Science, Engineering, and Sustainable Development: Cases in Planning, Health, Agriculture, and the Environment 9783110757507, 9783110757491

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Robert Krueger, Yunus Telliel and Wole Soboyejo (Eds.) Science, Engineering, and Sustainable Development

Integrated Global STEM

Series Editors Robert Krueger and Wole Soboyejo

Volume 1

Science, Engineering, and Sustainable Development Cases in Planning, Health, Agriculture, and the Environment Edited by Robert Krueger, Yunus Telliel and Wole Soboyejo

The WPI Press

Editors Prof. Robert Krueger Institute of Science and Technology for Development Worcester Polytechnic Institute 100 Institute Road Worcester, MA 01609 USA [email protected] Prof. Yunus Telliel Institute of Science and Technology for Development Worcester Polytechnic Institute 100 Institute Road Worcester, MA 01609 USA [email protected] Prof. Wole Soboyejo Institute of Science and Technology for Development Worcester Polytechnic Institute 100 Institute Road Worcester, MA 01609 USA [email protected]

ISBN 978-3-11-075749-1 e-ISBN (PDF) 978-3-11-075750-7 e-ISBN (EPUB) 978-3-11-075760-6 Library of Congress Control Number: 2023936400 Bibliographic information published by the Deutsche Nationalbibliothek The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data are available on the internet at http://dnb.dnb.de. © 2024 Walter de Gruyter GmbH, Berlin/Boston Cover image: RuriByaku/iStock/Getty Images Plus Typesetting: Integra Software Services Pvt. Ltd. Printing and binding: CPI books GmbH, Leck www.degruyter.com

Foreword We are delighted to offer the first title of our new series, Integrated Global STEM, which is a partnership between the recently created WPI Press and De Gruyter Publications. The idea for this series has taken us two years to shape and finally realize. It started with editor Steve Elliot, who had worked with Wole Soboyejo while at another press, came to De Gruyter and with VP Daniel Tiemann expressed interest in a book series that related STEM topics to issue of global development. Thus began our yearlong discussion about the state of STEM scholarship, STEM’s checkered past in ‘developing’ in low- and middle-income countries, and the great work being done by scholars and practitioners in these countries that would never be read by anyone in the ‘Global North’ because of the lack of access, financial and otherwise. We also lamented how the story of the ‘Global South’ or ‘developing countries’, or post-colonial states, especially around innovations in science and technology, was told by many scholars beyond STEM. We decided to create a space that would explicitly examine these tensions in the hope of creating a new brand of STEM, integrated global STEM. For us, the notion of integrated global STEM at its best embodies the fluidity and reciprocity attendant to scientific, technological, and cultural knowledges—cultures of inquiry and cultures of practice, if you will. This framing implies both recognition of ‘other’ ways of thinking and doing and the equality among them. It acknowledges different traditions in methodology, modes of reporting, and what the very concept of innovation implies. Innovation can occur at the so-called frontiers of science and technology, but it also occurs in other places that have different needs, resources, and expertise—formal or informal. There is a long way to go between here and the ideal and we hope the pages of this series will provide readers, thinkers, innovators, and hackers from around the world to share their use of sciences, technologies, engineering, and maths so we can work together to address global grand challenges in the multitude of ways they affect us. This book, Science and Engineering for Sustainable Development: Cases in Planning, Health, Agriculture, and the Environment, represents a significant effort to openup the topic of integrated global STEM so readers of any stripe can see themselves in the process of doing science and developing technology. We seek to shine a light on the process for stepping into the perceived chaos of stepping out of the lab to the field where conditions are not so controllable. The volume stops short of being a ‘how to’ book but it seeks to provide a process for understand the relationship between science, technology, and society. It also seeks to provide concrete examples for how one might move across the continuum of an exclusive focus on science to a complex, entangled set of social relations.

https://doi.org/10.1515/9783110757507-202

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Foreword

Authors of the various chapters attempt to frame the different positions, challenges, opportunities, to doing science and engineering with high impact. We hope readers will take from this volume a clear pathway for taking a deep dive into science, engineering, and society to further concepts and practices for true social justice. Rob Krueger, Barre, Massachusetts

Contents Foreword

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List of contributing authors

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Robert Krueger, Wole Soboyejo, Yunus Telliel Introduction 1 Pamela Weathers, Matthew Desrosiers, Lucile Cornet-Vernet Chapter 1 Artemisia annua, a cost-effective sustainable therapeutic for the masses and the political challenges for its implementation 21 Nada Aborajedeh, Jackson Hauman, Alexa Freglette, Sam Leonard, Julian Bennet, Hector Boye, Ben Nephew, Hermine Vedogbeton, Mustapha Fofana, Robert Krueger Chapter 2 Researching health impact disparities among women at the Agbogbloshie e-waste site 37 Sarah E. Stanlick, Nora P. Reynolds Chapter 3 Reframing professional practice, technical competency, and good intentions: assessment and reflection tools for ethical engagement in student STEM training 53 Juan Lucena, Samantha Temple Chapter 4 The Road Less Travelled: development engineering with vulnerable communities through NGOs 69 Casey Gibson, Jessica Smith, Kathleen Smits, Juan Lucena, Oscar Jaime Restrepo Baena Chapter 5 Rapid Assessment Procedure as a tool for stakeholder needs analysis in development engineering projects 87

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Contents

Stephanie Eccles, Elisabeth A. Stoddard, Mark Rice Chapter 6 Engineered waste management systems and environmental injustice in Eastern North Carolina: power, pollution, and innovation 105 Timothy J. Downs, Ravi Hanumantha, Yelena Ogneva-Himmelberger, Morgan Ruelle, Nigel Brissett, Marisa Mazari-Hiriart Chapter 7 Integrative collaborative design of research-based, climate-change resilience engineering education: insights from México–Lerma–Cutzamala hydrological region 119 Timothy J. Downs, Ravi Hanumantha, Yelena Ogneva-Himmelberger, Morgan Ruelle, Marisa Mazari-Hiriart Chapter 8 Illustrating climate-change resilience engineering: Conceptual design of water supply and wastewater/stormwater system for the México–Lerma– Cutzamala hydrological region 143 Jessica Antoine, Ema Mehuljic, Meron Tadesse, Kofi Gyimah Amoako-Gymiah, Emmanuel David, Pratap Rao, Robert Krueger Chapter 9 Designing an activated carbon adsorption column to mitigate mercury pollution from artisanal and small-scale mining in Ghana 167 Akansha Deshpande, Poorvi Mohanakrishnan, Dirk Albrecht, Solomon A. Mensah Chapter 10 Medical device development and implementation in low-to-middle income countries: the importance of product specifications and regulatory considerations 183 Elkorchi Kenza, Salhi Ibrahim, Berbia Hassan, El-Korchi Tahar, Van Dessel Steven Chapter 11 Solar Decathlon Africa–Team Oculus experience: realizing a global sustainable solar house 203 Brigitte Servatius, Rainer Reichel Chapter 12 Arboreal homes 219 Index

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List of contributing authors Robert Krueger Worcester Polytechnic Institute

Ben Nephew Research Assistant Professor, WPI

Wole Soboyejo Worcester Polytechnic Institute

Hermine Vedogbeton Visiting Assistant Professor, College of the Holy Cross

Yunus Telliel Worcester Polytechnic Institute Pamela Weathers Department of Biology and Biotechnology Worcester Polytechnic Institute Worcester MA USA Email: [email protected]

Mustapha Fofana Associate Professor, Mechanical Engineering, WPI Sarah E. Stanlick Worcester Polytechnic Institute Assistant Professor, Department of Integrative and Global Studies, WPI

Matthew Desrosiers Department of Biology and Biotechnology Worcester Polytechnic Institute Worcester MA USA

Nora P. Reynolds University of Pennsylvania

Lucile Cornet-Vernet La Maison de l’Artemisia Paris France

Samantha Temple Colorado School of Mines

Nada Aborajedeh Industrial Engineering Student WPI Jackson Hauman Mechanical Engineering student WPI Alexa Freglette Computer Science student WPI Sam Leonard Computer Science student WPI Julian Bennet Graduate Student in WPI Hector Boye Academic City College, Accra Ghana

https://doi.org/10.1515/9783110757507-204

Juan Lucena Colorado School of Mines

Casey Gibson Department of Engineering Design, & Society Colorado School of Mines Golden CO 80401 USA Jessica Smith Department of Engineering Design, & Society Colorado School of Mines Golden CO 80401 USA

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Kathleen Smits Department of Civil and Environmental Engineering Southern Methodist University Dallas TX 75205 USA Juan Lucena Department of Engineering Design, & Society Colorado School of Mines Golden CO 80401 USA Oscar Jaime Restrepo Baena Department of Materials & Minerals Universidad Nacional de Colombia Medellin 050041 Colombia Stephanie Eccles PhD. Candidate, Concordia University Elisabeth A. Stoddard Associate Professor of Teaching, Worcester Polytechnic Institute Mark Rice North Carolina State University, Extension Specialist, Biological and Agricultural Engineering – Retired Timothy J. Downs International Development Community & Environment (IDCE) Clark University Ravi Hanumantha International Development Community & Environment (IDCE) Clark University Yelena Ogneva-Himmelberger International Development Community & Environment (IDCE) Clark University

