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How to develop traditional medicine in Nigeria, by experts

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Maurice Iwu

Validate ginger, turmeric, Artemisia, Moringa, others to boost immunity against COVID-19, others

As part of efforts to develop traditional medicine in Nigeria and to mark African Traditional Medicine Day (ATMD) 2021, on August 31, stakeholders have made recommendations.

The stakeholders include World Health Organisation (WHO); National Agency for Food and Drug Administration and Control (NAFDAC); Pax Herbal Clinics, Ewu, Edo State; Bioresources Conservation and Development Group (BCDG)/Interceed Health Products (IHP); Model Herbal Clinic of the Department of Pharmacognosy Faculty of Pharmacy, University of Lagos; Drug Research and Production Unit, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State; Centre for the study of Human Health, Emory University, United States; and Institute of Biochemistry and Molecular Medicine, University of Bern, Switzerland.

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Director, Pax Herbal Clinics Ewu, Edo State, Rev. Fr. Anselm Adodo told The Guardian that at the outbreak of the virus in 2019, countries of Europe, Asia and America looked inwards to find solutions and that the pandemic was a call for nations to tap into their outer and inner resources for sustainable solutions.

Adodo, however, said African governments were, as usual, waiting helplessly for other continents to come up with solutions. He said it is no wonder that even though diseases such as malaria, sickle cell-cell anemia, which is black people’s disease, Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), Ebola, tuberculosis, are more prevalent and critical in Africa, there is no African centre of excellence in research devoted to finding solutions to these health challenges. Rather, he said, Africa has remained a consumer of solutions made by others, from drugs to vaccines. Paradoxically, Adodo said African scientists, economists, and innovators living outside Africa are making impacts across the globe.

The Catholic monk said the field of traditional medicine is still largely unregulated and disorganised and the government has not been able to properly regulate this field.

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He said Pax Herbal Clinic and Research Laboratories, Ewu in Edo State, has developed an herbal remedy for the treatment of symptoms associated with COVID-19.

Pax Herbal Cugzin, which had earlier been produced under the brand name, ‘CVD PLUS,’ before it was rebranded to ‘Paxherbal Cugzin,’ is in capsules and packaged in a container of eighty 290mg capsules, each containing Garcinia kola (bitter kola), Curcuma longa (turmeric) and Zingiber officinale (ginger).

Former Director, Drug Research and Production Unit, Faculty of Pharmacy, Obafemi Awolowo University (OAU), Ile-Ife, Osun State, Prof. Joseph Agbedahunsi, in his keynote address at the 5th Annual Traditional Medicine Day Symposium organised by Model Herbal Clinic of the Department of Pharmacognosy Faculty of Pharmacy, the University of Lagos, titled “Advances in Research and Development of Natural Immunity Boosters” said the loss of biodiversity, high intake of Western and processed foods have destroyed the immune system’s capacity to effectively fight diseases.

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The professor of pharmacognosy, however, at the symposium which was held online, said sunlight, which is the best source of vitamin D, and traditional foods such as ginger, garlic, turmeric, lime/lemon, Artemisia annua, and Moringa oleifera among others have been shown to boost the immune system.

Agbedahunsi said factors responsible for the low incidence of COVID-19 in tropical Africa include: adaptive immunity; sunlight; climate and immunity booster.

On immune boosters, he said: “Beside the aforementioned, our immunity is boosted by the food we eat. This includes fruits and vegetables. From the food, we derive vitamins and minerals. Ascorbic acid (Vitamin C) was discovered in 1912 and isolated in 1928 by Albert Szent- Gyorgyi. It is a remedy for the management of scurvy. Ascorbic acid was first derived from citrus fruit. 

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“Three major vitamins are implicated as immune boosters; Vitamins C, D, and B6. There are booster foods also, these include Citrus fruits, red bell peppers, broccoli, garlic, ginger, spinach, Yoghurt, almonds, pineapple, apricot, lemon, walnut, onion, watermelon mango, avocado, carrot, etc., 

“It has been discovered that feeding on certain foods may help keep your immune against some strong viral infections. Building your body immunity will help in the prevention of colds, flu and other infectious diseases such as COVID 19.”

In addition, Agbedahunsi said research has shown that supplementing with certain vitamins, minerals, herbs, and other substances can help improve immune response and potentially protect against illness.

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He added: “It is worthy of note that some supplements or fruits can interact with prescription or over-the-counter medications you’re taking. 

