Nairobi — At a recent conference in Nairobi, the World Health Organisation came under severe attack, especially because of a general suspicion by participants that its policies are tailored to benefit "big guys" - giant pharmaceutical firms - and because the health body had asked 18 companies across the world to stop manufacturing monotherapies - drugs based on artemisinin alone

AFRICAN HERBAL ANTIMALARIAL meeting held in Nairobi between March 20 and March 22 brought to the fore the frustration of Africans at the failure of multinational drug companies to confront the malaria pandemic in Africa.

"It is criminal to subject victims of malaria to preventable deaths while refusing to engage in research on compounds that allegedly promote massive resistance to the disease," said Dr Bola Omoniyi of Doctors for Life International, a South Africa-based non-governmental organisation.

Earlier, a representative from a drug company had termed it "criminal" for knowledgeable people to continue advocating the use of compounds and products that might eventually cause widespread resistance against Plasmodium, the malaria-causing pathogen.

Jointly organised by the World Agroforestry Centre (ICRAF) and the European Union-funded Centre for the Development of Enterprise (CDE), the conference was called to give participants a forum to share information on the current and future use of plant products for the control of malaria and to explore how different players can collaborate in the production and distribution of anti-malaria herbs.

At some point, proceedings became so charged that one of the moderators, Dr Tony Symons of ICRAF, decided to give a middle-ground perspective. He summarised the views advanced by participants into two; those that betrayed what he termed "unfounded belief" on the suitability of anti-malarial herbs and those that exposed "unjustified prejudice" against certain herbal products already in the market.

The three-day event brought together representatives of artemisinin-based drug manufacturers from China, growers of artemisia from many African countries, representatives of drug bodies in various African countries, World Health Organisation (WHO) representatives, representatives from Non-governmental Organisations, scientists and journalists.

The WHO had come in for much of the bashing, especially because of a general suspicion by participants that its policies are tailored to benefit "big guys" - giant pharmaceutical firms - and because the health body had asked 18 companies across the world to stop manufacturing monotherapies - drugs based on artemisinin alone).

According to Dr Symons, the disease robs Africa of 3,000 helpless victims every day. Thus, after the three-days that the participants engaged in arguments and counter arguments and articulated viewpoints on what needs to be done to control malaria spread in the continent, 9,000 Africans had died.

"It is like loading 7 jumbo jets with passengers every day and crashing each one of them into Mount Kilimanjaro," said the co-moderator Denzil Phillips. "To announce all the deaths caused by malaria each day, we might need 150 pages in a newspaper each with 20 announcements."

That Africans continue to die from Malaria, a preventable and curable disease, remains a big blot on the global conscience. Globally, the disease affects between 200-450 million people each year, 2.7 million of whom die. Out of those who die, 90 per cent are from Africa. The continent's predicament was best summarised by Dennis Garrity, the director general of ICRAF, who said, "By the time I finish presenting my introductory notes, 20 children in Africa will have died of malaria."

MULTINATIONAL DRUG companies were accused of not being keen on alternative anti-malaria drugs which can help turn the tide against the disease in Africa. In addition, current global production is not in tune with global demand from malaria victims. Only 25 million of the 130 million doses of Artemisinin Combination Therapy (ACTs) required to combat malaria throughout the world are available.

In addition, country-by-country analysis of coverage of anti-malaria campaigns in Africa shows very low coverage in countries like the Democratic Republic of Congo where only 34.6 per cent of the country is covered. According to Dr Garrity, this means that 40 per cent of African children under 5 years receive such treatment. The rest have either to do with whatever concotions are available or die.

Probably more than ever before, herbal alternatives are filling the gap. And following the rising global shift from synthetic to more natural, plant based drugs, herbs are now more acceptable as a viable treatment for various diseases by many drug-regulating authorities in the continent as well as the WHO.

However, the United States of America still officially regards herbal products as food supplements and additives, African countries have been slow in embracing herbs, particularly those identified through age-old traditional knowledge systems. For instance, Uganda and Kenya are still recognising legal statutes enacted by the former British colonial governments in the 1950s even with the full knowledge that these laws were meant to demonise African traditional knowledge on herbs. Indeed, the situation might be worse in Kenya than Uganda where, as Joseph Yano, a legal officer for the country's Pharmacy and Poisons Board, told participants, "the country does not have a system of regulating herbal medicine. And so thousands of unregistered herbal "doctors" traverse the country making all manner of claims including their ability to cure HIV/Aids.