Morgan Ruelle International Development Community & Environment (IDCE) Clark University Nigel Brissett International Development Community & Environment (IDCE) Clark University Marisa Mazari-Hiriart Laboratorio Nacional de Ciencias de la Sostenibilidad (LANCIS) Universidad Nacional Autónoma de México (UNAM) Jessica Antoine Chemical Engineering student WPI Ema Mehuljic Chemical Engineering student WPI Meron Tadesse Chemical Engineering student WPI Kofi Gyimah Amoako-Gymiah Executive Secretary, Okyeman Environmental Foundation Emmanuel David Kyebi High School/Technical School Kyebi, Ghana Pratap Rao Associate Professor, Mechanical Engineering, WPI Akansha Deshpande Therapeutic Innovations, Inc. Sutton MA And Center for Engineering in Surgery & Medicine Massachusetts General Hospital Charlestown MA

List of contributing authors

Poorvi Mohanakrishnan Massachusetts Academy of Math and Science 85 Prescott Street Worcester MA Dirk Albrecht Biomedical Engineering Department Worcester Polytechnic Institute Worcester MA And Therapeutic Innovations, Inc. Sutton MA Solomon A. Mensah Biomedical Engineering Department Worcester Polytechnic Institute Worcester MA And Therapeutic Innovations, Inc. Sutton MA

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Elkorchi Kenza National School of Architecture, Rabat, Morocco Salhi Ibrahim Professor; École Nationale Supérieure d’Arts et Métiers (ENSAM), Meknes, Morocco Berbia Hassan Professor; l’Ecole National Supérieure d’Informatique et d’Analyse des Systèmes (ENSIAS), Rabat, Morocco El-korhi Tahar Worcester Polytechnic Institute (WPI), Worcester, Massachusetts USA Van Dessel Steven Worcester Polytechnic Institute (WPI), Worcester, Massachusetts USA Brigitte Servatius Professor, Mathematical Sciences, WPI Rainer Reichel Khon Khaen University

Robert Krueger, Wole Soboyejo, Yunus Telliel

Introduction Science, engineering, and sustainable development: cases in planning, health, agriculture, and the environment

1 Introduction The United Nations’ 2030 Agenda for Sustainable Development Goals (SDGs) include 17 goals from zero hunger and poverty, to clean water and sanitation, to resilient cities and settlements (see Figure 1). Without doubt, science and technology are playing and will continue to play important roles as we move toward achieving these goals. Science, of course, asks important questions that improve our basic knowledge around our most pressing problems and engineers transform that knowledge into technologies capable – hopefully – of solving problems. Yet, as we have learned from numerous examples of failed development projects, technological interventions do not occur in a vacuum [1]. Without recognition of the broader cultural context, technological development and technology transfer can have unintended and often negative consequences for the very communities they hope to assist [2]. The UN’s Sustainable Development Agenda thus needs scientists and engineers to think about the interface between society and technol-

Figure 1: The UN’s sustainable development goals.

Robert Krueger, Wole Soboyejo, Yunus Telliel, Worcester Polytechnic Institute https://doi.org/10.1515/9783110757507-001

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Robert Krueger, Wole Soboyejo, Yunus Telliel

ogy if they are going to be capable of responding to real problems with appropriate solutions that will generate sustainable impacts. The relationship between international development, science, and engineering has been long and often tumultuous. Communities across the Global South have hosted – sometimes voluntarily, sometimes involuntary – technological projects that were designed to modernize their ways of living; to update them to the twentieth century. For more than 50 years, international development scholars have documented these inventions and, more often than not, they have criticized the outcomes. The criticisms have taken many forms. They range from claims of post-colonial exploitation, to viewing people in the Global South as ignorant and incapable of rational thought, to placing them in the middle of an ideological conflict between Communism and Capitalism. Some argue that community institutions and traditions have been trampled on by wellmeaning development agencies. Still others point out the implications of development agencies not taking into consideration traditional practices into contemporary decisionmaking processes, gender relations, community development, and new policies. Regardless, the focus has been on critique without alternatives. The field of development engineering, which sits at the intersection of basic science, engineering, and social sciences (predominantly neo-classical economics), has positioned itself as the antidote to these past mishaps. Coming out of the mechanical engineering department at the University of California at Berkeley, the combination of engineering design and the social sciences has been presented as a way to address the need of a new way of thinking about technology’s role and place in international development. Through its Blum Center for Developing Economies, multidisciplinary teams, including engineers, social entrepreneurs, economists, and policy makers, work to create technological interventions for low-resourced communities facing complex challenges. The reach of the program is global: it works on projects from Oakland to Africa. At MIT’s d-Lab, students travel to the reaches of the world seeking to come up with techno-fixes that the community identifies but is only minimally involved in the design process. Kindred spirits at the Colorado School of Mines (CSM) “Humanitarian Engineering” that brings together social scientists, engineers, and others in an effort to transform the way engineers think about, define, and solve problems. CSM’s program is distinguished from MIT and UC Berkeley with its focus on social responsibility and social justice – instead of the basic economics of entrepreneurship and return on investment. This book takes stock these visions and brings to the fore case studies from around the world that exemplify and characterize these new forms of innovative problemsolving. Essential to pushing the field forward, this book approaches context-sensitive design not as an after-thought, but as a central concern in the future of science, technology, and development. With rapidly advancing technological capabilities, humanity has entered an era when many problems plaguing developing world, such as food shortages, water scarcity, health care delivery, and the effects of increasingly powerful and common natural hazards, could be eliminated or minimized. As such, our challenge today is not whether, but how we can reach SDGs. Most essays in this volume agree that

Introduction

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our technological prowess can be best operationalized in this direction when we challenge our preconceived notions of technological expertise to dialogues between academic experts and community experts. This is especially important in today’s world because the Global South, a region with an enormous stake in the outcomes of the SDGs, is mobilizing the effort at the request of the UN’s Secretary General to coordinate its own technological interventions. The UN’s Office on South-South Cooperation, for example, has mobilized a Commission on Science and Technology for Sustainable Development in the South that aims to codefine problems and cocreate solutions with communities that will be most affected by development projects. This requires that we turn away from the once-dominant one-way North-to-South flow of knowledge and technology and cultivate a transdisciplinary approach with empowered actors in developing countries. In addition to this conceptual account, this book is, at its core, an opportunity for thinking STEM education. Each chapter takes the reader through a different step of the process from basic scientific discovery to actual interventions. The chapters both imply and offer specific guidance for students of science and technology for innovation in global development to hone their skills so that they might produce the outcomes they seek as well as train the next generation to do so. According to the International Labor Organization, the ambitious agenda of SDGs will be increasingly shaping trends in the global labor market. One major expectation is that emerging technologies will be an important factor in hiring in the international development sector. In the United States, STEM schools and liberal arts schools alike have already been seeking ways to train the workers of the future; those who are technically capable, policy literate, entrepreneurial, and sensitive to the problems and solutions of end users. They will also need to expand their understanding of what it means to codefine, codesign, and cocreate with collaborators who may have valuable experiential knowledge even when they are not formally educated. While some institutions of higher education have undertaken remedial efforts in this area, they represent only a small step forward from the historical problems associated with development. With the projected growth in jobs in the engineering for development sector, students will need to be trained not only in technology but also in social scientific and humanistic perspectives that inform how technology is designed and delivered [35]. The same is true for the industrialized North (McKenzie 2019). In other words, the Global South, for us, is not a geographical constructed but a networked one. This book, the first of its kind, represents a conceptual approach and concrete pedagogical steps to support the synthesis of social theory, social science, design, and community partnering in new and exciting ways. This book intends to take a first step toward developing a new canon of knowledge that promotes social innovation, selfsufficiency, sustainability, and technological state of the art in engineering for development projects.

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2 Audience and concepts Designed for a broad audience, this book is presented to enable numerous entry points of engagement that will satisfy this range of people interested in designing a better world as it is rather than focusing on elegant or frontier technologies. It is for people who want to make a difference by improving the human condition through transdisciplinary problem definition and design solution. While the book is written with an eye to the Global South, the lessons it offers are certainly transferable to any region of the world. This book will offer a much-needed text for courses in the social implications of engineering, engineering ethics, engineering design, cross-cultural design thinking, as well as provide intellectual support for programs in development engineering, humanitarian engineering, and transition design. Ultimately, the book is a product of the scholar-educators at WPI and other kindred spirits who are ensconced in WPI’s culture of designing scientific and technological innovations for the public good, whether that public is in North America, Europe, or further afield, to the Middle East, Sub-Saharan Africa, or Latin America. Moreover, they understand that technology is not just transferred in one direction, from the industrialized “North” to the developing “South” but also technology is mobilized and circulates across different social and cultural contexts. The authors in this volume have a special interest in exploring and revealing the limitations of the current ways of thinking about “doing” engineering for development. They seek to, from the vast and disparate literature on science, engineering, and development, make sense of what was, what is, and what can be done to harness the power of science and technology so that it responds to real problems and creates appropriate solutions that prioritize self-sufficiency, dignity, and autonomy. Before discussing the chapters that follow, in the next section we offer some historical context of the problems that the authors and editors of this book seek to overcome.

