By Okot Nyormoi, a retired cancer biologist and editor

African Traditional MedicinesLast November, I published an article titled, “The impact of COVID-19 on science in Africa” in which I shared some positive impacts of the virus at a time that Africa had not yet experienced the full effect of the pandemic. It is now nine months later and so it is pertinent to check on the progress or lack thereof.

 Whereas some of the worst predictions of the pandemic in Africa have so far not materialized, what is happening is bad enough and the worst could still happen. Presently, African countries are far behind the curve in the race against preventing the spread of the virus. As of July 10, the world vaccination rates are as follow: North America (76%), Europe (74%), South America (48%), Asia (46%), Oceania (25%) and Africa (4%). The data do show a serious healthcare inadequacy in Africa, yet again. So how has Africa responded to its healthcare challenges posed by the pandemic?

The usual response is, of course, to appeal to developed countries for help. Different forms of assistance including testing kits, personal protection equipment, treatment drugs and now vaccines from the international consortium (COVAX). Though helpful in the immediate term, such assistance is like putting a band aid on a festering wound. It is always inadequate, and in many cases slow in coming since the donors understandably give priority to their own needs.

Once it became clear that there was no effective treatment or cure for COVID-19, and not enough vaccines to go round, the call to return to indigenous medicine grew louder and louder throughout Africa. Legitimate as well as quack traditional medical practitioners came out of the woodworks to stake their claims on the legitimacy of herbal medicines for treating and curing COVID-19. Of course, such calls met with skepticism on multiple grounds, including lack of science-based clinical trial evidence, lack of prior treatment of coronavirus, lack of standard formulation and dosing, safe packaging, storage, and distribution.

When the public was advised not to take herbal medicines indiscriminately because some of the herbal components could be toxic, carcinogenic, mutagenic, and teratogenic, some of the indigenous medical practitioners responded by claiming that since their medicine had been used for centuries, there is no need to subject them to clinical trials. They argued that their unpurified natural mixtures were also more effective, allegedly, because some parts may prevent side effects, facilitate bio-availability (absorption), or are synergistic. Some practitioners resorted to accusing big pharmaceutical companies of racism or unfair competition between them and the giant pharmaceutical companies.

Additionally, they argued that indigenous remedies are the simplest and the most accessible cure and preventive medicine. To their point, according to the World Health Organization (WHO), nearly 80% of the people in the developing countries rely on indigenous medicine for managing a wide range of ailments.  However, the caveat is that most poor people have no choice but to use whatever is available to them.

Other concerns of the herbalists are that they do not want to submit their herbs for advanced scientific studies for fear of losing ownership. They also resent modern doctors for looking down upon them and are afraid that their critics want to vanquish them. Truth be told, doctors trained in western medicine often view herbalists as ignorant and uneducated. While there may be some truth to such concerns, it is also true that some of the concerns are unfounded because many of the medicinal plants are well known to ethnobotanists. Scientists also know that many orthodox drugs are derived from medicinal plants and many of them have and continue to study medicinal plants.

Furthermore, traditional medical practitioners claim that their practice is better because they treat both body and soul whereas modern medical doctors focus only on treating just the body. Of course, the spiritual aspect of treatment relies on faith, which is “the substance of things hoped for, the evidence of things not seen”. Therefore, it cannot be compared to science-based evidence which must be observable, measurable, and reproducible under similar conditions.  

Despite the apparent intractable contradictions between indigenous and orthodox medical practices, attempts have been made to unite the two systems under the rubric of alternative and complementary medicine. The hybrid medical system is said to be used successfully in China, India, and Cuba, and has been endorsed by the WHO, but its implementation is still lagging far behind in many African countries.

To dispel mistrust between the two groups, it is important to understand and appreciate that everything is a process. Modern medicine did not just suddenly happen. It evolved from the basic to the more advanced levels in all human societies. The speed at which it evolves varies depending on multiple factors including geographical locations, availability of resources, intergroup interactions, luck, etc. Before modern medicine was developed, all human societies had to use whatever they could to manage illnesses. Gradually, some societies gained more knowledge about diseases as well as the medicine they used. From this perspective, it is not appropriate to view traditional and modern medical practices as mutually exclusive entities. Rather, they should be seen as part of the same process but are at different stages of evolution.

 In his article in this issue of Nile Journal, Johnathan Powers predicts that in the year 2250, the poverty and underdevelopment of Africa will be a thing of the past. The question is whether today’s Africa is on a trajectory which will make the present situation a thing of the past. What will trigger such a monumental transformation?

Some people think that COVID-19 is such a trigger, but Africa was already on the march. Way back in 2009, the African Union (AU) adopted a comprehensive vision for the future, named Agenda 2063, a blueprint for transforming Africa into a continent free of poverty, diseases, and wars. The implementation of the agenda is underpinned by development of science, technology, and innovation on the continent. Of course, 2063 is just a stage in a long process which will most likely extend up to 2250 or beyond.

Among other things, to implement Agenda 2063, the AU established Africa Centers for Disease Control and Prevention (Africa CDC) in 2006 to enhance the continent’s capacity (health infrastructure, human resources, disease surveillance, laboratory diagnostics and preparedness) for rapid response to health emergencies and disasters. Africa CDC has four regional centers located at Libreville (Gabon), Nairobi (Kenya), Cairo (Egypt), Lusaka (Zambia) and Abuja (Nigeria).

Apart from the continental action, individual countries have programs to meet their own specific goals. For example, Uganda and Ethiopia (see the article by Mekdelawit)  are building hydropower dams to meet their power needs. Many countries are developing their medical research institutions. Examples include the Kenya Medical Research Institute (KEMRI), the Ghanaian Center for Plant Medicine Research (CPMR), the Ugandan Natural Chemotherapeutics Research Institute (NCRI), the Nigerian Africa Center for Excellence for Drug Research, Herbal Medicine Development and Regulatory Science (ACEDHARS), the South African Herbal Science and Medicine Institute (SAHSMI), and many others.

African Traditional COVID-19 MedicinesIt is said that necessity is the mother of invention. Africa’s medical deficiencies during this pandemic have forced Africans to turn their energy to modernizing their indigenous medicines for managing COVID-19 and other illnesses. To that effect, various African countries have approved herbal drugs for clinical trials. Early this year, the Nigerian National Agency for Food Drug Administration and Control (NAFDAC) has line up 14 herbal drugs for clinical trials, Ghana approved 33 herbal medicines for investigation, South Africa, Zimbabwe, etc. are doing similar studies. In the meantime, innovators in some of the countries have unveiled several COVID-19 treatment products: Covid Organics from Madagascar, COVIDEX from Mbarara University and COVLYCES from Gulu University, both are in Uganda. Though the herbal drugs have not yet gone through rigorous scientific studies, they represent a good start. In any case, what matters most is whether they work or not. Then the next step is to acquire the necessary science-based evidence to convince people that they are of good quality, are safe, and efficacious. Hopefully, these baby steps will turn into giant leaps towards strengthening the fragile medical services in Africa.