“Some may not be appropriate for people with certain health conditions such as; diabetic patients consumption of ripe Carica papaya (Pawpaw), pineapple, sweet orange or mango are advised to limit the consumption of the above fruits.
 
“Be sure to talk with a healthcare professional before starting any supplements.

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With the 2019 COVID-19 pandemic, it is especially important to understand that besides supplements, diet, including fruits and vegetables. Other lifestyle modifications such as physical distancing, also known as social distancing, and proper hygiene practices can protect you from COVID-19.” 

Agbedahunsi said, currently, research supports for the use of any supplement or fruits and vegetables to protect against COVID-19 are scanty specifically.
 
He said it is imperative for natural products research scientists to intensify research in this area.

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The professor said his research team has predicted from Selected Medicinal Plants Potent Inhibitors of Transmembrane Protease Serine 2 (TMPRSS2) implicated in the entry of Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) into human cells.

SARS-CoV-2 is the virus that causes COVID-19.

He said molecular docking revealed the inhibitory potentials of three medicinal plants against TMPRSS2 implicated in SARS-CoV-2 infection
   
Agbedahunsi said in this study, 132 phytochemical compounds from Zingiber officinalis, Artemisia annua, and Moringa oleifera were screened as a potential inhibitor of TMPRSS2, an important protein for the successful establishment of SARS-CoV-2 infection in a human host.

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He said the result obtained showed that three phytochemical compounds, namely, niazirin, quercetin, and moringyne, exhibited potential as potent inhibitors of TMPRSS2.

He said the drug-likeness and absorption, distribution, metabolism, excretion, and toxicity (ADMET) properties of potential inhibitors of TMPRSS2 were also assessed in silico.

Agbedahunsi said the ADMET analysis revealed the need to exercise caution in the administration of quercetin because it exhibited hepatotoxic and mutagenic effects. 

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“However, niazirin and moringyne had good ADMET properties. The three compounds also have drug-likeness properties and except for quercetin, which may require caution in the application.
 
“These compounds can be studied further to derive drugs that can be used in the treatment and management of SARS-CoV-2 infection.

“It is our desire to determine the properties of chemical compounds present in some of the aforementioned fruits and for their activities as potential inhibitors of TMPRSS2.”

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Also, Prof. Anthony Elujoba of OAU said: “Let thy medicine be thy food and thy food they medicine.” To develop traditional medicine, he proposed the institution of a BSc programme on Herbal Medicine in Nigerian universities.

Chief Executive Officer of IHP, Prof. Maurice Iwu, said: “The enhancement of the immune system is critical for surviving COVID-19. We have clinical trials that are ongoing on some of our immune-boosting products. We are involved in cultivation. We have four farms across Nigeria and 23 products approved by NAFDAC. African traditional medicine is unique from other traditional medicine and should be explored the more.”

Adodo said the problem starts with the issue of nomenclature. What is the difference between traditional medicine, traditional herbal medicine, herbal medicine, natural medicine, complementary and alternative medicine, native medicine, and so many titles? He said these terms are often used loosely, depending on where one is coming from and that many people still have problems with the term ‘traditional’, and even the term ‘African’, depending on their adopted ideologies.

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Adodo said there are four key players in the herbal medicine industry. He said the government, through the ministries, agencies, and parastatals; contributes to research, regulation, organisation, and control of herbal medicine practice, use, and public application. He said these functions are presently not being fulfilled by the government and to perform these functions effectively, political will, transparency, innovative thinking, and proactive action are needed on the part of the government. “Even the various government agencies often have conflicts among themselves and are too preoccupied with endless bureaucracy, hampered by nepotism and corruption, and inefficiency. Individuals who are ready and willing to work in these agencies and ministries are frustrated out of the system. Often, the government regulatory agencies talk down and look down on their clients, which often leads to a lack of cooperation and mutual respect. In this scenario, herbal medicine development suffers,” Adodo said.

The Director of Pax Herbals said the second major players are academia, researchers in universities and institutes. He explained: “There is a lot of research work on herbal medicine development, isolation of active compounds, phytochemical screening of plants, etc. Most often, these studies end up as mere academic papers that are published in journals. Our university archives are filled with many research papers and proposals. Many Nigerian scholars became professors and specialists based on research publications. Unfortunately, this research work has not led to the production of life-saving drugs.”

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Adodo said lack of research funding is one major handicap. “But also there is the problem of the improperly conducted research, diversion of research funds to personal use and lack of transparency. The people in this group are often seen on TV and heard on pages of newspapers granting interviews on all aspects of Traditional African Medicine and pontificating on what herbal medicine is and should not be. They are the ‘experts, the ‘enlightened’, the ‘elite’, ‘the authorities,” he said.

