President Muhammadu Buhari on Saturday May 16, 2020, took delivery of samples of Madagascar’s COVID-Organics for use on Nigerian patients with coronavirus after scientific scrutiny by Nigerian Natural Medicine Development Agency (NNMDA), the National Agency for Food Drug Administration and Control (NAFDAC) and Nigerian Institute of Pharmaceutical Research and Development (NIPRD).
Unfortunately, the Minister of Health, Dr. Osagie Ehanire, recently, lamented lack of resources to carry out investigations on the local remedies. He referred to the Madagascar remedy, as so-called, meaning government is yet to subject it to test. Ehanire said the Madagascar herbal remedy is the same as Artemisinin, from Artemisia annua plant, which is used to treat malaria.
Critics say the situation suggests that Nigeria is far from working seriously on homegrown remedies. They ask: How long should it take government to verify the four samples it collected? How much should it cost and what are the implications of delays on properties inherent in samples if they are poorly stored? They insist that Nigeria urgently needs homegrown solutions?
Medical experts have blamed the country’s inability to develop homegrown solutions to COVID-19 on lack of support of Research and Development (R&D), poor funding of research institutes, poor perception of home made goods, lack of political will and poor leadership.
All efforts to reach the Minister of Health, Director General of NAFDAC, Prof. Christianah Mojisola Adeyeye, and the Director General of NIPRD, Dr. Obi Adigwe, were not successful. They refused to pick their calls, reply to text and WhatsApp messages and emails sent to them.
Reacting to the lack of approved homegrown remedies for COVID-19, Director General/Chief Executive Officer of NNMDA, Samuel Oghene Etatuvie, told The Guardian: “My take is that this country has one of the greatest potentials to develop our home remedies for at least the prevention and management of COVID -19 symptoms for identified asymptomatic, mild to moderate patients considering the vast bio-resources, huge traditional medicine knowledge, and experienced researchers the country has. However as a country we have consistently failed to harness these potentials as much as we should have done.
“The reason being our general poor perception of home made goods especially herbal/natural products. Another is our disdain for Research and Development. This partly explains why funding of R&D is generally poor as the Hon. Minister alluded to recently. However, I think with recent Tertiary Education Trust Fund (TETFund) and Central Bank of Nigeria’s (CBN’s) intervention, funding challenge is been addressed gradually.”
The pharmacist said R&D is a serious, costly and time-consuming venture. “However post formulation, standardisation studies take one to three months or more looking at quality, safety and other parameters. For clinical studies six months to three years or more from stages one to four or more to the level of pharmacovigilance. If samples are well development and stored at the appropriate condition it should be able keep safe for one to two years and sometimes three years which is usually best to use or expiration date,” the NNMDA DG said.
Pharmacovigilance is the practice of monitoring the effects of medical drugs after they have been licensed for use, especially in order to identify and evaluate previously unreported adverse reactions.
A consultant clinical pharmacist, public health specialist/health educator and National Chairman, Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN), Dr. Amibor Kingsley, told The Guardian: “… Although it is generally believed that most herbal preparations are safe for consumption, some herbs like most biologically active substances could be toxic with undesirable side effects.
“This is the basis of the insistence of Nigeria’s Federal Government, the World Health Organization (WHO), the NAFDAC that all herbal medicines being proposed for treatment of COVID-19 must be subjected to clinical trials to establish their efficacy and safety in humans, including the much talked about COVID Organics from Madagascar, which is claimed to be effective in curing COVID-19, but has not been validated yet.
“There are phases in clinical trials of new drugs and even drugs for repurposing like the suggested use of Artemisua annua for treatment of COVID-19. Even though artemisinine has proved useful in the treatment of malaria over the years, with generally tolerable safety patterns, it cannot be subjected to similar use in COVID-19 without adequate and satisfactory testing. Granted that the drug may not necessarily be subjected to every phase of clinical trial like is compulsorily the case for new drug molecules, there is still need to carry out tests to establish potential use in COVID-19, to determine possible doses at which the Madagascar tonic can produce desirable clinical outcomes in confirmed COVID-19 patients if any, and potential side effects or adverse effects that may accompany such use. Artemisinine is the major active ingredient in COVID Organic.”
Reacting to the delay in announcing the result of the scientific investigation of Madagascar’s herbal remedy, Amibor said: “So I wish to use this opportunity to appeal to Nigerians to be patient with the Federal Ministry of Health and NAFDAC as regards giving approval for use of herbal medicines in treatment of COVID -19 in Nigeria. For completely new products, which have not been subjected to clinical trials before now, the process of validation could even be longer than that required for COVID Organics for reasons explained above.
It is better for us to exercise patience and get it right the first time, than to rush and then regret the consequences later.