3 The troubled past of science and engineering for development International development has its roots in post-WWII negotiations at Bretton Woods that dealt with how to rebuild Europe and contain the spread of any social movements that would threaten the economic interests of the emerging capitalist hegemony. At this time, development was viewed through a dualistic lens that distinguished Europe from the so-called developing world, and the outcomes from these negotiations demonstrated that development efforts would be top down, full of technological and social elitism, and undisguised racism. Lord Keynes, for example, referred to the non-European countries involved in the Bretton Woods negotiations as a “monstrous monkey house” [3,

Introduction

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p. 42]. It was in this context that the post-war allies created two financial agencies: the International Monetary Fund (IMF) and the International Bank for Reconstruction and Development (now called the World Bank). The latter’s mission was to provide private bank loans for long-term investments in infrastructure that supported industrially productive activities. The social philosophy of the Bank was largely guided by sociologist Talcott Parsons, whose view of social systems was evolutionary in nature [34, p. 4]. Parsons was especially interested in a society’s adaptive capacity. For him, adaption could occur in one of two ways: first, it could occur internally in the context of creating a new type of structure, as with the Industrial Revolution in England. Second, it could occur due to external sources such as the importation of new ideas, institutions, and technologies. For Parsons there was another mitigating factor in adaptation – a society’s value system, defined as a cultural pattern that is institutionalized and thus reinforces the continuing desirability and durability of a given social order. By objectifying “cultures” of non-Western societies, this perspective paved the way for modernization theory, which elaborates on the differences between modern and “backward” societies. The model all societies at the time were measured against was the modern industrial society, and the further a society was from modern industrialism the more backwards it was considered. For Parsons, modern societies were internally and externally expansive, becoming so by abdicating their “traditional” elements. Development was therefore viewed as an evolutionary process that human adaption and capacity increased by its adoption of the principles of modernization – free markets, specialized division of labor, urbanization focusing on large systems of production, and democratically elected elites (rather than traditional tribal leadership). Since “backwards” communities maintained traditional value systems and lived in quantitatively measured poverty, they, according to this ideology, were ripe for modernization with the right expert advice. This developmentalist ideology found its way into formal global politics in the late 1940s. In his inauguration speech in 1949, President Harry Truman called for a program for making available the benefits of the United States’ technology and industrial knowledge to areas that suffered from “underdevelopment.” He also called for a “democratic fair deal” for the entire world, a sort of Global New Deal [36, p. 3]. Truman remarked: More than half of the people of the world are living in conditions approaching misery. Their food is inadequate, they are victims of disease. Their economic life is primitive and stagnant. Their poverty is a handicap and threat to both them and more prosperous areas. For the first time in history humanity possesses the knowledge and the skill to relieve the suffering of these people . . . I believe that we should make available to peace-loving peoples the benefits of our store of technical knowledge in order to help them realize their aspirations for a better life . . . What we envisage is a program of development based on the concepts of democratic fair dealing . . . . Greater production is the key to prosperity and peace. And the key to greater production is a wider and more vigorous application of modern scientific and technical knowledge. [5]

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In 1951, the United Nations, reflecting Parsons, revealed some of the challenges associated with Truman’s vision of development: rapid economic progress is impossible without painful adjustments. Ancient philosophies have to be scrapped; old social institutions have to disintegrate; bonds of caste, creed, and race have to burst; and large numbers of persons who cannot keep up with progress have to have their expectations of a comfortable life frustrated. [38, p. 15]

For Fry [37] this amounted to the “design of elimination.” It was “. . . aimed literally at scrapping the vernacular design and endogenous practices that for centuries had nourished, for better or worse, the lives of millions. . .” [32, p. 6]. The idea of development, then, was to liberate “backward” societies from their traditional cultural mores and adopt modern economic goals (e.g., growth) and develop the infrastructure, institutions, skills, and technology to deliver on these goals.

3.1 Science and engineering for development: the early years In the last section, we set the stage to understand the social context of engineering and development following WWII. Here, we provide an exemplary case that reveals how these perspectives shaped the development process from a technological design perspective. The case illustrates the overarching social theory of non-Western humans at the time, the types of transitions that they were expected to make, and the transfer of technology and best practices from the modern world to the developing world. In 1950, at the request of the Uruguayan President Andres Martinez Trueba, a joint mission of the United Nations Food and Agriculture Organization (FAO) and the International Bank for Reconstruction and Development engaged in a joint mission to survey the agricultural problems in Uruguay. In its cover letter to the Bank President and the Director-General of the FAO, the committee targeted three areas: increasing livestock production, lowering production costs, and improving marketing methods [45]. They go on: These recommendations, taken as a whole, constitute a major modification of the total agricultural economy [in Uruguay]. The mission has been impressed by the need for concentrated effort along the lines proposed. After making remarkable progress for long periods in the past, the agricultural economy of Uruguay is approaching a static condition, which even involves the danger of decline. (Joint Mission, 1951, pp. 2–3)

The mission recommended a pilot study to test the technical innovations they sought to implement. “With improved experimental and demonstration facilities, the research and advisory organizations can play a critically important part in testing and evaluating the proposed measures and in promoting their acceptance throughout the country” [45, p. 3]. Despite gaining this local technical knowledge, the mission invoked best practices. “The recommendations made in this Report have all been based on

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practices that have been tested and proved successful elsewhere” (Joint Mission, p. 4). Best practices then were crucial for any project’s adoption. For Hirschman [2, p. 21] this gives “policy makers and project planners the illusion that the ‘experts’ have already found all answers to the problems and that all that is needed is faithful ‘implementation’ of these multifarious recommendations.” After the original mission completed its work in 1951, they began developing local “scientific” knowledge on 600 pilot sites throughout the country with experts brought in from Australia and New Zealand. This new cohort of experts brought outside technical approaches to the Uruguayan context. Not surprisingly, then, in 1965, as a result of the technical recommendations, the World Bank granted the project $12.7 million for pasture reclamation and marketing projects. The original struggle was framed as a project to overcome technical issues associated with Uruguay’s diverse physical geography. What followed, however, was a set of social interventions, which created an explosive discord amongst different groups of farmers and ranchers. Technical interventions required day-to-day management, supervision, and delicate decision-making that resulted in cultural and social tensions. Absentee landowners had to become present, or pay someone to do carry out the recommendations for them, or to sell their land. The new techniques required a great deal of individual variation and came with a diverse set of specialized technology, experimentation, and exercise of new forms of judgment. Those who accepted the financial incentives to participate in the program had significant changes to their lives while those who chose not to participate were often stigmatized – not wanting to become “modern.” All of this calls for a different type of problem-solving. Social change always accompanies technological change. For an effective uptake of a technological change, project designers need to understand the attitudinal and social changes required alongside the technical solution, rather than as an afterthought, or even not at all. The problem, as pointed out by Mitchell [1], was that the narrowly focused, linear process of design failed to capture the broader implications of technological interventions. Developing countries were seen as tabula rasas for development experiments. Hirschman [2] argued that if experts knew the complexity of seemingly simple technological interventions before-hand, they probably would not have had the confidence to take them on in the first place. In this section, we have fleshed out how the dominant social theory at the time translated into policy rhetoric and development practices that affected real people and real projects in situ. The example, only one of many thousands, communicates the problematic relationship between scientists and engineers and the socio-cultural contexts they were working in, and how the two created a highly problematic approach to development. It illustrates Fry’s “design of elimination” – the leveling of culture for instrumental ends. Implicit in our argument is that it would be folly to lay complete blame on the scientists and engineers who participated in these programs. After all, there is a long, widely accepted, social theory that supported this view. One that informed policy makers, design, and technical fields.

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Despite the continued dominance of this perspective scientists, engineers, and social scientists have been laboring to develop new approaches that celebrate and integrate local contingencies, cultural differences and traditions, understand innovation as a two-way process between “experts” and “locals,” and rather than large-scale infrastructure, they seek more modest interventions that treat communities as codesigners, not as backward and irrelevant. The next section describes the next effort to achieve this goal. Regretfully, it falls short, but it does lay a solid foundation for future efforts.

4 Reimagining engineering for development In the 1960s, the “modernization” model of development began to be challenged, focusing on the degree to which a given technology fits its intended context. Many point to the publication of Schumacher’s Small is Beautiful (1973) as the beginning of the appropriate technology movement.1 While this may have been a tipping point in the movement’s development, there is actually a deeper history of concern around technology and the developing world. For some, Mahatma Gandhi (who advocated for villagebased technology that could lead to self-reliance in the 1920s) created the intellectual underpinnings for this thinking [39]. He sought democratic forms of technology, those that did not benefit a minority at the expense of a majority. The early 1960s brought the first critiques of engineering, technology, and development. Lewis Mumford [7], for example, provided the first definition of “democratic technology”: [D]emocratic technics is the small scale method of production, resting mainly on human skill and animal energy but always, even when employing machines, remaining under the active direction of the craftsmen or the farmer, each group developing its own gifts, through appropriate arts and social ceremonies, as well as making discrete use of the gifts nature . . . This democratic technics has underpinned and firmly supported every historic culture until our own day, and redeemed the constancy tendency of authoritarian technics to misapply its powers. [7, pp. 2–3]

Similarly, in 1965, Murray Bookchin [8] called for a “Technology for Life” [8, p. 157] that could play a vital role of integrating one community with another. Rescaled to a revival of crafts and a new conception of material needs, technology could also function as the sinews of confederation . . . A technology for life must be based on community; it must be tailored to the community and the regional level . . . [i]t could serve to confederate them to the basis not only of common spiritual and cultural interests but also common material needs. [7, pp. 157–158]

 Appropriate technology and intermediate technology were often used interchangeably.

