Mark Tekyi Manu is a 43-year-old plumber in a facility management company in Accra who has been using herbal medicines to protect himself and his family from contracting the Covid-19 virus. Manu attributes his recovery from what he thought was the virus to the different concoctions and infusions of medicinal herbs which he took over a 21 -day period in October last year.
Manu is not alone in using traditional medicinal herbs to keep the virus at bay or at best, to treat symptoms of the disease. The efficacy of some of these herbal remedies is the subject of research at many research institutes on the continent.
Prior to the Covid-19 pandemic, traditional medicine has played a significant role in the healthcare systems of many countries. The importance of traditional medicine and the need to harness its potential to contribute to the health and wellness of communities has been acknowledged by the WHO Traditional Medicine Strategy (2014-2023) which sets out guidelines on how these medicines can be used to complement conventional medicine in the health care systems. The Ghana Health Act recognises the role of traditional and alternative medicine in universal health care.
Some of the herbal-based remedies that many Ghanaians are using to shore up their immune systems as well as for the primary treatment of common ailments include decoctions or infusions of herbal plants such as Neem, the Rosella Hibiscus, Moringa, Pawpaw Leaves and many others. The World Health Organisation estimates that about 70 percent of Ghanaians depend on herbal medicine for the treatment of various ailments.
The use of herbal medicines for the treatment and management of Covid-19 was inspired by the treatment of SARS caused by the outbreak of SARS coronavirus (SARS-CoV) in late 2002. Traditional Chinese medicine has featured prominently in the management of COVID19 in China as has conventional medicines.
In Kenya, the Kenya Medical Research Institute (KEMRI) is testing the efficacy of a herbal treatment — Zedupex—in the alleviation of some of the symptoms of the virus. The herbal medicine was developed by Kenyan researchers in 2015 and has been used for the management of herpes.
Last year, President Andre Rajoelina of Madagascar made headlines when he announced the country had come up with a cure, Covid-Organics, a tea made from Artemisia annua (Sweet wormwood, Annual mugwort) and other medicinal plants. The tonic was widely distributed to the public including school children.
The widespread use of the tea tonic continues despite criticism and warnings from the WHO against the use of such remedies which have not gone through rigorous scientific trials. The Madagascar remedy is among those included in the Solidarity trial, a multinational clinical trial organised by the WHO to find a cure for the virus. The WHO was also concerned that the widespread use of artemisia herbal medicine might hasten drug resistance towards antimalarial drug therapies used to prevent or treat those with Malaria.
During the daily briefing issued on May 20 last year, the Information Minister Kojo Oppong Nkrumah announced on State TV that the country was considering acquiring the ‘herbal cure from Madagascar’: “We are considering it [the herbal cure]. We have reached out to them [Madagascar]. We have asked that it [should] be made available to us and like all drugs, it will be tested by FDA and in this case by the Center for Plant Medicine and if proven efficacious, we can recommend its use,” he said at the time. By last month, the ministry had yet to send a formal request for the Madagascar remedy for testing by the Ghana FDA.
A platform for testing herbs
Recognising that the majority of the people were dependent on traditional herbal medicines to deal with many ailments, the Ghana Ministry of Health developed guidelines for the use of herbal medicines in the treatment of Covid-19.
The standards include basic pharmacological procedures for the assessment of herbal products.
These standards are among those endorsed last September by the WHO, the Africa Center for Disease Control and Prevention and the African Union Commission for Social Affairs for clinical trials of herbal medicine for the treatment of the novel coronavirus.
These organisations also established the Regional Expert Committee on Traditional Medicine for Covid-19 in July 2020 to help fast track and support research, data and safety monitoring boards for herbal medicine clinical trials. During the launch, Dr Prosper Tumusiime, Director of Universal Health Coverage and Life Course Cluster at WHO Regional Office for Africa said if a traditional medicine product was found to be safe, efficacious and quality-assured, the WHO would recommend it for a fast-tracked, large-scale local manufacturing. But months since this initiative was established, none of the proposed remedies has progressed beyond phase 11 clinical trials.
In Ghana, the Noguchi Memorial Institute for Medical Research based at the University of Ghana has been the foremost institution in the research of various herbal medicines since Ghana reported its first Covid-19 case on March 12, 2020. The Director of the Institute, Professor Abraham Anang said Ghana is currently working on developing herbal remedies for Covid-19.