He said the third players are the pharmaceutical industries that manufacture and mass-produce medicines. Adodo said some pharmaceutical companies in Nigeria are licensed to produce drugs, usually, orthodox medicines, mostly under a franchise or contract manufacturing, and herbal supplements are also produced by some companies. “Many of them import the drugs from Asia and simply repackage them for the Nigerian market. The primary goal here is profit,” he said.

Adodo said the fourth major players are the local healers, herbal medicine dealers, and traditional healing homes. He said the local healers are the custodians of the traditional form of medicine, which has its own philosophy, modalities, and worldview. According to him, originally, Traditional African Medicine refers to this category of healers and their practices, which also incorporates science, religion, and culture. He said the local healers are often the first point of contact in the rural communities and they are a very crucial provider of primary health care and have a huge deposit of knowledge that is often neglected, shunned, and looked down upon by people in the previous three groups. Adodo said the local healers have a long history of treating diseases of different kinds.

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He said the challenge is how to form a synergy between these four categories. Adodo said, presently, each group operates on their own, viewing the other groups with suspicion, which makes hinders cooperation.

The chemist said the challenge is to be innovative enough to design a template for working together because the potentials are huge if properly harnessed. He said until this is done; do not expect much from Traditional African medicine, because the house must be put in order.

He said one wrong approach is a tendency to import integration systems and methods from the western world and impose such systems on Africa countries, instead of promoting a system that reflects the unique and dynamic nature of the environment.

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Adodo said the tendency to look towards Abuja for the development of traditional African medicine is another problem. “In my view, Traditional Medicine will grow well if State and Local government invest in it through personnel training and contract manufacturing. The Lagos state government has done more than other states in Nigeria to develop traditional medicine. However, in the past few years, things seem to have slowed down. The danger is always the dichotomy between the categories mentioned above,” he said.

WHO Regional Director for Africa, Dr. Matshidiso Moeti, said the Day is celebrated to promote the important role of the continent’s rich biodiversity of medicinal plants and herbs in improving well-being.

Moeti said for generations, the vast majority of people across the continent have relied on traditional medicine as the main source of their health care needs, as it is trusted, acceptable, affordable, and accessible.

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She said, now as part of the COVID-19 response, promising traditional medicine therapies are emerging. “In Cameroon for example, the Ministry of Health has approved two products as complementary therapies for COVID-19. Madagascar’s herbal remedy, COVID-Organics Plus Curative, is in phase III trials, and encouraging preliminary results have been reported. We look forward to the final results of this trial, and of trials underway for different products in 12 other African countries, including the Democratic Republic of Congo, Nigeria, Uganda and South Africa,” Moeti said.

She said with the support of national and district authorities, traditional health practitioners are also leading the charge in building buy-in for COVID-19 prevention measures and referring patients for timely care. This, she said, is contributing to strengthening and building confidence in health systems throughout Africa.

Moeti said, at the highest levels, the pandemic has improved awareness of the value of traditional medicine. She said investing more in research and development would contribute to harnessing homegrown solutions to improve well-being on the continent, and in other parts of the world.

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Moeti further stated: “Natural remedies are burgeoning in popularity in western countries and have a long history in China, India and other places. Major pharmaceutical companies are also looking to Africa for new active ingredients. With the right partnerships and investments, tried-and-tested African traditional medicines could find a broad global market.

“WHO and other multilateral organisations are playing key roles in supporting capacity development in the traditional medicine sector, including the development of local manufacturing.

“Recently, we looked back on the progress achieved in the Second Decade of African Traditional Medicine from 2011 to 2020 and in the implementation of the Regional Strategy on Enhancing the Role of Traditional Medicine in Health Systems 2013–2023.”

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Moeti said WHO evaluation showed that 40 African countries now have policy frameworks for traditional medicine, up from only eight in the year 2000. She said communities have been mobilised to participate in raising awareness of the value of traditional medicine.

Moeti, who is also a physician, public health specialist, and medical administrator, said capacities of researchers, traditional health practitioners, and national regulatory authorities have been built through training in partnership with WHO, Africa Centre for Disease Control (CDC), and the European and Developing Countries Clinical Trials Partnership. She said efforts are also being made to conserve medicinal plants to ensure quality raw materials are available and abundant.

The physician said, last year, WHO, the African Union Commission, and Africa CDC jointly launched the Regional Expert Advisory Committee on Traditional Medicine for COVID-19 Response. “This Committee is accelerating the pace of research by supporting countries to collaborate on clinical trials of traditional medicines in line with international standards,” Moeti said.