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Bookchin’s interest was to distribute technology to smaller social groups with shared interests. He sought a world of compassion for one’s neighbor, whether across the street or the world. Such ideas were also reflected in international political arena. For instance, between 1963, when the UN organized its first conference on the Application of Science and Technology for the Benefit of the Less Developed Areas, and 1979 [9], the year of the UN Conference on Science and Technology for Development in Vienna, the UN switched its discourse from a perspective relying on technology transfer to one more concerned with equitable access to the world’s technology and resources. Schumacher’s appropriate technology movement represents a concerted effort to create democratic and community-based technology. But, his work came from the perspective of an economist where reform at the time focused efficiencies in production and consumption. Through his work in India and Burma, the economist Schumacher sought to take on the labor/capital imbalance in South Asia. In his 1962 report to the Indian Planning Commission, Schumacher noted that: If, therefore, it is intended to create millions of jobs in industry, and not just a few hundred thousands, a technology must be evolved which is cheap enough to be accessible to a larger sector of the community than the very rich and can be applied on a mass scale without making altogether excessive demands on the saves and foreign exchange resources of the country. [39, p. 110]

Appropriate technology, then, is the average per capita capital cost for a workplace; it ought to be affordable in terms of the average per capita income of people in a given region. It is technology that is designed or chosen to exhibit cost characteristics to bridge the gap between the out of reach capitalization levels of industrial economies and the low capita income of a traditional economy. It sought the middle path. For Schumacher there was no universally valid figure that optimized his notion of medium capitalization. For Schumacher, there were three other criteria that would support his notion of appropriate technology: 1) Smallness: impoverished rural communities need their technology to fulfill their smaller market needs. The cost of technology must also be able to be supported in a particular region. 2) Simplicity: much modern imported technology requires technical back-up, specialized maintenance, and sophisticated management skills, the kind probably not available in rural areas of developing countries. Thus, the complexity of technology employed in rural areas must be manageable in terms of the human skills available within the region. 3) Nonviolence: appropriate technology must operate in accordance with environmental principles, so as to efficiently use local resources. Appropriate technology will not impose harm on people. Finally, technology must have low propensity for unintended consequences, such as harmful side effects or impacts (cf. [10]).

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For Schumacher, these principles, taken together, would enable engineers to revolutionize workplace functionality and optimize capital costs. With these principles in mind, engineers were put to a variety of appropriate technology challenges. One area they examined first was traditional technologies and if they could be upgraded to serve modern needs. Some examples include: the development of efficient and affordable water collection tanks, improved cotton-spinning techniques, and alternative types of mortar and cement. A second method he and his team focused on was to modify large-scale technologies to appropriately sized scales for their local needs. For example, in Zambia there was a perceived need for manufacturing eggs trays from waste paper. The machine that Zambia had would most efficiently run if it produced 1 million trays per year. With the assistance of Schumacher and his team – the Industrial Liaison Group – UK, Reading University, and the Royal College of Art – the Zambians received a mini-machine that could produce on an appropriate scale. The technology was much cheaper than the existing technology. Yet, Schumacher continued to assume that new technologies – or interventions as in the upgrade of traditional technologies – would have to come from the Global North. To implement the principles of appropriate technology Schumacher and his colleagues established the Intermediate Technology Development Group (ITDG). The purpose of the group was to identify the knowledge gaps about technologies that were considered suitable for the conditions of a location. ITDG engaged its process in three main ways. First, it reviewed the state of the art in technology and compiled it into an accessible volume including drawings, design specifications, photographs, and other materials to coordinate existing information that could be mobilized to help those in the Global South. To ITDG, it seemed that there were appropriate technologies in use in some locations, but not widely known, and there were technologies that were no longer in use that could still be useful to someone. Second, the IDTG also had a research and development agenda, partnering with development and research organizations to determine the technical gaps that were not covered in the catalogue. Finally, through a large network of partner groups in the Global South they planned and disseminated their knowledge to numerous communities. By traditional economic indicators much of Schumacher’s work was considered successful. His technological interventions improved efficiency and created jobs in places where they otherwise might not have been [11]. Despite the kudos the movement received in improving efficiencies, Nieusma and Riley [12, p. 33] wondered why “. . . with over four decades of experience with appropriate technology in the South, why do so many engineering-for-development initiatives still struggle to produce successful, sustained outcomes?” One reason is that, as Nieusma and Riley rightly point out, the model remained flawed. While an improvement over the large-scale engineering projects of the 1950s and 1960s, the appropriate technology movement of the time remained wedded to the assumptions of the practice that it was critiquing. ITDG and Schumacher himself maintained the modernist and paternalistic view held by the conventional development proponents. First, the team assumed that efficiency was

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the highest order concern. This supports the canon of economics in the Global North, but how about the people it was designed to help? Similarly, northern technicians adapted and invented new technologies for the South. Moreover, this practice still employed best practice approaches to technological implementation. The discussion above – and below – identifies the flaws of the “best practices” practice. It lacked the place-based nuance necessary for successful projects. Finally, it assumed that local people were not capable of sustaining themselves. The appropriate technology movement continued to conceive of the designer and the technology as separate from each other and operating in an “objective” culture/ environment/location-neutral space. Design occurred in the laboratory first; prototypes were developed, fabricated, tested in the laboratory, and only then taken to the field. The next generation of engineering projects for development opens up additional possibilities for design, self-determination, and sustainability.

5 Engineering and development: Redux? In the 1990s, communities and their cultures came to be seen as resources for (rather than the target or object of) development projects. Amartya Sen’s [40] “capabilities” approach offers an example that has received increased attention among practitioners and scholars in recent decades. This approach shifts the evaluative space of engineering for development projects away from income, resources, primary goods, utility, or preferences to “what people are effectively able to do and be” [13, cited in 14]. Oosterlaken argues that technology is ultimately used to increase the capabilities of human beings [14, p. 94]. By focusing on well-being as the potential for development, Oosterlaken suggests that capabilities should be a core principle for any development project. This evolving perspective opens the discussion to our third iteration of engineering for development projects. This approach works at the smallest scales (e.g., village and household), often linking experts from the North directly with communities in the Global South. In contrast to its predecessors, today the framework of engineering for development projects is largely shaped by programs and departments within universities, especially those with STEM programs, that place students working in groups in direct contact with communities to codesign solutions to local problems [12, 15, 41]. Engineering for development project gained visibility through the work of institutionalized humanitarian organizations such as Engineers Without Borders (EWB) [41]. The first EWB was founded in France in 1982 and inspired many European and North American engineers to establish EWB chapters in their own countries in the 1990s and the 2000s. Since its establishment in the United States in 2002, EWB has spread across the United States with nearly 300 chapters and over 14,000 members. EWB and other humanitarian engineering organizations, which focus on volunteerism, have

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been followed by the establishment of educational programs that seek to combine engineering and technology with social science, resilience, economics, and sustainability [16, 42]. Smith et al. [41] identified 79 such programs worldwide as of 2019, of which only two existed before the 2000. Mattson and Wood [15] suggest that interest in these kinds of programs has been growing steadily since around 2005. While these programs focus on traditional topics such as technology and general engineering, the programs sought to develop competency in community resilience, humanitarian work, disaster management, and sustainable development.

6 Codesign This new field of “development engineering” reflects two broader shifts. The first is the re-centering of development discourse on community well-being. Instead of stateinitiated development models, community has become the site where development needs are expressed and addressed. Community engagement and empowerment figure prominently in the recent development engineering literature [12, 15, 17–23, 43]. For Murcott [22, p. 124] codesign revises the relationship between the expert and the community to include concepts of interdependence, iterative learning, and improvement. Similarly, Moseson et al. [44] offer “technology seeding” as a methodology for the design and dissemination of technology in the developing world context by building technology from first principles and adapting it locally and with its eventual self-propagation [44, p. 490]. This process distinguishes itself from others in that it privileges social justice as an outcome, it shifts power to the clients from the designers, and the technology itself is not disseminated; rather the ideas that informed its creation are. Related to the “codesign” process are a number of different principles that engineers have established when working with communities. Leydens and Lucena [24, p. 10] developed six social justice criteria to inform engineering projects for development. These are: (1) basic listening, identifying structural conditions that give rise to needs, (2) increasing human rights, (3) increasing opportunities and resources, (4) reducing risks and harms, and (5) enhancing human capabilities. Mattson and Wood [15] identified nine principles for design in the developing world, including codesign, field testing, adapting new technology to the developing world context, recognizing the needs of urban and rural dwellers, revising project management techniques to the developing world context, using interdisciplinary teams, gaining cooperation of those who govern the region where your work takes place, and using existing distribution strategies for introducing projects to developing world markets [15, p. 2]. Despite the existence of well-intentioned principles these may not be enough to achieve their desired ends. As Nieusma and Riley [12] pointed out, engineering for development projects might aggravate the very things that they hope to address. For exam-

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ple, it is not really possible to claim that a development project staff have established a trusting relationship with a community when only a certain sub-set of the community is comfortable speaking or, worse, has the right to speak. How can the social justice box be “ticked” when the very power relations and design problems that a community in the developing world faces is because of some previous technological intervention or the remnants of the colonial past? Related to this are Mazzurco and Jesiek’s [25] five principles for engaging communities in engineering for development projects. They identified these from a literature search spanning the years 1992–2015. These are: collaborating with local champions, harnessing local resources and expertise, integrate ethics and social justice, build trusting and equitable relationships, and create competent multidisciplinary or interdisciplinary teams. These principles are important to motivating projects that facilitate community benefits that privilege self-determination after the project is over. They found 49 relevant development projects that were active between 1992 and 2015; Table 1 reproduces Mazzurco and Jesiek’s findings. Table 1: Principles for engaging communities in engineering. Five principles

Total N = 

Harnessing local resources Collaborating with local champions Creating a competent team Integrating ethics and social justice Building trusting relationships

N =  N =  N =  N =  N = 

Given how important it is for any ethical development project to incorporate these five principles into project design, these findings suggest that there is more work to be done to reach the ideals posited in the latest iteration of engineering for development projects. We have presented three periods of engineering projects for development and situated them in different social practices of designing interventions. From the topdown approaches of the 1950s and 1960s, to the hopeful, yet still top-down, appropriate technology, to the current state of affairs where, under the best conditions, project teams will turn over their power to the community they seek to assist and thereby create more egalitarian, appropriate, and sustainable interventions. Another subtle change seems to have occurred. In earlier periods of engineering for development projects the idea was the western scientists, engineers, and development bureaucrats were there to fix a problem for the community. Moreover, these problems were often identified externally or had to fit into external rationalities that brought outside experts and funding schemes. Today, there seems to be an acceptance of the fact that, against Parsons, people in the developing world are just as intelligent, resourceful, and insightful as their western counterparts. This sensibility opens up the opportunity

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for us to explore further the liberatory potential of our engagements with these communities both for them and us.