"We haven’t gone far into developing new vaccines to be introduced into people. We are now looking more at the information and trying to look at how to design such a vaccine," he said.
He said the institute has been receiving local herbal medicines from the public who wanted them tested to determine their efficacy in the treatment of the virus and other diseases There is a lot of hope because we have received a number of local medicines that are being screened for possible treatment of Covid-19 symptoms,” he says.
The Centre for Plant Medicine Research (CPMR) has also been involved in researching herbal medicines for the treatment of the virus and boosting the immune system. The Center’s Acting Executive Director, Dr Kofi Bobi Barimah, said the centre was charged by Ghana's President, Nana Addo Danquah Akufo-Addo to find possible solutions for the management of the virus and its symptoms.
The Center which was established in 1976, has produced a number of herbal medicines, such as Mist Tonica, a herbal haematinic (iron supplement) effective for the treatment of Anaemia and Lippia tea, a stress relief tea. It also runs an out-patient clinic.
Apart from its own researchers, the centre receives herbal products from the public.
Following the outbreak of Covid-19, the centre has been inundated by people from all walks of life who present herbal products which they want to be tested as they believe they are a ‘cure’ for the disease. Some of the products are brought by known herbal medicine practitioners while others are submitted by individuals who claim they received divine direction from God or from their ancestors who appear to them through dreams and visions.
Ten samples of the herbal product are currently undergoing testing at the centre’s Drugs Analysis Unit. The product is also tested on animals such as rats to ensure it is safe for human consumption and also checked to see if it has any antiviral properties.
At the centre, all products submitted, go through detailed and thorough laboratory analysis to ensure that the products meet the highest quality and safety standards and that they are wholesome for human consumption.
"Research takes time and we want to make sure that the products that come out are good. We want to gain the highest recognition for our work," said Dr Barimah.
However, he added that before any herbal products can be sold, the manufacturer needs to get approval from the Food And Drugs Authority (FDA).
Nine drugs for immune-boosting
As of November 2020, the Centre was analysing 100 herbal products from various applicants. Out of the number, 33 were from the Ghana Federation of Traditional Medicine Practitioners Associations (GHAFTRAM) and had been submitted to the Centre through the Ministry of Health. GHAFTRAM is the umbrella body of all traditional medicine practitioners, associations and practice groups in Ghana.
After analysing the 33 products, the Public Relations Officer of the Centre, Mr Baffuor Osei Akoto, said the Centre had recommended nine of the herbal medicines as immune boosters and supportive treatment for some symptoms of Covid-19. The other 24 products did not pass the test.
The nine products are COA FS, Herbetine Herbal Powder, Herbetine Herbal Mixture, Viva Plus Powder, Ayisaa Opinto Herbal Tea, CD Capsules, Amen Depomix Powder, Amen Fevermix Capsules and Amen Chestico Capsules.
According to an evaluation report on the products, the recommendation was based on four major factors — the biological activities of the medicinal plants used in the formulation, the status of the product as Food and Drugs Authority (FDA)-registered dietary supplement to support the immune system to fight a variety of diseases, the traditional uses of the plant constituents and some chronic toxicity studies and anecdotal clinical data available on the product.
The assessors also looked at the various medicinal plants used in the preparation of the products, reviewed information available and the microbial load analyses on relevant products.
The FDA has registered COA FS as a dietary supplement to support the immune system to fight a variety of diseases, and that chronic toxicity studies showed the drug did not have a deleterious effect in rats on prolonged administration.
“Studies show COA FS has antiviral activity against HIV. Anecdotal clinical data collected showed COA FS significantly reduced viral loads in HIV and Hepatitis B patients,” said a report from the centre.
The FDA has also registered the Herbetine Herbal Powder, Herbetine Herbal Mixture, Viva Plus Powder, Ayisaa Opinto Herbal Tea, CD Capsules and Amen Depomix Powder, as immune boosters.
The Amen Fevermix Capsules and the Amen Chestico capsules have been registered as having properties for the treatment of Malarial fever and general bodily pains. Both herbal medicines were also found not to have a deleterious effect in humans after prolonged administration on rats.
