens of institutes were set one task — find a new antimalarial — during the very years when the Cultural Revolution was closing universities and sending scientists to the countryside. Research continued under the project's protection, unpublished and anonymous by design.

One branch of the project took a road Western pharmacology would not have taken: back through China's own medical past. In 1969, Tu Youyou — a 39-year-old researcher at the Academy of Traditional Chinese Medicine in Beijing, trained in both modern pharmacology and classical medical texts — was appointed to lead the search of the tradition. Her team combed ancient recipes, provincial folk knowledge and dynastic pharmacopoeias, and assembled a list of more than two thousand candidate remedies, which they narrowed and began, one by one, to screen against the malaria parasite in mice.

The personal price was of its era. Her husband had been sent away to a labour camp; sending herself fully into the project meant placing her two young daughters in care — one with her parents, one in a nursery — and she has spoken of her younger daughter failing to recognise her when they were finally reunited years later. She would say afterwards, simply, that the work needed doing and it was hers to do.

One candidate kept flickering: qinghao, sweet wormwood — a roadside herb that Chinese texts had recommended against fevers for well over a thousand years. Extracts of it sometimes suppressed the parasite dramatically, and sometimes did nothing at all. The inconsistency was maddening, and by the standards of drug screening it should have disqualified the plant. Tu went back — not to the laboratory, but to the library.

She found the answer in a slim volume by Ge Hong, a physician and alchemist of the fourth century: A Handbook of Prescriptions for Emergencies, written around 340 CE. For fevers, it advised: take a handful of qinghao, soak it in cold water, wring it out, drink the juice. Cold water. Every standard laboratory extraction used heat — and heat, Tu realised, might be destroying the very substance they were hunting. Her team rebuilt the process at low temperature, using ether as the solvent, and in October 1971, extract number 191 achieved what nothing else in the project had: one hundred per cent suppression of the malaria parasite in infected mice, and then in monkeys. A 1,600-year-old preparation note had corrected the twentieth century's laboratory technique.

Then came the step that places her beside Marshall in this series. Animal safety data was thin, the era's clinics were chaotic, and the malaria season in the south would not wait a year. Before any patient would be asked to swallow the extract, Tu and two colleagues volunteered to take it themselves, under observation in hospital, in escalating doses. She was the project's head, she argued; the risk was properly hers. There was no harm. Trials on malaria patients in Hainan followed within months: fevers that used to burn for days collapsed in hours, and parasites vanished from the blood. The active compound was isolated and named qinghaosu — artemisinin — and, in the project's anonymous fashion, announced to the world in a 1977 paper with no authors' names at all.

The drug conquered the world slowly, and mostly without her name. Through the 1980s and 1990s artemisinin and its derivatives proved themselves the fastest-acting antimalarials known; combined with partner drugs — the artemisinin combination therapies, ACTs — they became, from the 2000s, the World Health Organization's standard treatment worldwide. The global death toll from malaria fell by roughly half in the two decades that followed, a decline in which ACTs, alongside bed nets, carry a great share of the credit; the lives saved are counted in millions, most of them African children. Meanwhile the discoverer worked on in Beijing, obscure even at home — famously a "three noes" professor: no doctorate, no study abroad, no membership of the national academies, which never elected her.

Recognition arrived through detective work. In the 2000s, researchers tracing the anonymous Project 523 record — interviewing veterans, reading the unpublished archives — established what the namelessness had hidden: the cold-extraction insight, sample 191 and the first self-test led back to Tu Youyou's group. The Lasker Prize, American medicine's most prestigious award, followed in 2011, and in 2015, at the age of eighty-four, she received the Nobel Prize in Physiology or Medicine — the first Chinese scientist honoured for work done in China, and the first female Chinese laureate. In Stockholm she gave her lecture seated, and framed the discovery her own way: as "a gift from traditional Chinese medicine to the world" — while insisting, in the same breath, that the gift had required modern science to unwrap it. Neither tradition alone nor the laboratory alone had cured anything; the cure lived in the collision.

The story remains open at both ends. At one end, the parasite is doing what parasites do: artemisinin-resistant strains have emerged in Southeast Asia and are being watched anxiously in Africa — the chloroquine story beginning again, with the world's stockpile of miracles one drug lighter. At the other end sits the question her career poses to every research system: the cure for humanity's oldest killer was found by an unfashionable researcher, in an unfashionable institute, reading unfashionable books, under a programme no committee would approve today. How many Ge Hong sentences — in Ayurvedic texts, in monastery recipe books, in grandmother's instructions nobody wrote down — are still waiting for someone trained to read both ways?