7 Cultures of inquiry: science and technology from across cultures For most people in STEM education, Science and Engineering implicitly refer to Western Science and its practical, or engineered, outcomes. But there are numerous cultures of inquiry situated around the globe. The Valley of the Kings in Egypt, the Terra Cotta soldiers in China, the Taj Mahal in India, and the work of the Incas, Aztecs, and Mayans throughout Central and South America are all well-known examples of the technical prowess of those who came before us. Lesser known examples are cataract surgeries in 600 BCE in India, Persia, and the Middle East, disease therapy as practiced by the Shona in Southern Africa, the astronomical acumen of the Dogon tribe in modern Mali, or the Carolinians in modern Micronesia. We must recognize the knowledge held by people that are embedded in place and as relevant as our own “expert” knowledge. The work of Mavhunga [26, 46] on “African” design, technology, and innovation can offer some insights into how developing countries, or even low resourced communities in the North, have problem-solving capacity of their own even though western design and engineering approaches do not recognize these alternative realities. Against Parsons, African history is replete with examples of people adjusting their traditions to craft self-help solutions to everyday challenges and to selectively tap into resources from the outside [46, p. 7]. Ordinary people, Mavhunga [46, p. 8] argues, employ creativity to solving their problems and generating values relevant to their needs and aspirations. Writing about animal poachers who use cyanide and guns to kill elephants, rhinos, and other game, Mavhunga (2012) suggests that the journey of cyanide and guns should not be traced to the chemical and firearm companies that produced them but that the Zimbabwean villagers should be seen as the designers – as they deploy these “weapons” to support their local economies by producing ivory for sale in global markets. Similarly, Mavahunga [27] examines how Southern Africans understood and used the Tseste fly by drawing white invaders to Tseste fly-infested areas so that they and their animals would be sickened or killed by the fly. This requires reasoning in ways that their colonial aggressors did not expect because the Zimbabwean “blackness” (i.e., the color of their skin) was considered to represent the antiintellectual – incapable of rational thought, and there for scientific discovery or technological implementation. This is not simply about the ingenuity of the design practices of Africa or the nonWest. There is indeed much to celebrate in non-Western histories, yet what is especially concerning is how in the West we silenced these histories, achievements, and experiences. Our concern is thus the lack of imagination of the Western science and

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engineering in thinking of the ways in which others have prospered and sustained their communities. Carr’s [28] writing about the Cape Coast region of Ghana describes how, depending on the annual harvest, changes in land tenure, or the value of the Ghanaian Cedi in the global market, villagers decide whether to engage in subsistence, regional, of global agriculture. Furthermore, Midheme [33] shows how the city of Voi, Kenya, appropriated the US conceived community land trust model on its own to combat rapid urbanization in the region. The local innovators used a design process much like the ones described above and reshaped it so that it fit with Kenyan culture and the goals and aspirations of the stakeholder groups involved in its creation. For Mavhunga (2012, p. 4) innovative design should not be one of simply tracing mobility of: Western artifacts, situating them in the Global South, and commenting on their behavior in different environments, but taking seriously what technology means from the perspective of people in the South. It requires not merely looking at how people respond to incoming things, but placing the latter’s arrival, meanings, knowledges, and materialities within the locals’ technological longu durée.

Good design can codesign technology that can contribute to imagining and effecting meaningful social change. Design must start with the community – not with the market or a particular technological fix. Take handloom weaving in India, for example. Handloom weaving is the second largest rural livelihood with almost 4.5 million workers. Although this practice is more than 2,000 years old, weavers have had to adapt to changing conditions in order to sustain their livelihoods. For instance, Annapurna Mamidipudi [30, 31], a social scientist with an engineering background, discusses how weavers in southeastern India, when faced with the cotton price crisis in 2013, diverted their strategy from productivity-gaining technology. Instead they used computers to design their products and mobile phones to reach their customers. This strategy served them well, helping them to sustain their livelihood. The choice here was not between technology and tradition, but between different ways of engaging with technology and design, and ultimately different ways of thinking about how to adapt to their circumstances. According to Latour [29] design can offer an important touchstone for understanding how our modernist approach to helping the developing world might fare better. Or, to answer Nieusma and Riley’s [12] question: how do we go about fixing our development interventions so that community transformation is less defective and humbler? The more we think of ourselves as careful designers and the less we think of ourselves as modernizers the more we will engage in effective solutions to problems of the developing world and beyond.

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8 This book The book is organized into seven chapters. We made the chapters flow from questions of basic scientific discovery with the case of Artemisia Annua. In this chapter, Weathers et al. discuss those interventions that already exist but are unable to make an impact because the discovery process lived outside of Western Science. Then, we look at approaches for engaging in social research to identify technological interventions. Here, Chapter 2 discuss their student work in Ghana (albeit remote!] with women living on the Agbogbloshie E-Waste site. They seek to find out the health impacts to women of e-waste processing. They learned that going on assumed behavior would not lead to appropriate interventions. Rather, behavioral questions are empirical ones and should be based on other factors such as gender and age. Gibson digs deeper into research methods that can be useful for scientists and engineers seeking to conduct proper social research. Her case study comes from her MS thesis from the Colorado School of Mines. In their chapter, Stanlick and Reynolds pivot to considering the broader implications identified in the first three chapters (e.g., community engagement and ethics) and the impact these approaches will have on pedagogy. Servatius and Reichel pick up ethical engagement and green design in their case study of arboreal homes. In his chapter, Juan Lucena looks at another group of actors, nongovernmental organizations (NGOs), and their role in supporting engineering for development projects. He also examines how student engagement with these groups can be leveraged ethically. Continuing this thread Downs et al., from Clark University, provide a case study of their integrative collaboration model for engaging NGO, indigenous people, development experts, and engineers in climate and water access issues in Mexico City. In the next chapter, we hear again from Downs et al. who detail their work in an area they call resilience engineering. Moving from resilience to issues of environmental injustice, Eccles et al. reflect on how engineering design and assumptions can negatively impact those who are already overburdened by environmental risk. Linking their contribution back to previous chapters, we can explore how engineering education would benefit from the broader approach to engineering and science education, especially for those interested in working with marginalized groups. Using medical device development and implementation in Africa as a case study, Deshpande et al. examine the holistic way they have sought to address issues of medical device accessibility and affordability. The final two chapters offer student project experiences that were mentored by WPI faculty. The first case study, from Antone et al., explores water purification and artisanal mining in Ghana. In this project the students collaborated with miners, teachers, and students to develop an inexpensive and scalable water purification device for miners who need a place to dispense of mercury-laden water. Finally, Kenza et al. report on their experience at the 2019 “Solar Decathlon” hosted in Morocco.

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These chapters are laid out to be read in order. However, different people need different ways of learning. If the applied cases at the end provide context for the first few chapters then the chapters can be read in any order. Earlier this year, Krueger attended an expert workshop for integrating SDGs 9 and 11. Here he was reminded that the SDG program is almost half-way to its conclusion (2030). In a year or so, experts and communities from around the world will begin developing the next set of goals that will take us to 2040. If we have learned anything after a generation of sustainability research and implementation, the goals are important, so is the process of implementation. Implementing these goals requires careful consideration for a variety of contexts and cultures; one size does not fit all. We hope that the contributions of this book will enable better outcomes.

References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]

[18]

Mitchell, T. (2002). Rule of Experts: Egypt, Techno-politics, Modernity. Berkeley, CA: University of California Press. Hirschman, A. O. (1964). Development Projects Observed. New York, NY: Brookings Institution Press. Moggridge, D. E. (1980). Keynes. Toronto: University of Toronto Press. Parsons, T. (1948) The Position of Sociological Theory. American Sociological Review, 13(2) 156–171. Truman, H. S. (1999). Inaugural Address: Thursday, January 20, 1949. Western Standard Publishing Company. Fry, T. (2011). Urban Futures in the Age of Unsettlement. Futures, 43(4), 432–439. Mumford, L. (1968). The Urban Prospect. New York: Harcourt, Brace & World. Bookchin, M. (1965). Crisis in Our Cities. Englewood Cliffs, N.J.: Prentice Hall. United Nations. (1979). United Nations Conference on Science and Technology for Development: Vienna Program of Action. International Legal Materials, 18(6), 1608–1643. Willoughby, K. W. (1990). Technology Choice: A Critique of The Appropriate Technology Movement. Boulder, US: Westview Press. World Bank. (1979). Appropriate Technology and World Bank Assistance to the Poor. Washington, D.C., US: World Bank. Nieusma, D. & Riley, D. (2010). Designs on Development: Engineering, Globalization, and Social Justice. Engineering Studies, 2(1), 29–59. Robeyns, I. (2005). The Capability Approach: A Theoretical Survey. Journal of Human Development, 6(1), 93–117. Oosterlaken, I. (2009). Design for Development: A Capability Approach. Design Issues, 25(4), 91–102. Mattson, C. A. & Wood, A. E. (2014). Nine Principles for Design for the Developing World as Derived from the Engineering Literature. Journal of Mechanical Design, 136(12), 121403. Bourn, D. & Neal, I. (2008). The Global Engineer: Incorporating global skills within UK higher education of engineers. London: Engineers Against Poverty. Mazzurco, A., Leydens, J. A., & Jesiek, B. K. (2018). Passive, Consultative, and Coconstructive Methods: A Framework to Facilitate Community Participation in Design for Development. Journal of Mechanical Design, 140(12), 121401. Moseson, A. J., Lama, L., & Tangorra, J. (2015). Development by Technology Seeding. Journal of International Development, 27(4), 489–503.