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She, however, said more work is needed to integrate traditional medicine into orthodox health systems and to strengthen partnerships and mobilise resources, particularly for research and development.

“So, on this African Traditional Medicine Day, I call on governments, research institutions, practitioners, and the private sector to strengthen collaboration around traditional medicine research and production.

“Let’s work together to identify and expand access to safe, efficacious, and quality traditional medicines to improve well-being and save lives,” Moeti said.

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Meanwhile, Director-General of NAFDAC, Prof. Mojisola Adeyeye, told journalists, yesterday, that to achieve rapid development of the herbal medicine industry in Nigeria, there is a need for both herbal medicine practitioners and researchers to collaborate.

To this end, she said that NAFDAC set up an herbal medicine product committee in March 2019 before the COVID-19 pandemic broke out, to advance research in herbal medicine.

Adeyeye made the disclosure, in Abuja ahead of ATMD, Tuesday, August 31, 2021.

She said the goal of the herbal medicine product committee was to make sure that the herbalist and the researcher are collaborating so that whatever the herbalist knows from ancestral history that does not have research to back it up, collaboration with the researcher will enable that herbal medicine to be advanced to be listed by NAFDAC if it is deemed safe’.

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“Right now, there is no single herbal medicine that has gone through the full clinical trial the way the clinical trial is supposed to be done. Of course, there could be herbal medicines that have been used to treat a symptom of COVID – 19 or whatever, but it has not been published. In which case it is not an official clinical trial,” she said.

The NAFDAC DG, in a statement by the Agency’s Resident Media Consultant, Sayo Akintola, on Monday, said many of these herbal products are being subjected to review by different agencies of government in the country. “In terms of going through clinical trials and official protocols, none has come through yet. That doesn’t mean they will not because the process is still on. In the review process, there are different organisations involved.”

The pharmacist advised Nigerians to use herbal medicines with caution to prevent avoidable death and complications.

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“The general public should use herbal medicine with care. First of all, we don’t know the quantity that you are supposed to take. And the fact that it is natural doesn’t mean it is not toxic,” she warned.

Adeyeye added: “Toxicity is not about the volume consumed. It is not about the amount. Something can be in a micro quantity and kill. It just depends on the type of drug or chemical. It is extremely important not to take it as you see it. Just because you prepare it in your house doesn’t mean you can drink it like water. It may be dangerous.”

The pharmacist advised that, for safety reasons, no liquid herbal formulation should be ingested after 14 days of preparation, and such medicines should always be kept refrigerated.

Adeyeye further explained that after fourteen days if it is liquid, it might start to develop bacteria that can make people sick.

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“It is the measure, quantity, and then the stability.” According to her, the problems associated with herbal medicine are many because our people do not understand that it is all supposed to be driven by science.

“If you prepare a herbal medicine in liquid form you don’t know how stable the medicine is going to be in water. If it is not stable and it is degrading to another thing, it may hurt.”

Adeyeye cited the example of those who engage in hawking herbal preparations on the streets under the scorching sun. The heat generated by the sun may have a way of causing decomposition of the active ingredients in the medicines being sold, which may pose significant health risks to those buying and consuming these preparations.

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“That is why herbal medicine in Nigeria has to be handled with care. Some people take herbal medicine like vaccines. No. Herbal medicines are derived from plants mostly, sometimes from animals in few cases. Vaccines are different. Vaccines are from human or animal cells that have been programmed to elicit immunologic effects in the body,” she posited.

Adeyeye further advised against the simultaneous use of both herbal and conventional medicines by members of the public. “If someone is using herbal medicine and a conventional medicine simultaneously, there may be a problem,” she said.

The pharmacist added: “Let’s say that medicine is supposed to lower the blood pressure or lower sugar content for diabetes, and that person took conventional medicine and the sugar level is lower and he now takes a herbal remedy, that person may go into hypoglycemic shock. Meaning the level of sugar in the blood is too low because the two are now working synergistically.”

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According to her, sometimes, herbal medicine may actually reduce the effectiveness of conventional medicine.

“That is why studies need to be done. A lot of people use herbal medicine today. But if they now combine it with the conventional medicine that is supposed to be used for the same thing, it may harm them,” she said, adding, ‘’there is drug-herbal medicine interaction that may cause a lot of harm. Whoever is taking herbal medicine should talk to their pharmacist and medical doctor for professional advice.’’

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