On May 4, 2020, the Africa office of the World Health Organization (WHO) issued a statement on COVID-19 deeply at odds with policies in Europe and North America. Of the hundreds of millions of dollars with which governments and foundations are spending on research, virtually nothing is directed toward potential traditional, complementary and integrative contributions. Media coverage of the widespread interest in such approaches, when it occurs, focuses on extremes. The Wall Street Journal led with cow dung, garlic and prayer and Nature with “cow urine, bleach and cocaine” together with the broadly dismissive “pseudoscience” and “bunk”. Scores upon scores of in vitro and other trials showing antiviral activity of herbs are dismissed. In contradistinction, WHO’s statement models calmness and reason. The agency calls for research while warning about over-claims. Should WHO’s integrative, inclusive statement be actively endorsed by natural health and integrative organizations?
The banner under which the WHO’s traditional medicine section operates is “traditional, complementary and integrative medicine”. In the last four years, the section has expanded to embrace “complementary” and “integrative”. Here is the core statement on WHO’s position on natural agents in the treatment of COVID-19:
“WHO is working with research institutions to select traditional medicine products which can be investigated for clinical efficacy and safety for COVID-19 treatment. In addition, the Organization will continue to support countries as they explore the role of traditional health practitioners in prevention, control, and early detection of the virus as well as case referral to health facilities.”
WHO’s “diplomatically framed statement”
WHO is not arguing that everything traditional is useful against the peculiar virus. In fact, WHO’s statement appeared to be timed in part to counter some brash claims with little scientific justification. The president of Madagascar, Andry Rajoelina, is promoting a liquid cure, Covid Organics, developed by the Malagasy Institute of Applied Research (IMRA). The decoction is based on artemisia, a plant widely respected for its medicinal qualities. Covid Organics also includes additional herbs not presently disclosed. Following Rajoelina’s widely publicized pitching of his nation’s product, multiple African nations including Tanzania, Chad, Ghana and Guinea Bissau are importing Covid Organics or have announced intention to do so.
The evidence Rajoelina cites is limited to a loose observation of a few score users. In WHO’s statement, the global agency directly warned against promotion of products that have only observational claims. WHO Africa closes with a warning:
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.
WHO’s statement was a balancing act. A Health Policy Watch thought piece, accompanied by pictures of rows of artemisia annua growing on a West Virginia farm, credited WHO’s “diplomatically framed statement.” The writer noted that:
Several decades ago, the same plant [artemisis annua] was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria.
Split perspectives on the WHO message
In a very short notice on the WHO Africa statement, the New York Times included a note of surprising, if minimalist, balance: “The WHO said it supported scientifically proven traditional medicine, adding that complementary and alternative medicine had many benefits.” Yet the news organization’s disinterest came through in multiple ways. While for instance a Nigerian paper led with a positive headline (“WHO Endorses Scientifically Proven Traditional Medicine”), the New York Times‘ headline writer reached down to near the end of the WHO statement to frame the statement negatively: “WHO Cautions Against Untested COVID-19 Traditional Remedies.” One headline drives people away, the other pulls readers toward.
The fact that the Times’ piece was a cursory notice based on news from Reuters spoke also of the lack of importance the paper gave to the topic. While the Times briefly referenced WHO Africa’s multi-year involvement in supporting research, the Nigerian paper included instructive background. WHO Africa shared WHO’s commitment to building infrastructure for traditional medicine research since the agency began systematically working with nations in Africa and elsewhere two decades ago and most recently reflected in the Traditional Medicine Strategy 2014-2023:
“Over the past two decades, WHO has been working with countries to ensure safe and effective traditional medicine development in Africa by providing financial resources and technical support. WHO has supported clinical trials, leading 14 countries to issue marketing authorisation for 89 traditional medicine products that have met international and national requirements for registration. Of these, 43 have been included in national essential medicines lists.”
In an interview mid-May for France 24, the Madagascar president wondered aloud whether prejudice was playing a role in the response: “What is the problem – is it a problem with Africa? What if this product was from France? Is it that a country that is the 63rd poorest in the world could come up with something?” Prejudice against the potential value of traditional and integrative approaches from Africa may play a role. Yet the minimal level of research behind Covid Organics undercuts the charge.
Benin-based researcher and educator on African traditional medicine Erick Gbodossou, MD, founder of Senegal-based PROMETRA, has been active in researching anti-viral activity of African herbs over the past three decades. He’s established collaborations at Emory University, Morehouse School of Medicine, the Andrew Young Foundation. the Georgia Research Alliance, the US Army Medical Research Institute for Infectious Disease, and elsewhere. These have shown remarkable anti-viral activity in vitro for multiple African herbs against HIV. In an article in New Delhi Times, Gbodossou is quoted supporting Madagascar’s outspoken president. He speaks to the potential role of bias:
“This courage [of Rajoelina] is to be saluted because we Africans must try to make humanity understand that Africa is not just dances and songs, that Africa can bring real, effective, serious solutions to the various health concerns of humanity.”,
WHO as integrative medicine ally
Colleagues in integrative medicine have raised one significant question about the WHO Africa statement: the focus on herbs as drugs rather than on also examining the potential value of the herbs as part of the practice of a whole system of African medicine. In the WHO Traditional Medicine Strategy 2014-2023, the agency intentionally widened its lens. The center of the prior WHO strategy for 2002-2005 strategy focused on herbs as drugs and thus potentia development of pharmaceuticals. The current strategy expanded to include traditional medicines “products, practices and practitioners.” WHO-Africa should similarly widen its lens in its promotion of research relative to COVID-19..
That said, it is fair to say that the integrative health and medicine communities in North American and Europe, and around the world, similarly believe that the integrative body of knowledge also faces challenges in being fairly evaluated, examined, and taken seriously for COVID 19. These communities might echo PROMETRA’s Gbodossou and declare that integrative treatment is not just hobby practices for wealthy white women but that their multiple tools, and their focus on host resilience and the restoration of health, “can bring real, effective, serious solutions to the various health concerns of humanity.”
The position WHO Africa took in the May 4, 2020 statement effectively aligned the agency with the position, for instance, of a University of Arizona Andrew Weil Center for Integrative Medicine team that documented the potential “Integrative contributions for COVID-19” from multiple natural agents and practices as potential allies during the COVID-19 pandemic. The WHO statement is aligned with the integrative use of TCM presently being explored in scores of trials in China. It would support research on the COVID-19 protocol led by Paul Marik, MD at Eastern Virginia Medical School and the recent paper, “Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery” , from Joe Pizzorno, ND and others.
There is much talk of how the pandemic may be a time to re-set. The integrative community likes to imagine that a piece of such a profound shift might be a new era of greater inclusion of integrative practices with the dominant school of health and medicine. Perhaps a good step toward actively promoting this preferred future of more balance, inclusion and influence will be for integrative organizations to reach across borders and directly endorse the action of WHO Africa on traditional medicines relative to COVID-19 – while also prompting WHO to embrace the whole systems of traditional medicine “practices and practitioners.” WHO is, after all, the most powerful, policy-aligned voice for an integrative model anywhere in the world.
Acknowledgement: Thanks to Daniel Gallego-Perez, MD, DrPH (cand.), Nadine Ijaz, PhD and Tabatha Parker, ND, for their useful reviews and inputs prior to publication.