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[19] Wasley, N. S., Lewis, P. K., & Mattson, C. A. (2012, August). Designing Products for Optimal Collaborative Performance with Application to Engineering-based Poverty Alleviation. In ASME 2012 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, pp. 463–470. [20] Hamza, et al. (2010). [21] Baumgartner, et al. (2007). [22] Murcott, S. (2007). Co‐evolutionary Design for Development: Influences Shaping Engineering Design and Implementation in Nepal and the Global Village. Journal of International Development: The Journal of the Development Studies Association, 19(1), 123–144. [23] Fisher, M. (2006). Income is Development: KickStart’s Pumps Help Kenyan Farmers Transition to a Cash Economy. Innovations: Technology, Governance, Globalization, 1(1), 9–30. [24] Leydens, J. A. & Lucena, J. C. (2014). Social Justice: A Missing, Unelaborated Dimension in Humanitarian Engineering and Learning through Service. International Journal for Service Learning in Engineering, Humanitarian Engineering and Social Entrepreneurship, 9(2), 1–28. [25] Mazzurco, A. & Jesiek, B. K. (2017). Five Guiding Principles to Enhance Community Participation in Humanitarian Engineering Projects. Journal of Humanitarian Engineering, 5(2), 1–9. [26] Mavhunga, C. C. (Ed.) (2017). What Do Science, Technology, and Innovation Mean from Africa? Boston, MA: MIT Press. [27] Mavhunga, C. C. (2018). The Mobile Workshop: The Tsetse Fly and African Knowledge Production. Boston, MA: MIT Press. [28] Carr, E. (2011). Delivering Development: Globalization’s Shoreline and the Road to a Sustainable Future. New York, NY: Palgrave Macmillan. [29] Latour, B. (2005). Making Things Public: Atmospheres of Democracy, MIT Press. [30] Mamidipudi, A. (2019). Crafting Innovation, Weaving Sustainability: Theorizing Indian Handloom Weaving as Sociotechnology. Comparative Studies of South Asia, Africa and the Middle East, 39(2), 241–248. [31] Mamidipudi, A. (2016). Towards a Theory of Innovation in Handloom Weaving in India. Maastricht: Maastricht University. [32] Escobar, A. (2018). Designs for the Pluriverse: Radical Interdependence, Autonomy, and the Making of Worlds. Durham, NC: Duke University Press. [33] Midheme, E. & Moulaert, F. (2013). Pushing Back the Frontiers of Property: Community Land Trusts and Low-income Housing in Urban Kenya. Land Use Policy, 35, 73–84. [34] Peet, R. & Hartwick, E. (1999). Theories of Development. New York: The Guilford Press. [35] Watters, L. (2018). How technology is changing the global development jobs landscape. https:// www.devex.com/news/how-technology-is-changing-the-global-development-jobs-landscape-92970, Retrieved on June 15, 2023. [36] Escobar, A. (1995). Encountering Development Princeton University Press. Princeton, NJ. [37] Fry, T. (2017). Design for/by “The Global South”. Design Philosophy Papers, 15(1), 3–37. [38] United Nations. Department of Economic Affairs. (1951). Measures for the Economic Development of Under-developed Countries: Report by a Group of Experts Appointed by the Secretary-General of the United Nations (Vol. 51). United Nations, Department of Economic Affairs. [39] Willoughby, K. W. (1990). Technology Choice: A Critique of The Appropriate Technology Movement. Boulder, US: Westview Press. [40] Sen, A. (1999). Development As Freedom. Oxford University Press. [41] Smith, J., Tran, A. L., & Compston, P. (2020). Review of Humanitarian Action and Development Engineering Education Programmes. European Journal of Engineering Education, 45(2), 249–272. [42] GDEE. (2015). Global dimension in engineering education. https://gdee.upc.edu/en/about-gdee, Retrieved on June 15, 2023.

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[43] Nieusma, D. (2004). Alternative Design Scholarship: Working Toward Appropriate Design. Design Issues, 20(3), 13–24. [44] Moseson, A. J., Lama, L., & Tangorra, J. (2015). Development by Technology Seeding. Journal of International Development, 27(4), 489–503. [45] Food and Agriculture Organization of the United Nations (1951) World Bank Document: 21098 [46] Mavhunga, C. C. (2012). Which mobility for (which) Africa? Beyond banal mobilities. Mobility in history: Reviews and reflections, 73–84.

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Chapter 1 Artemisia annua, a cost-effective sustainable therapeutic for the masses and the political challenges for its implementation 1.1 Malaria, artemisinin, and the rediscovery of Artemisia annua L. by the west Malaria, caused by Plasmodium species and transmitted by mosquitos, is one of the number of neglected tropical diseases with 241 million cases in 2020, a rise >6% compared to 2019 (https://www.who.int/news-room/fact-sheets/detail/malaria, accessed June 22, 2022). Of the ~627,000 deaths in 2020, 96% were in Africa along with 95% of all cases; 80% of all malaria deaths are children under the age of 5. Many drugs, for example, quinine and chloroquine, were developed over the last century to combat this dreaded disease, but all succumbed to the evolution of drug resistance by the parasite. The most recently developed drug, artemisinin, was isolated from the plant Artemisia annua L. and shown to be highly effective against malaria. Despite major efforts to combat the spread of malaria through use of subsidized artemisinin derivatives and combinations with other drugs, access was and remains unaffordable and inaccessible to many especially in the extensive rural areas of Africa. This has led to reconsideration of using the source medicinal plant, A. annua, for more cost-effective, accessible treatment. Artemisia annua L. (Figure 1.1) (Qinghao in Chinese) has a long documented the ethnobotanical use and was first mentioned in bênção literature (Materia Medica) in 168 BC. Physician Ge Hong (AD 283–343) was the first to recommend qinghao for the treatment of “intermittent fevers” [1], many of which were probably malaria. Ge Hong (Emergency Prescription kept in one’s sleeve, Chapter 3, Section 16) first recorded

Acknowledgments: The authors thank Dr. Melissa Towler (WPI) and Professor Dominique Mazier (CimiParis, France) for critical feedback. Some of the work described herein was funded in part by a grant to PJW from the National Center for Complementary and Integrative Health, award number NIH-2R15AT008277-02. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Complementary and Integrative Health or the National Institutes of Health. ✶

Corresponding author: Pamela Weathers, Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA, USA, e-mail: [email protected] Matthew Desrosiers, Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA, USA Lucile Cornet-Vernet, La Maison de l’ArtemisiaParis, France https://doi.org/10.1515/9783110757507-002

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qing hao as an antimalarial: “take a bunch of qing hao, soak in 2 sheng of water, wring out the liquid and drink” (one sheng is equivalent to 0.2 L) [2]. In 2015, Chinese pharmacologist Tu Youyou received the Nobel Prize in Medicine for her discovery of artemisinin, which was identified in 1972 as the active antimalarial component in A. annua [3]. Professor Tu led the Project 523 Team organized by the Chinese government in 1967 as a national agency to combat malaria. They delved back into ancient Chinese literature searching for traditional remedies used to treat “fever,” a common term for what has been considered malaria. They used the ancient documents for material descriptions and techniques for extraction and in 1971 began focusing on the qinghao herb. They compared methods including wrung juice, leftover water, dried infusions, and pounding and respective recoveries [4]. A breakthrough came between December 1969 and January 1972 with a diethyl ether fraction that proved 100% effective versus the parasite in malaria-infected rodents and then in monkeys. Professor Tu even tested an extract of A. annua on herself and later her team determined that dihydroartemisinin (Figure 1.1) was more therapeutically effective than artemisinin. In the 1960s, Project 523 not only aided the Chinese people in battling malaria but also the Viet Cong during their war against the United States [1]. Artemisinin derivatives (dihydroartemisinin, artesunate, and artemether; Figure 1.1) are now semisynthesized mainly from artemisinin and artemisinic acid extracted from A. annua grown in large plantations around the world, and along with a second antimalarial to minimize emergence of artemisinin drug resistance, for example, lumefantrine, mefloquine, and amodiaquine comprise artemisinin combination therapies (ACTs), the World Health Organization (WHO) currently approved antimalarial treatments (as of July 30, 2021, https://www.who.int/activities/treating-malaria).

Figure 1.1: Artemisia annua, artemisinin, and its derivatives.

Chapter 1 Artemisia annua, a cost-effective sustainable therapeutic

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Although A. annua was traditionally used for >2,000 years as a documented fever therapeutic, only ACTs are considered acceptable by WHO for treating malaria let alone any other disease. Indeed, WHO has a prescribed strategy for the use of traditional medicines (as of July 30, 2021, https://www.who.int/health-topics/traditional-complementaryand-integrative-medicine#tab = tab_1), yet it continues to oppose the use of nonpharmaceutical treatments for malaria, specifically A. annua (as of July 30, 2021, https://www. who.int/news/item/10-10-2019-the-use-of-non-pharmaceutical-forms-of-artemisia). Here we describe key elements of this controversy and the politicization of this medicinal plant.

