Due to the growing interest of this plant as a possible treatment against COVID-19 or as a complementary treatment combined with other treatments, Madagascar President Andry Rajoelina announced the creation of Covid-Organics , an herbal drink based on Artemisia annua , to prevent and cure COVID-19. As a consequence, WHO according to an announcement dated May 4th, does not reject its use to prevent and cure treatment for COVID-19, but requires to conduct trials to prove its effectiveness. The WHO added that “Medicinal plants such as Artemisia annua are being considered as possible treatments for COVID-19 and should be tested ” In fact, the WHO supports scientifically proven traditional medicine and promotes activity in research centers to select natural medicinal products.
The artemisinin molecule, produced in the Artemisia annua plant, is currently recommended by the WHO to traet malaria in ACT ( Artemisinin Combination Therapy ) format. Moreover, in recent years the huge potential of this molecule, and derivatives, to combat other diseases , such as cancer, autoimmune, inflammatory or parasitic diseases, has been discovered. Additionally, the excellent safety index of this plant and its minimal side effects , convert Artemisia annua , and its main molecule artemisinin, in a real potential candidate to combat or at least increase recovery rates from this disease.
Different scientific articles published in the last decade have demonstrated the great potential of artemisinin molecule. Actually it has been demonstrated both in vitro and in vivo (Zhang & Gerhard, 2009; Klonis et al., 2011) that the potent activity of artemisinin is dependent on the digestion of hemoglobin. In fact, the heme group, formed by iron and porphyrin, when released by the breakdown of hemoglobin – by a parasite or a virus – is the most relevant physiological mediator of artemisinin cytotoxic activity not only against malaria but also against cancer.
So, could antimalarials be a real and tangible alternative to combat COVID-19? The reality is there; since these molecules appear to work in diverse ways fo r protecting hemoglobin against infection , hence their possible successful application against COVID-19. Hydroxychloroquine , a chloroquine derivative used for decades to fight malaria, has been the first case study. Various clinical studies, carried out on a small scale in France, China and the United States have shown that hydroxychloroquine could be an alternative, mainly due to its ability to act as an immunomodulator rather than as an antiviral. However, the results of the tests to date are not yet conclusive. In addition, the severe side effects and allergic reactions of the use of hydroxychloroquine are something to consider seriously.
Furthermore, its antiviral properties have been described for various types of viruses (Hahn et al., 2018; D’Alessandro et al., 2020; Ou et al., 2020; Wang et al., 2020) including other types of coronaviruses such as MERS-CoV and SARS-CoV (Nature Plants, March 2020).
According to a recent publication in the magazine ChemRxiv (Liu & Li, April 2020) coronavirus COVID-19 it is likely to have a mechanism of infection similar to the malaria plasmodium . In other words, our famous virus could act on the lungs and cause pneumonia not in a direct, but in an indirect way. According to the authors, it seems that this virus, like the malaria parasite, directly infects red blood cells (erythrocytes), attacking the 1-Beta chain of hemoglobin and dissociating iron and porphyrin, from which it probably gets energy to replicate the virus. Furthermore, this attack on hemoglobin, which we remember, is responsible for transporting oxygen and carbon dioxide in the blood, thus making transport and exchange getting smaller. As a consequence, lung cells, where this oxygen-carbon dioxide exchange occurs, suffer an extreme reaction of poisoning and inflammation ; which results in the typical images of lungs with crystallized carbon dioxide so characteristic of many seriously patients infected with COVID-19. Logically, this defective gas exchange, and the excess of iron released, will have other negative consequences in the human body as it acidifies the blood.
In the fight against COVID-19, which has generated thousands of infected and deceased, unceasing research and tests continue in order to find effective treatments against this aggressive virus. Around the world, different research institutions and companies have been working to discover new drugs and create new therapies. But of special utility, in order to minimize faster the impact of pandemic, can be searching in the past and present to rediscover traditional medicines used for other therapeutic applications and verify their potential as a treatment to combat this virus.
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.
As efforts are under way to find treatment for COVID-19, caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. 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 recognizes that traditional, complementary and alternative medicine has many benefits and Africa has a long history of traditional medicine and practitioners that play an important role in providing care to populations. Medicinal plants such as Artemisia annua are being considered as possible treatments for COVID-19 and should be tested for efficacy and adverse side effects. Africans deserve to use medicines tested to the same standards as people in the rest of the world. Even if therapies are derived from traditional practice and natural, establishing their efficacy and safety through rigorous clinical trials is critical.
Brazzaville – The World Health Organization (WHO) welcomes innovations around the world including repurposing drugs, traditional medicines and developing new therapies in the search for potential treatments for COVID-19.
African governments through their Ministers of Health adopted a resolution urging Member States to produce evidence on the safety, efficacy and quality of traditional medicine at the Fiftieth Session of the WHO Regional Committee for Africa in 2000. Countries also agreed to undertake relevant research and require national medicines regulatory agencies to approve medicines in line with international standards, which include the product following a strict research protocol and undergoing tests and clinical trials. These studies normally involve hundreds of people under the monitoring of the national regulatory authorities and may take quite a few months in an expedited process.
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 authorization for 89 traditional medicine products which have met international and national requirements for registration. Of these, 43 have been included in national essential medicines lists. These products are now part of the arsenal to treat patients with a wide range of diseases including malaria, opportunistic infections related to HIV, diabetes, sickle cell disease and hypertension. Almost all countries in the WHO African region have national traditional medicine policies, following support from WHO.
WHO welcomes every opportunity to collaborate with countries and researchers to develop new therapies and encourages such collaboration for the development of effective and safe therapies for Africa and the world.