WHO Forum on Traditional Medicine
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Dear Colleagues,
Someone wrote to AFRO-NETS asking about traditional African medicines
and AIDS (as in, Do any work?). If it is not too long to post, here
is a short article about a recent WHO forum held in Zimbabwe, that
illustrates progress in African traditional medicine and in the wis-
dom of the WHO for recognizing its value.
"The WHO Forum on Traditional Medicine in Health Systems, Zimbabwe,
Harare, February 14-18, 2000"
Journal of Alternative and Complementary Medicine; 2000, Vol. 6(5)
Oct. 2000, pp.379-382.
Edward C. Green, Ph.D.
Preparation for the WHO African Forum
Most readers of this journal know that the World Health Assembly of
the World Health Organization passed a resolution in 1977 promoting
the development of training and research related to traditional medi-
cine. The following year in Alma Ata, WHO and UNICEF issued addi-
tional resolutions supporting the use of indigenous health practitio-
ners in government-sponsored health programs.
In preparation for the African Forum on the Role of Traditional Medi-
cine in Health Systems (Harare, February 16-18, 2000), WHO's Regional
Office for Africa had earlier (1998) submitted a questionnaire to its
46 member states. A completed questionnaire was received from 30 of
the countries. Although 35 percent of countries did not respond and
it was not possible to verify validity of answers submitted, the
findings nevertheless shed light on the Africa-wide situation regard-
ing traditional medicine and practitioners.
Findings suggest that a national management or coordination body for
Traditional Medicine activities exists in 17 of the 30 countries
(57%). Twenty-two countries (73%) indicated that associations of tra-
ditional medicine practitioners (TMPs) have been established. Ten
countries (33%) indicated that a directory of TMPs exists. Four coun-
tries (13%) indicated that a training program for TMPs exists, and 17
countries had such programs for traditional birth attendants (TBAs)
(WHO 1999).
There were many other findings from this survey that will probably be
published in more detail by the WHO. The survey findings were sent to
the delegates invited to the Forum prior to the meeting, to set the
stage for assessments of how far traditional medicine has come since
1977, and for discussions about where to go from here. Much organiza-
tional work was done before and during the Forum by Dr. O.M.J.
Kasilo, Acting Regional Advisor for Africa, WHO Traditional Medicine
Programme. She also provided a great deal of leadership during the
conference.
The WHO African Forum Itself
Delegates invited to the Forum represented most of the countries of
Africa. A majority were connected with ministries of health or other
government agencies, or with university departments of pharmacology
or chemistry. A number of traditional healers were also present,
mostly representing national traditional healers' associations.
In an opening plenary speech, Dr. Ebrahim Samba, Regional Director,
Regional WHO for Africa, told the delegates that there is keen inter-
est on the part of WHO in the mass production of phytomedicines for
the treatment of malaria, AIDS, and other diseases identified as pri-
ority diseases by member states. It is a strategic objective of the
WHO to develop a framework for the integration of traditional medi-
cine into national health systems. The idea is to encourage local in-
dustry to invest in the local production of indigenous medicines, and
make them commercially viable. Governments should create policies re-
lated to conservation, safety and toxicity, and phytomedicine regula-
tion in order to assist local production industry. If outside funding
is necessary, both the African Development Bank (ADB) and the WHO are
possible sources. The ADB now invests more money in Africa than the
World Bank, and it too has become very interested in traditional
medicine.
There has been relatively little mass-production, promotion and dis-
tribution of phytomedicines in Africa. However, countries such as Ni-
geria and Mali seem quite advanced in this regard. For example, Nige-
ria has developed phytomedicines for ulcers, anemia, contraception,
malaria and HIV, and it now holds patents for some of these medicines
in several countries. Nigeria is about to have two phytomedicines
registered with the MOH there: one for HIV and one for sickle cell
anemia. Dr. Charles Wambebe, Director General of the National Insti-
tute for Pharmaceutical Research and Development (NIPRD) in Abuja,
Nigeria, gave a fascinating presentation about the development of two
phytomedicines. Both were developed from herbal medicines obtained
from local traditional healers. The NIPRD followed a procedure in
which the traditional healers and their patients sign consent forms,
allowing study of the phtomedicine and the effects on patients. In
phase 1 placebo-assisted clinical trails, patients were given the ex-
perimental phytomedicines for both sickle cell anemia and for HIV.
After three months, patients in the experimental group were found to
be improving. The clinical trials are continuing. The NIPRD is also
targeting malaria, and is starting a pilot clinical trial of a new
antimalarial phytomedicine in July 2000.
The HIV/AIDS phytomedicine is called Dopravil. From preliminary anec-
dotal and experimental evidence, this new compound looks promising.
But since research results will no doubt be published, I will confine
my comments to the NIPRD's plan for recognizing the intellectual
property rights of traditional healers by means of a scheme for shar-
ing any future royalties from a phytomedicine that becomes a profit-
able drug (or patentable comound). For most of the history of drug
development in which initial drug discovery leads came from indige-
nous healers, both the healers and their communities received no
benefit.