1.2 Implementing broad Artemisia use: grassroot successes across Africa Despite obstacles described later in Sections 1.4 and 1.5, several nongovernmental organizations (NGOs) have supported the use of A. annua or Artemisia afra as a herbal tea against malaria. IFBV-BELHERB with Congolese partners initiated a culture of locally grown and used A. afra (as of July 30, 2021, https://www.facebook.com/LUMARTE MISIA/). IDAY helps promote the culture of A. annua in African schools (as of July 30, 2021, https://iday.org/en/projet-en/project-to-improve-education-and-health/). Anamed has been helping Africans grow A. annua for many years by offering starter kits (as of July 30, 2021, https://www.anamed-edition.com/en/artemisia-annua-anamed.html) and doing seminars in Africa (as of July 2021, https://anamed.org/en/calendar.html). However, the most effective NGO effort to date is La Maison de l’Artemisia. La Maison de l’Artemisia (The House of Artemisia, LMA; as of June 2022, https:// maison-artemisia.org/en/home/) was born in 2012 after Alexandre Poussin recounted to Lucile Cornet-Vernet his recovery from a malaria attack. He was given A. annua tea in a bush dispensary in Ethiopia. As is often the case in Africa, this dispensary became depleted of antimalarial drugs. To continue treating malaria patients, the American doctor, a Catholic nun in charge of the dispensary, grew A. annua in the garden. She even had a dosing system using an old film cannister (diameter: 33 mm; height: 54 mm) that held ~5 g of leaves. After reading literature about the plant, the question kept arising: “Why was this inexpensive local therapeutic solution that seemed to be effective not more known and studied?” An herbal tea is consistent with African culture [5]. Thus, began the long trek to developing LMA, an effort that brought along many courageous and committed people toward the goal of learning about how this plant works as a simple malaria therapeutic with other far-reaching therapeutic effects. LMA was started in Senegal. Lucile Cornet-Vernet brought together a Belgian University professor, Guy Mergai (deceased in 2021), who was working on adapting A. annua seeds to subtropical countries, a Senegalese NGO (Presence Locale) working

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on simple solutions adapted to vulnerable populations, and a social and solidarity economy company, Le Relais. LMA purchased its first field for large-scale A. annua cultivation. Plants were grown and harvested in 2014, and the First House of African Artemisia was born without realizing it. In September 2014, Cornet-Vernet met Dr. Munyangi from the Democratic Republic of the Congo (DRC) who was in Paris for MS studies in synthetic biology. Together they reviewed the A. annua literature and understood that without a randomized clinical trial on a large patient population, A. annua tea would never be taken seriously. Therefore, it was decided, very naively but with a lot of enthusiasm, to do a trial in the DRC with Dr. Munyangi as principal investigator. Private funding was obtained, and the study began. For 6 months, there was intense stress with many threats and difficulties. Despite those severe circumstances, the results were beyond what had been imagined and even superior to the ACT reference drug (artesunate-amodiaquine, ASAQ) designated as appropriate for that region. The Artemisia tea taken by 800 patients also killed the gametocytes in their blood, thus breaking the chain of transmission. This was later confirmed in a 2018 study in the health zone of the study where the incidence of malaria declined by 60% from the time of the study and for three subsequent years (2015–2018) as tracked by Lucie Peters (University of Bordeaux; as of July 30, 2021, https:// lavierebelle.org/IMG/pdf/2018_impact_de_la_prise_de_tisane_d_artemisia_annua_en_pre ventif.pdf). Local farmers continue cultivating A. annua and the populations continue consuming it. More recently, others [6, 7] also reported gametocyte killing in vitro by A. annua and A. afra tea infusions. By killing gametocytes, transmission of the parasite back to the mosquito is blocked. LMA then began cultivation of A. annua in 2014–2015 in Togo and Benin. Partnerships with LMA began in 2016–2017 in Cameroon, Chad, Gabon, Burkina Faso, Côte d’Ivoire, Niger, and Guinea. Slowly, a model emerged. Centers of competence were created around the people who cultivated Artemisia in each country, the local Houses of Artemisia. Together with local Artemisia leaders, a common charter was developed to link everyone to establish consistency. The LMA in Paris, France, is an NGO in the service to the African La Maison de l’Artemisia Houses, which are local centers for cultivation, production, and distribution of Artemisia. The African LMAs also provide agronomic and medical training and knowledge sharing. The goal remains to make A. annua therapy widely available to as many people as possible by guaranteeing product quality, a fair price, and medically proven advice. The network is expanding with communication via social media networks. Dozens of WhatsApp and Facebook (now Meta) groups were created by country, by profession, and by language. Dozens of agronomic, medical, economic, and communication documents were written and circulated. Many are referenced and available on the LMA website (as of June 22, 2022: https://maison-artemisia.org/en/home/). LMA is a vast community of grassroots citizens who joined to foster consistent A. annua cultivation, production, and use, all for the common good with more than 7.5 million successfully treated for malaria. Here are the main tenets of La Maison de l’Artemisia.

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Vision: Save millions of lives with Artemisia Mission: Accelerate research on Artemisia tea and supervise and increase consistent use and distribution of A. annua in malaria endemic countries. LMA, through local competent leaders, coordinates the knowledge and distribution of the plant. Values: LMA is a broad network of people who work with kindness, trust, and transparency. Guided by common values of sharing, fraternity, and justice, they move forward together in respect of the Earth and humans. To date, growers have cultivated A. annua in 130 LMA Houses in 28 countries in Africa, South America, and Asia (Figure 1.2). More recently, the emergence and spread of COVID-19 also spurred planting of A. annua for prophylactic and therapeutic use against the virus (as of July 30, 2021, https://globalvoices.org/2020/06/08/the-rise-of-arte misia-in-cameroon-in-the-fight-against-covid-19/).

Figure 1.2: Global locations of Les Maisons d’Artemisia. Different colors indicate orange, LMA houses; green, national LMA houses; brown, original LMA houses; and black, expert members of the LMA network (as of June 29, 2022).

1.3 WHO, NIH, and foundation support of traditional medicines Currently 70–80% of people globally use herbal medicines. In response to the shortage of doctors and pharmaceutical products in developing countries, where primary health care relies mainly on traditional practitioners and local medicinal plants, WHO officially established its traditional medicine program in 1977 with periodic updates [8]. In the United States, the Office of Alternative Medicine (now the National Insti-

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tutes for Complementary and Integrative Health, NCCIH) was initiated within NIH in 1992. That year, about a third of the US population used alternative treatments including herbal medicines, acupuncture, chiropractic, and homeopathy. In 2017, Rashrash et al. [9] reported that herbal treatments alone were used by 35% of the US population. Traditional treatments are rising and require more investigation to establish the science explaining their putative efficacy. Unfortunately, research proposals on traditional medicines are often ignored. For example, a major international foundation rejected A. annua proposals four times from one of the authors. Typically, no critiques are provided, but a behind-the-scene inquiry after the fourth rejection found that the foundation would not consider anything that was not a pure drug. In another example, Fields provided evidence of bias against excessive cautions against possible herbal treatments for COVID-19 [10] while others provided constructive advice on promoting “ethically sound international herbal medicine research that contributes to global health” [11]. Publications also are difficult to achieve in tier 1 journals with efforts relegated to only a few lower tier journals; others go to predatory journals, those that publish for a fee, but without adequate peer-review or editorial services. Numerous journals also must be queried to find one that is willing to consider sending for review studies on mixtures versus pure drugs despite empirical comparisons to pure drug controls. In summary, there is generally a bias, beyond legitimate scientific concerns, by modern science and medicine against nonpure herbal drug studies, and this is especially true for studies involving A. annua [12].

1.4 Political challenges to implementing Artemisia A. annua is grown globally in large plantations across equatorial regions where malaria is particularly endemic. A politics of knowledge has emerged pitting traditional use of the plant (>2,000 years of documented use [1, 3] against canons of Western knowledge [12]. This conflict has resulted in many efforts to block broader traditional use of the plant as provided in the following examples. In several countries, problems arose for fields of A. annua. In Bangangté, Cameroon, a prefect had a 1 ha field of A. annua that was uprooted and burned in June 2019 (as of July 30, 2021, https://malariaworld.org/blog/revolting-artemisia-plantations-de stroyed-police-cameroon-0). Entire fields also disappeared overnight in Kenya in 2019 (IDAY), in Maroua, Cameroon, in April 2020, and in Côte d’Ivoire in 2019 at an orphanage after the director was inveigled by a doctor. Small plots of Artemisia are regularly destroyed by passing oxen, by stealing pumps or irrigation systems, by tearing down fences, etc. In another case, in September 2019, Dr. Dieudonné Manenga Galambo was distributing A. annua to his patients and had been trained by the NGO, Anamed. He

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was murdered in Uvira, South Kivu, DRC. The intentions of these malicious acts are difficult to know, but they had negative effects on growers and the general population. In 2014 when Dr. Munyangi (https://fr.wikipedia.org/wiki/J%C3%A9r%C3%B4me_ Munyangi, accessed June 25, 2022) was in France for his MS in synthetic biology, he managed to convince a laboratory manager from INSERM to do experiments using tea infusions of A. annua tea. They worked together for three weeks with interesting results. However, when the head of the laboratory returned from vacation and saw what they had achieved, he confiscated Dr. Munyangi’s notebook telling him, “This plant is a bomb and I don’t want it to explode in my lab!,” referring to the lab’s funding by a pharmaceutical company. In October 2015 in Maniema, DRC, Dr. Munyangi obtained all locally required authorizations and then began a clinical study of the efficacy of A. annua and A. afra tea infusions against malaria and schistosomiasis. When the head doctor of the zone learned of the study, he stopped it despite the provincial health minister having given his approval. After spending several thousand dollars, the study was again allowed to resume. About a month later, Dr. Munyangi fell very seriously ill. As no local treatment was effective, he was rushed to the antipoison center in Goma, DRC, where it was determined that he had been poisoned. He suffered from painful aftereffects for a long time. The documentary Malaria Business by Bernard Crutzen (as of July 30, 2021, https://www.youtube.com/watch?v=OvC4uSYprU8) relates these episodes. In 2018, in Lubumbashi, Dr. Munyangi witnessed a road accident. While giving testimony, the prosecutor asked a bizarre unrelated question: was Dr. Munyangi the one working on the Artemisia plant that was causing sales of antimalarial drugs to decline? Later it was learned that the brother of that prosecutor was in the drug business. After refusing a bribe to stop working on A. annua antimalarial tea, in March 2019 Dr. Munyangi was arrested in Kinshasa under false pretext and incarcerated. Efforts were successful by LMA to obtain his release, but a few days later he was arrested again and reimprisoned. LMA again succeeded in getting him released and then exfiltrated him from DRC. After waiting for 2 months in Bangui, DRC, he obtained a political refugee visa for France in 2019. Attacks on Dr. Munyangi also included kidnapping of his daughter who survived, but with serious injuries (https://susanne-wolf.com/2022/06/ 23/eine-pflanze-als-corona-heilmittel/, accessed June 29, 2022). In 2018 and 2019, after multiple rounds of rigorous peer-review, the clinical trials led by Dr. Munyangi were published in the journal Phytomedicine [13, 14].1 However, in 2019 both were challenged by one group of investigators [15, 16]. Despite sharing all data and considerable effort to provide details of all aspects of each study [17], only authors’ responses to the schistosomiasis study were published. A response was originally accepted and published by the authors for the malaria study, but then with-

 Both original studies are available upon request from [email protected].