He blamed the situation on herbalists who he said had frustrated the board's attempt to come up with regulation through an anti-regulation campaign they had taken before Kenya's Attorney General, Amos Wako. Although many countries have, to some extent, made attempts to regulate the practice of herbal medicine, the majority have been reluctant to treat the matter with any urgency. This is despite the fact that over 80 per cent of Africans rely on herbs for "first-line" anti-malaria treatment.

During the conference, many representatives of regulating authorities in different countries volunteered information on how far their organisations have gone in regulating what herbs enter into the market. On the other hand, private companies also came forward to paint rosy pictures of how they develop, distribute and market anti-malaria herbs. At the same time, representatives of companies operating venture capital businesses indicated a future willingness to finance the development of modern herb-based drugs.

On their part, scientists from such institutions as the International Centre for Insect Physiology and Ecology (ICIPE) took time to detail how they are developing anti-malarial herbal teas on a pilot basis. Further, farmers and manufacturers like Oliver Icharia - who took the participants on a tour of his artemisia farm in Red Hill, 15 kilometres west of Nairobi - took the opportunity to showcase the potential of capitalising on herbal agriculture.

INDEED, THERE WAS OPTIMISM that a serious anti-malarial campaign is well on course in Africa. But how far such optimism will be translated into cost-effective drugs that could rival those already in the market remains to be seen. Nevertheless, what emerged from many of the presentations made by representatives of the 21 countries present was that Africa and indeed, Asia, had for thousands of years continued to utilise herbs to cure malaria.

In China, for instance, the use of Artemisia annua, a herb from which artemisinin is derived, is said to have begun more than 2,000 years ago. But it was only 15 years ago that the active ingredient, Artemisinin, was isolated from the plant. Today, a number of ventures in different African countries are involved in commercial cultivation of Artemisia annua. The practice of using herbs to treat diseases in Africa is equally old. Pioneers of the treatment are said to have been herbalists and witchdoctors.

Usually, these practitioners have continued to shroud their trade in mysticism so that the isolation and extraction of the bark or the leaf of a medically-useful tree remains a secret that is normally passed on to a selected few within their family largely through word of mouth. The trade went underground during the colonial period when white missionaries and officials of colonial governments engaged in open demonisation of the practice. However, there is ample evidence today that more than a century after the scramble for Africa, the use and trade in herbal medicine is becoming more entrenched.

From some quarters, this is seen as an offshoot of the high pricing of conventional anti-malaria drugs and especially the Artemesinin Combined Therapy (ACTs) that are recommended by the WHO. But it is also related to the fact that Africa is rich in medicinal herbs. According to biodiversity experts, the continent is home to thousands of species of useful herbs with countries like the DRC which has enormous botanical resources having about one-third of all medicinal plants. Although this is under serious threat from other land uses, it is nevertheless gradually creating the base for an emerging herbal industry thus enabling Africa to progress from mere traditional usage to modern marketing of these products.

For instance, over the years, herbal products have been marketed through crude "bottled" containers in Kenya. This seems to be changing. As was demonstrated during the conference by the Kenya-based Natural U company of Mr Icharia and ICIPE's bioprospecting venture, research and development, sophisticated packaging and marketing of anti-malarial herbs are taking root in a number of African countries.

THIS IS MORE SOPHISTI- cated in Ghana where anti-malarial herbs are marketed under such brands as Herbaquin, Top Fever, Malacure, Phytolaria and Malaherb among others. The country has detailed statutory organisations, a standards board, the medical council and the Ministry of Health to regulate the use and trade in anti-malaria herbs. According to Victor Attafua of Vicdoris Pharmaceuticals Ltd of Accra, some of the requirements imposed by these organisations are that a trader must be a legally registered pharmacist with the country's Registrar General. They must have registered offices and must comply with all the regulatory requirements that are monitored on a regular basis.

Thus, as one participant put it, the use of herbal teas in Africa is bound to continue whether the WHO and other regulators, "liked it or not." But a representative from a Chinese Company, Guilin Pharma, which has established an artemisia-based industrial chain, called for caution saying that blanket use and cultivation of anti-malaria herbs and especially artemisia, is not the solution since not every plant has the right anti-malaria compounds.

BUT AS THE DISCUSSIONS during the conference proved, getting the Chinese to share with Africans the artemesia plant with the best anti-malaria compounds is quite complicated and such permission has to come directly from the Chinese government.

What remains a thorny issue is how Africa, just like China, can protect herb-based intellectual property rights. In the past, herbs that have been identified, selected and isolated by Africans have been patented by multinationals from the West in extremely controversial circumstances. And while such companies continue to reap millions of dollars in profits from the products, the West largely ignores the contributions Africans might have made in the development of such herbal products. In this regard, participants during the conference expressed the danger of vesting property rights of indigenous species on one commercial operator.