COVID-19: Reawakening old debate between trado and Orthodox medicine

In recent times, several natural cures have shown promise in the prevention, treatment and management of not just the novel Coronavirus disease (COVID-19), but other arguably, more deadly viral infections like Ebola and smallpox.

But despite these breakthroughs, the World Health Organisation (WHO), the Nigeria Centre for Disease Control (NCDC), the Federal Ministry of Health (FMoH), the National Agency for Food and Drug Administration and Control (NAFDAC), and other relevant agencies are still paying lip service towards the development and integration of traditional medicine practices, especially herbal medicine into the conventional health system.

Also, despite several studies that have demonstrated how Nigeria can make up to N240b ($1b) a month from the herbal medicine industry, if the government provides the enabling environment, the government’s inaction by not providing adequate funding has left plans to develop traditional medicine practices, especially herbal medicine in the cold.

Several attempts in the past by NAFDAC and the Nigeria Institute of Pharmaceutical Research and Development (NIPRD) to verify herbal cure claims, after clinical trials were aborted due to lack of funds and the absence of political will.

The promise by the past administration to introduce herbal medicine into the curricula of medical schools has also not been matched with any circular to that effect.

The Guardian gathered that despite the establishment of relevant agencies, such as the Nigerian Natural Medicine Development Agency (NNMDA) Lagos, the NIPRD Abuja, Nigerian Medicinal Plants Development Company (NMPDC) Abuja, and some colleges of alternative and complementary medicine, the country has not made much progress in this area as most of these agencies do not receive enough funding to go into research and development of expected products. Funds received by the agencies are also said to be just enough to pay salaries.

In fact, the production of a herbal drug for sickle cell anaemia- NICOSAN, developed by NIPRD, which was celebrated even by the United States Food and Drug Administration (FDA), was shut down due to poor funding and poor political will.

Indeed, despite the huge potential of traditional medicine, its capacity to generate income, boost primary healthcare (PHC) services, and ensure Universal Health Coverage (UHC), governments at all levels have continued to neglect the practice.

Little attempts made by the Federal Government to advance the practice, such as the development of the Traditional Medicine Policy for Nigeria 2007; the establishment of the NNMDA, and NIPRD have not been given adequate political will and funding.

To address this anomaly, a bill for an act to provide for the establishment of the Complementary and Alternative Medicine Commission passed third reading in the Seventh House of Representatives.Also, a bill for an act to provide for the establishment of the Traditional Medicine Council of Nigeria passed third reading in the last National Assembly.

And as part of efforts to improve traditional medicine practice in the country, the Federal Government in 2006, formed the National Association of Natural and Traditional Medicine Practitioners (NANTMP).

The President Olusegun Obasanjo-led Federal Government, through the then Minister of Health, Prof. Eyitayo Lambo, established the NANTMP on December 19, 2006.

Also, a Scientific Committee on Verification of Herbal Cure Claims set up by NAFDAC in 2013, identified 15 potential herbal drugs, but there were no funds to continue with the development.

Earlier in 2012, NAFDAC blazed the trail in traditional medicine development with the constitution of the Expert Committee on Verification of Cure claims by herbal products. The committee was set up to develop guidelines on clinical trials of herbal medicinal products to be able to upgrade them to full registration status.

In 2013, the country began an investigation into alleged herbal cures for the Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), cancer, malaria, asthma, diabetes and contraceptives, with the first meeting of the Scientific Committee on Verification of Herbal Cure Claims with stakeholders taking place in Lagos.

Unfortunately, due to paucity of funds, the Committee was abandoned. All these notwithstanding, experts believe that the country could develop herbal cures for COVID-19, HIV, cancer, malaria, asthma, diabetes and contraceptives with effective collaboration among the stakeholders.

They argue that if Nigeria can develop NICOSAN, which is accepted worldwide, the country can do it again by finding herbal cures for COVID-19, and other ailments and diseases.

Interestingly, the noise over the Madagascar’s COVID-Organic, which President Muhammadu Buhari, penultimate week received samples of has, yet again, reignited the country’s interest in herbal medicine, even as almost all health workers in the country including, the Pharmaceutical Society of Nigeria (PSN), National Association of Resident Doctors (NARD), the Nigerian Medical Association (NMA), National Association of Hospitals and Administrative Pharmacists of Nigeria (AHAPN), Joint Health Sector Union of Nigeria (JOHESU) among others condemned the government’s position.

They criticised the neglect of cure claims by erudite scientists in the country for a product from a foreign and less endowed country. In recent times several Nigerian scientists of repute, institutes and universities have put forward homegrown solutions and cures for COVID-19. Top on the list are Prof. Maurice Iwu, a pharmacognocist and President, Bioresources Development Group (BDG); Prof. Jeremiah Abalaka; Prof. Olukemi Odukoya, a pharmacognocist from the University of Lagos, a team of researchers from the University of Ibadan, as well as Dr. Paul Ojeih, of Iris Medical Foundation; among others.