Mr Baffuor Osei Akoto said the products were recommended for use as supportive treatment of symptoms of Covid-19 based on the initial test including microbial load analysis, acute toxicity test and phytochemical analysis of the products.
So far, he said, none of the remedies has been proven to be efficacious against Covid-19.
“The nine herbal products recommended are not for curing Covid-19 but have properties that can support the immune system to fight against the virus,” he says.
During a visit to the GHAFTRAM head office at Weija, in Accra, the General Secretary, Nana Kwadwo Obiri showed a letter signed by the Director of the Centre for Scientific Research into Plant Medicine, Dr Kofi Bobi Barimah, that was addressed to the Minister of Health, Mr Kwaku Agyeman which confirmed that nine herbal products out of 33 submitted by the federation had passed the centre's evaluation tests.
"The scientific analysis by the Centre shows that the products we submitted support the immune system to fight a variety of diseases. The chronic toxicity studies showed that the products did not have harmful effects on the laboratory animals such as the rats they used for the tests", he said.
He says GHAFTRAM represents about 25, 000 herbal medicine practitioners who have specialities in managing and treating various acute and chronic disease conditions.
Most often, the skills of members of GHAFTRAM, Mr Obiri explains, are inherited and also gained from continuous training and education.
"A lot of impediments have been put in the way of Traditional Medicine Practitioners making it difficult for us to find a solution to Covid-19. We can do it, all we need is the support," he claims.
Even though he wouldn't give details about the impediments, he said in order to overcome the challenges, GHAFTRAM has put together a team for scientific exploration of using traditional medicine for the management and treatment of Covid-19 and the development of home remedies with herbs to boost the body immune system against COVID- 19.
The Federation is also advocating the setting up of a traditional medicine development fund to support and encourage research to discover treatments for grey areas in medicine.
In one of the rooms at GHAFTRAM head office, Mr Obiri shows 200 products neatly packed in boxes and bags waiting to be submitted to the Centre for Scientific Research into Plant Medicine or the Noguchi Memorial Institute for Medical Research of the University of Ghana.
"These medicines have been developed by our members across the country for scientific testing. We can get a solution for the treatment or management of Covid-19 if we get the needed support." In the meantime, he said, the Federation was working on getting the FDA to give approval for the nine products that have been recommended by CSRPM to be put on the market.
"A delegation of our members have met the FDA but the authority says it is waiting for the Ministry to come out with a basic pharmacological approved protocol before it can give us the green light," he said.
A herbal medicine producer, Mr Peter K Hegan who is the national Organizer of GHAFTRAM said the Federation welcomes innovations by its members who are developing new therapies in the search for potential treatments for Covid-19.
He said it was time for the government and the public to accept the fact that traditional, complementary and alternative medicines have many benefits.
Researchers at the School of Public Health at the Kwame Nkrumah University of Science and Technology have received approval to commence clinical trials of a potential herbal treatment for Covid-19.
The approval which was granted by Ghana's Food and Drugs Authority (FDA) and the National Medicine Regulatory Agency (NMRA) is for the herb Cryptolepis Sanguinolenta, a scrambling thing-stemmed shrub that has been used in the treatment of malaria, diarrhoea and respiratory conditions. The herb, known locally as Nibima, Kadze and Gangamau is from the Apocynaceae or dogbane family of flowering plants that includes trees, shrubs, herbs, stem succulents, and vines.
The FDA approval follows "results from laboratory studies conducted by the KNUST research team which points in the direction of possible clinical benefits".
"In the search for a treatment for the ongoing Covid-19 pandemic researchers from the School of Public Health at the Kwame Nkrumah University of Science and Technology (KNUST), submitted a clinical trial application in September 2020 to assess the safety and efficacy of Cryptolepis Sanguinolenta as a potential treatment for Covid-19. This follows results from laboratory studies conducted by the KNUST research team which points in the direction of possible clinical benefits".
However, as promising as these remedies are, Ghanaians will have to wait as the government has yet to allocate the necessary resources to conduct clinical trials. Ghanaians will be looking to these efforts to tide them over as they wait for enough vaccines to be available to the country’s 30.95522 million citizens even as the country received the first delivery from COVAX of 600,000 of the AstraZeneca vaccine doses on the 24th of February 2021.
This report was supported by the Africa Women Journalism Project (AWJP) in partnership with the International Center for Journalists (ICFJ).