“Drugs are not food, there are some side effects or adverse effects that may manifest with immediate use of drugs including herbal medicines, there are others that will not manifest immediately but will take some time before they start manifesting maybe months or even years as the case may be. Ever since the case of the Thalidomide Tragedy of the early 1960’s, during which the use of a sleeping pill called Thalidomide that was thought to be harmless then, later gave rise to birth defects which manifested long after product was introduced. This is why the Food and Drug Administration of the US, NAFDAC and different regulatory bodies of countries across the world are very mindful about giving rushed approvals for new drugs. Same goes for production of vaccines. Thorough processes are involved which must be rigorously implemented without cutting corners because human lives are involved here, lest you succeed in curing COVID-19 in a patient, but end up afflicting such patient with one form of cancer or the other which is incurable.
“Patience is the watchword, results of clinical trials of artemisinine for treatment of COVID-19 have started to trickle in from Europe, some with signs of promise, but these results are still in the early stage, and time will tell whether COVID Organic or other herbal products submitted to the Federal Ministry of Health for COVID-19 treatment are useful or not.”
Meanwhile, the West African Health Organization (WAHO) is working to promote clinical trials of some of the local plants and medicine that are reputed to support the management of COVID-19 adding that none of the traditional medicine practitioners in the West African region has presented any medicine that cures COVID-19.
Meanwhile, the organisation has advised Nigeria and other countries in the Economic Community of West African States (ECOWAS) region to put into consideration the areas that are hot spots while opening up its borders and implement differential lockdowns and restrictions.
It also urged countries to strike a balance between jeopardizing the academic career of their children with exposing them to COVID-19.
Briefing journalists on the 33rd Anniversary of the organisation in Abuja, Director General of WAHO, Prof Stanley Okolo, observed called on ECOWAS member states to start thinking of a world with Covid-19 as opposed to the world without Covid-19 by leveraging on technology and warned that if they don’t have the infrastructure to reopen schools virtually, they must be confident that they are at a time where they can do it physically before they can reopen schools.
He said, “Countries are balancing how do they not jeopardize the academic career of their children with how do they we not expose them to Covid-19 and that is why this balance has to be struck and in some areas, they have gone back to school not physically, some have reopened virtually but if you do not have the infrastructure to do that, you have to be confident that you are at a time where you can do it physically before you can reopen schools.”
Okolo who stressed the need for Nigeria and the ECOWAS in general to start planning for the longer term, flatten the curve, and be smart and use data to make their decisions in order to strike a balance said, “If we destroy the economy, we don’t even have money to secure the state, buy drugs and people don’t have any money to eat, so we must have a matured balance but we have to use data. We have to weigh the evolution of COVID-19 as we open up the boarders. COVID-19 is likely to be with us for a long time, even China that appeared to have finished their phase and opened up is now facing a resurgence.”
According to him, “As we are opening up the borders, there is nothing that says that you can’t treat hot areas differently from others. Around the world, people are opening up but they say this country is a hot area and we are not going to let in people from that country for now, we are going to review it in two to four weeks and see what happens, we are advising the same thing for the region. Within the region, you can implement differential lockdown.”
He pointed out that though the trend of new infection is going down in some countries, in other countries including Nigeria, the trend is going up. He noted that WAHO has proposed that governments in the region rebuild trust and confidence in citizens using community, religious and leaders.
The WAHO DG encouraged pool testing for Nigeria to detect more infections if the country has the capacity and urged any governor who is denying his people opportunity to be tested to have a rethink and bear in mind that this is a global pandemic.
He said, “WAHO encourages governments to continue to mitigate the impact of the pandemic on vulnerable populations, to safeguard the delivery of essential health services particularly to women, children, the elderly and marginalised populations, and to reward the selfless services of all those in the frontline of fighting this pandemic – the doctors, nurses, contact tracers, laboratory, volunteers, and their families.”
Okolo noted WAHO and ECOWAS agreed that anything that we can manufacture locally in Africa couldn’t be procured from elsewhere adding that the organisation has supported local manufacture of drugs and vaccines.
“Government will not defeat this, it is not a war you fight with bullets and the only people that can defeat COVID-19 are the population by abiding to non-pharmaceutical guidelines. The scale and nature of the pandemic has exposed weaknesses in our health systems that have undermined response efforts, including weaknesses in infrastructure, human resources, diagnostic and therapeutic facilities. The pandemic therefore offers us both an insight into our shortcomings, but also an opportunity to resolve to do better. Both the leaders and the led have had to endure the same facilities and utilise the same health resources with the obvious challenges. We can therefore commit ourselves to break the stranglehold of poor health funding, neglect of human resources for health, and weak health systems through innovative involvement of the private sector, civil society organisations and universal community health insurance schemes. We must rebuild trust with our populations and engage community and religious leaders in strengthening public adherence to the social distancing and personal hygiene measures critical to defeating the current pandemic,” he added.