Internationally, the World Health Organisation (WHO) recently broke its silence on the array of scientifically based herbal cure claims for COVID-19. The United Nations’ body said that medicinal plants such as Artemisia annua were being considered as possible treatments for COVID-19 and should be tested for efficacy and adverse side effects.

“Africans deserve to use medicines tested to the same standards as people in the rest of the world. Even if therapies are derived from traditional practice and natural resources, establishing their efficacy and safety through rigorous clinical trials is critical,” it noted.

The WHO also added in a statement: “As efforts are underway to find treatment for COVID-19, caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing, which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.”

The WHO said it welcomes innovations around the world including repurposing drugs, traditional medicines and developing new therapies in the search for potential treatments for the novel coronavirus, adding that it recognises that traditional, complementary and alternative medicine have many benefits and Africa has a long history of traditional medicine and practitioners that play an important role in providing care to populations.

Interestingly, three drugs from plant sources have shown promise in treating viral infections, including the COVID-19 and HIV. In recent decades, drugs used to treat malaria have been beneficial for many other diseases, including viral infections. In particular, they have received special attention due to the lack of effective antiviral drugs against new emerging viruses (that is, HIV, Dengue virus, Chikungunya virus, Ebola virus, Coronavirus) or against classic infections due to drug-resistant viral strains (that is, human cytomegalovirus).

This, perhaps, explains why the National Chairman, of AHAPN, Dr. Kingsley Chiedu Amibor, said that Nigeria must encourage research into herbal medicines, which hold a lot of promise for the treatment of COVID-19 and other disease conditions.

According to him, “As you may know, herbal medicines are generally believed to be safe and of low toxicity. But research has to be carried out on them to determine their efficacy and confirm their safety status. A plant such as Artemisia annua, which grows here in Nigeria, is gradually becoming a candidate for treating COVID-19. It should be grown in commercial quantity once it is confirmed to be effective,” he said.

The pharmacist said a petrochemical industry would need to be established in the country that would be a source of some of the much-needed active pharmaceutical ingredients that would reduce Nigeria’s dependence on imported finished products, as well as Active Pharmaceutical Ingredients (APIs).

Amibor said the COVID-19 pandemic is a wakeup call to policy makers in the country to begin to pay close attention to the healthcare sector in the country, stressing that the country’s healthcare sector cannot afford to remain the same post-COVID-19.

“COVID-19 pandemic made it impossible for citizens to rely on foreign health services, and medical tourism has decreased drastically with the ban on foreign flights in and outside the country as part of control measures to check the spread. So, there is need to bring medical tourism to a permanent end in Nigeria post-COVID-19,” he said.

President of PSN, Mazi Sam Ohuabunwa, equally told The Guardian that: “Nigeria has some of the best scientists (pharmaceutical, medical, biochemical, biological etc.,) in the world who have done so much work on natural and herbal medicines. Nigeria has developed a pharmacopeia of natural and herbal products, and has one of the richest flora and fauna – potent sources of phytomedicines. Since the outbreak of the COVID-19, a number of them have raised their voices that they have herbal and natural products that can be used to treat or manage COVID-19. Some have patents. Many herbal companies and producers have announced specifically that they have herbal formulations that can do what this ‘invention’ from Madagascar can do.

“We have raised our voices severally that the Federal Government should review these claims and help put them through clinical evaluation as most of these producers cannot afford to conduct clinical trials. We have recommended that a portion of the nearly N25b donated for the COVID-19 pandemic should be dedicated for local research and development. But our government has remained essentially silent only waiting to participate in WHO-sponsored or mandated trials. We have been told that Nigeria is participating in the WHO solidarity trial, but nothing on trying our own inventions and formulations.

“Now we want to import COVID Organics from Madagascar to try. Why are we like this? If the world can supply us synthetic and chemically-sophisticated medicines, which we apparently lack the technology to produce, why must we wait for the world to supply us herbal formulations, which we can easily make and which we have similar products.

“We urge our government to save Nigerian pharmaceutical scientists and other scientists from the shame of having our country import and try herbal remedies, which God has given us in abundance, and some of which our
grandfathers and grandmothers have used for ages. Let us try our local formulations before we try COVID Organics, or any other imported remedy. Every well-meaning nation has been in a race to find cure, remedies and other medical supplies used for COVID-19, while we seem to wait for other nations to solve our problems.

“There is much talk but little action. This dependency mentality needs to change and now is the time. We must seize this opportunity to look inwards, build confidence in our abilities, competences and re-orientate our national economic philosophy from import dependency to export driven. And Nigeria can beat India and China in the production and export of herbal products if anyone is willing to lead us down this part.”