Dr. Wambebe was very eager to talk about this often-ignored issue. He
gave me a copy of a Consultancy Agreement between the NIPRD and tra-
ditional healers who serve as consultants and provide phytomedicines
they are already using. When a healer signs this contract, she be-
comes eligible for three types of benefits: an on-going consultant
fee during the clinical trial phases; a share of future royalties
"amounting to at least 10 percent" of net profit, or a one-time pay-
ment in lieu of on-going royalties. Nigerian researchers found that
healers are more likely to cooperate if they are able to gain some-
thing from the relationship here and now, and not have to wait until
some future date when there may or may not be royalties.
Development of an African Phytomedicine Industry
Some delegates made the point that the high Western standards of
testing new drugs, costing in the neighborhood of at least four hun-
dred million dollars and taking 20 years, can never be used in Af-
rica. Dr. Gerard Bodeker (from GIFTS of Health, Oxford, UK) and oth-
ers argued for a quicker research strategy based on affordable, ap-
propriate technology (Bodeker calls it Rapid Response Research) that
can allow the development of crude extracts through a process of re-
search that results in either a synthetic drug, or at least a complex
phytomedicine that can be approved, mass-produced, widely distributed
in-country and exported to the world market. Another idea discussed
was to develop something like the German Commission E monographs
which establish toxicity, dosage and use, and which document that a
herbal medicine has already been widely used for many years. The hope
was that Africa can develop and export indigenous phytomedicines,
just the USA and Europe export herbal tablets such as St. John's Wort
and Echinecea to the rest of the world.
The cultivation, mass-production, local distribution and export of
African phytomedicines could help reduce dependency on expensive
Western pharmaceuticals (saving money for other purposes), help take
care of the health needs of Africans, and develop much-needed local
industries. But this is far from easy to accomplish. As became clear
from presentations and discussions, local production of phytomedici-
nes requires a complex partnership between groups such as the WHO,
the ADB, ministries of health and agriculture of member countries,
local businesses, agricultural interests, local regulatory officials,
environmentalists, traditional healer associations, etc. A complicat-
ing factor is that there is major asymmetry in levels of education,
power and resources among these partners. Moreover, a regulatory
framework is needed to guide advertising, sales, manufacture, and
distribution of phytomedicines. There is also a need for testing
plant medicines for heavy medals, pesticides and microbial contamina-
tion. Development of an African phytomedicine industry furthermore
requires an environment of political support and popular acceptance,
not easy to achieve.
Private Sector African Medicine
There had been several comments throughout the Forum about how noth-
ing is possible without funds from donors or governments. On the last
day of the conference, professor M. Gundidza from the University of
Zimbabwe (Dept. of Pharmacy) stood up and made a powerful point about
resources available in the private sector. He started by asking for a
show of hands to see how many people present actually consulted tra-
ditional healers. At first virtually no hands were raised. He urged
us further, saying that we needed to be honest and put our hands up
if we ever consulted traditional healers. A few hands finally went
up, perhaps no more than 10 percent of the audience. The professor
said this proved the point he wanted to make: We come together at
conferences like this to extol traditional medicine, and yet deep
down, we regard it as second-class. He has asked his colleagues why
they don't use traditional medicine or go to healers and their favor-
ite answer is "that traditional healers have no training."
To remedy this, this professor teaches naturopathic medicine at the
University of Zimbabwe. He asked two of his recent graduates to stand
up and take a bow, which they did. He then mentioned that a couple of
other graduates had wanted to be at the Forum but their clinics were
so full of patients waiting for treatment that they simply couldn't
get away. He said (and I paraphrase from my notes):
"This is homegrown African enterprise! Why wait for the World Health
Organization to help us? WHO has no money! Come and see our clinic!
Our students come from O- and A-level high school graduates whom I
then train at various levels: certificate, graduate, post-graduate.
They learn complementary and alternative medicine. They learn physi-
ology, anatomy, hygiene, and more. You say you feel that traditional
healers aren't properly trained. Well, that's why we are here! To
train Africans more comprehensively and systematically."
This made the point dramatically that there is plenty of money to be
made in and through the private sector in traditional medicine. Mil-
lions of people, rich and poor, in Africa and elsewhere, are ready to
pay for treatment with herbal and other natural medicines. Not that
this example necessarily solves the problems of mass production, con-
servation, forming complex partnerships, etc. But Dr Samba made a
strong, eloquent speech at the end of the conference about the need
for private sector initiative. Such initiative will need to be demon-
strated to attract donor support from the likes of the WHO or the Af-
rican Development Bank.
Reference:
WHO (Regional Office for Africa), African Forum on the Role of tradi-
tional Medicine in Health Systems; Harare, 16-18 February 2000. Tra-
ditional Medicine in the African Region: an Initial Situation Analy-
sis (1998-1999).
--
Edward C. Green
mailto:EGreendc@aol.com
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