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drawn by the journal with no explanation to authors. To this date the journal has not responded to explain or reverse their withdrawal of the authors’ responses despite multiple inquiries by multiple authors. Authors viewed the retractions as unjustified based on unproven charges, political motivation, and potential biases. Indeed, the journal aimed to hide any response by the authors making retraction of the malaria study clearly one-sided. These attacks and oppression have terrorized the small communities of Africans and other researchers who study Artemisia. Many have stopped their research. In some countries, money from trafficking falsified medicines or even legitimate medicines benefits heads of the state, so efficient and cheap local solutions like A. annua are fought.

1.5 WHO challenges to implementing Artemisia The WHO is the primary global health advisory institution. WHO supports some use of traditional medicines [8]. Nevertheless, in October 2019, the WHO published a new position statement on the use of nonpharmaceutical forms of Artemisia to treat malaria [12]. In their statement, the WHO raised several concerns about the use of various forms of Artemisia species. While the WHO has good reason to point out these concerns, they neglected to mention data published in reputable journals that especially supported the use of Artemisia. They cite on page 1: the main limitations are related to standardization of plant cultivation and preparation of formulations, dosages, quality assurance, and evidence of clinical safety and efficacy.

We contend that the WHO document failed to include many reports that had already addressed some of those concerns including a major one in 2015 [18] on artemisinin versus A. annua drug resistance. Those studies and more recent studies further counter the WHO’s position on use of A. annua.

1.5.1 Standardization of plant cultivation Cultivar selection is challenging to establish. Which cultivar(s) are effective, and which are not? These questions remain to be answered. However, there are already several cultivars of A. annua that have proven effective in peer-reviewed animal studies: SAM [18–20]; and human clinical trials, for example, Artemis [21]; Anamed A3 [22]; LUX, and BUR [14]. There is, however, some questions as to how much artemisinin is required because as [14] showed, even A. afra containing a negligible amount of artemisinin (0.045 mg/g plant dry weight) eliminated parasites in malaria patients and with greater efficacy at day 28 than ASAQ. Those results were corroborated by others

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[6, 7] who showed that A. afra cultivars containing little or no artemisinin still eliminated asexual parasites in vitro. In 2006, Anamed also noted antimalarial activity in nonartemisinin plants (A. absinthium, A. abrotanum, and A. afra; as of July 30, 2021, see https://www.anamed-edition.com/en/downloads.html?file=files/Tim/revo_E_16-082006.pdf). However, we do not recommend the use of Artemisia species other than A. annua and A. afra, both of which have a long history of safe traditional use. A. annua favors cross-pollination, with selfing rates of only 1% [23], which means planting by seed can result in large variations in phytochemical content. By propagating the plant via rooted cuttings, annual crops have long-term consistency of both artemisinin and other phytochemicals [24]. For example, the A. annua SAM cultivar grown in the field, home garden, or laboratory produced an average artemisinin and total flavonoid content over seven years of 1.28 ± 0.23% and 0.46 ± 0.09% (w/w), respectively [25]. Others reported good phytochemical consistency with rooted cutting clonal propagation [26]. Alternatively, through controlled self-pollination, homozygous cultivars can be created that subsequently provide seed with consistent artemisinin content [27, 28].

1.5.2 Stability of artemisinin and other phytochemicals in dried A. annua Another question that arises is the stability of artemisinin and other phytochemicals in stored dried plant material used for tea infusions or powdered for encapsulation. If the dried plant material remains dry, artemisinin and the other phytochemicals still “locked inside” the plant trichomes will remain quite stable. For example, Simonnet et al. (as of July 30, 2021, https://assets.publishing.service.gov.uk/media/ 57a09de840f0b652dd001c2a/storage_losses_in_Artemisia.pdf) reported on the longterm stability of artemisinin in dried leaves stored at 10 ng/mL for >3 h and well above the minimum threshold. Compared to an average of eight other human artemisinin pharmacokinetic studies, the tea infusion delivered in one study [21] showed the Cmax was 2.5 greater. In a recent human malaria study [14], patients given tea made from A. afra leaves contained only 0.036 mg artemisinin/g DW. We (unpublished) and others [32] showed that preparation of tea infusions following the method described in [14] delivers close to 100% of the artemisinin in the dried tea material; thus, each day each patient received 0.18 mg artemisinin for 7 days and by day 28, 88.8% of those patients had no microscopically detectable Plasmodium parasites. Recently, in Nair et al. [29] (see the report’s supplemental material), a female human subject ingested 3 g of encapsulated A. annua (cv. SAM) leaves containing 15 mg artemisinin/g DW. Blood was drawn and serum extracted and analyzed for artemisinin. At the 2- and 5-h postingestion, 7.04 and 0.16 mg/L artemisinin was detectable, respectively, in her serum. While only a single individual, those results suggested that the high bioavailability of artemisinin observed in vivo in rats also may translate to humans. However, the human pharmacokinetics/bioavailability of artemisinin delivery via A. annua should be more rigorously investigated.

1.5.5 Efficacy and safety Although we agree that the published recent clinical trials were not done to the highest specifications of a pharmaceutical drug, the studies are still valuable in providing two key areas of evidence: – A. annua showed efficacy against malaria in a number of different human test groups [14, 22, 29, 40] and ICIPE 2005 (as of July 30, 2021, and https://plutgen.files. wordpress.com/2012/12/revicipetablets.pdf) – A. annua to this point did not evince any significant adverse effects in the above human studies A. annua is established as a generally recognized as a safe (GRAS) plant [41] (US FDA: as of July 30, 2021, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch. cfm?fr=172.510) if thujone free. While thujone is found in other Artemisia species, it is not present in A. annua. A GRAS recognition is not equal to that used when assessing a drug in patients; nevertheless, it is a strong indicator of the probable, oral safety of a plant. Recently, Han et al. [42] compared the safety of an A. annua hot water extract powder (SPB-201) to a placebo delivered orally in patients with nonalcoholic mild liver dysfunction. After 8 weeks of treatment there were no significant differences in

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22 of 23 measured hematological parameters between placebo and A. annua treatments, thus providing a strong safety profile, also observed in prior clinical studies [13, 14]. Artemisia annua-treated patients also had significantly improved liver function compared to the placebo.

1.5.6 A. annua is not a monotherapy A monotherapy for treating malaria is to be avoided to prevent emergence of drug resistance. Several in vitro studies showed efficacy of individual phytochemicals found in A. annua against various malaria strains, albeit with much lower IC50 values than artemisinin. For a recent listing of those studies see [25]. The WHO consistently focused only on artemisinin and not the plant per se, declaring that use of the plant is a monotherapy. While synergism among phytochemicals is challenging to study and explain, there is unmistakable evidence that A. annua is not a monotherapy and is effective against multiple stages of the parasite even when there is no detectable artemisinin, for example, with A. afra. The malaria parasite has numerous stages in the human segment of its life cycle including several asexual forms in the liver and blood. Some parasites mature into sexual gametocytes that transfer back to the mosquito with another bite to complete the life cycle. A. annua and A. afra tea infusions kill both blood (trophozoite, schizont, ring) [6, 7, 33] and gametocyte stages [6, 7]. Importantly, Ashraft et al. [7] showed that the artemisinin-deficient species, A. afra, was more effective than artemisinincontaining A. annua against both rings and schizonts and even more effective than dihydroartemisinin. Some malaria species, for example, Plasmodium vivax, are notorious for going dormant in the liver (hypnozoite stage) resulting in relapse after an apparent “cure,” but Ashraft et al. [7] also showed that tea infusions of both A. annua and A. afra disrupted hypnozoites. Together these studies validate that A. annua and A. afra tea infusions are not solely dependent upon artemisinin and therefore are not monotherapies.

1.5.7 Cost The WHO states that a complete treatment of ACT can be procured for US 5 years ago said the cost was closer to US $6/treatment, ~15% of subsistence income. In Ghana, ACTs cost ~$10 for a treatment course of artemether–lumefantrine [43], but in 2021 >75% of Ghanians lived on $3.2–5.5/day, so at $10 for that family of four, they would need ~$40 for one bout of malaria (as of July 30, 2021, https://www.statista.com/statistics/1221864/middle-

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income-poverty-rate-in-ghana-by-level/). The WHO goal was to produce a treatment for US