On his part, the Director General of NIPRD, Dr. Obi Adigwe, who is of the view that the country has a huge potential readily available to be harnessed in traditional medicine, added that in recent years, significant efforts have been made by the Federal Ministry of Health to actualise its full development.
He said the publication of the National Traditional Medicine Policy in 2007, and the creation of the Traditional, Complementary and Alternative Medicine (TCAM) Department in 2018, among others show how consistent the Federal Government has been strategically laying a solid foundation to strengthen traditional medical practice in the country.

The Director, Pax Herbals, Ewu, Edo State, Rev. Fr. Anselm Gbenga Adodo, said practitioners who have been blaming the government for the neglect of traditional medicine for the past 11 years should do something more innovative.

“What if practitioners of herbal medicine in Nigeria were to form a formidable pressure group to ensure that government gives the required support and attention to the development of herbal medicine?” he asked.

To do this, Adodo said, great leadership, selflessness and interest in the common good would be required on the part of the practitioners. “But are they up for that?” he asked.

Adodo said this is where he expects government agencies like the NNMDA, Lagos and NIPRD to play leadership roles. NIPRD specifically, the cleric said needs to expand its understanding of research to embrace tapping into the human resources in traditional healing and helping to organise them and same applies to the NAFDAC.

For Professor of Botany and Vice Chancellor, University of Lagos, Akoka, Toyin Ogundipe, the situation that traditional medicine is contending with is due to ineffective campaign for it to be given appropriate recognition. So, improved and explosive sensitisation is needed. He also said that traditional medicine education should be injected into early education curriculum in the country, even as he stressed that talks about integrating traditional medicine into mainstream healthcare remains a welcome initiative.

“Plans to integrate traditional medicine into mainstream healthcare delivery in Nigeria is real, but as clearly enumerated in the National Traditional Medicine Policy (NTMP), there are specific steps and processes, which have to be followed to ensure sustainable integration.”

Insisting that the idea is very good and progressive, he noted that it cannot be rushed just for the sake of playing to the gallery. “So far there are joint plans by the NIPRD and TCAM Department of the FMoH to train and upscale the Traditional Medicine Practitioners (TMPs), with particular emphasis on the herbalists amongst them to improve their good manufacturing practices, as well as undertake other relevant practices that will lead to better engagement with relevant products. For instance, listing with the regulatory agencies.”

He said these are strategies that NIPRD believes will improve the quality and acceptability of the herbal products in the long run. Ogundipe, who is also an advocate of natural medicine, described integrating traditional medicine into mainstream healthcare as an absolutely excellent and laudable idea as done elsewhere, especially in Asia, and the end products traverse the region to the rest of the world, including the so-called developed nations.

The academic said that it is important that the country takes similar steps because the greater parts of the population are in the rural areas, where there is huge abundance of biodiversity, and this is being used for healing.

While Adodo stressed the need for government to recognise and support herbal medicine as a complementary healthcare system, which can exist side-by-side with the orthodox allopathic healthcare system, so that one will learn from the other and complement each other, he also maintained that he is for “collaboration rather than integration.”

Adigwe on his part said identified promising products that have passed the compliance to safety and potency tests could ultimately be integrated into the mainstream healthcare systems.

He explained that Niprisan, a drug produced by NIPRD, “has now been successfully commercialised for mass production through a licensing agreement between NIPRD and May & Baker Plc, and the product should be in the market shortly, and there are about seven other fully developed phytomedicines by the institute all awaiting uptake for commercialisation such as the Niprimal (anti-malarial), Niprimune (Immune booster) and other products.

Adigwe described the herbal medicine space as one, which NIPRD “has always understood its potential and in Nigeria, the evidence suggests that around 8, 000 indigenous plants have ethno-pharmaceutical and ethno-medicinal properties. Therefore, in line with its statutory mandate, NIPRD has over the last two decades successfully developed phytomedicinal products and process technologies.”

While seven products have been fully developed, with over 20 at different stages of development, Adigwe said the institute has also developed a number of contextual processing protocols for extracting aromatic and essential oils and other active principles of interest from indigenous plants and other natural resources.

All these, he said, were achieved with very little funding. The true potential of NIPRD has not been tapped essentially due to gross under funding.

“Funding has been the greatest challenge to the development of traditional medicine in the country. With improved funding and government’s prioritisation of the sector, it would be easy to actualise Nigeria’s emergence as Africa’s pharma hub, and NIPRD would naturally become the nucleus to drive the industry’s revitalisation.

“NIPRD has now leveraged this administration’s new momentum to develop new synergies with the National Agency for Food and Drug Administration and Control) and the TCAM Department, as well as with the practitioners and general public. This, he said, is the foundation for future of traditional medicine in Nigeria, and with the right support from all stakeholders, Nigeria can finally begin to reap the health and socioeconomic benefits of the sector’s under-utilised potential.