On April 20, the president calls a press conference to announce a breakthrough in the fight against COVID-19. It’s a new use for an old malaria treatment, he says, one that is seeing miraculous results among the country’s most ill patients. It’s so safe that even schoolchildren could take it. In fact, he urges them to do so daily, as a preventative. He admits that he, too, is taking the medicine.
No, this is not the President of the United States touting an unproven remedy for a virus that has infected nearly 5 million people worldwide. It is Madagascar’s President Andry Rajoelina, who is just as willing to use the presidential platform to promote a hypothetical treatment as is his American counterpart. To prove the safety of his new discovery, he picks up a bottle placed prominently on the podium and takes a swig of the amber liquid. “This herbal tea gives results in seven days,” he avows. “Tests have been carried out—two people have now been cured by this treatment.”
Aides pass bottles of the herbal remedy, labelled “Covid-Organics,” to the assembled diplomats, ministers and journalists. They sip appreciatively, then break into applause as the president of this island nation announces that the first African cure for coronavirus, based on traditional African medicine, will be distributed countrywide, and, eventually across the continent.
According to the World Health Organization, there are no medicines that have been shown to prevent or cure COVID-19. That hasn’t stopped people—some of them presidents—from grasping at any potential treatment that might provide a way out of the devastating lockdowns that are collapsing national economies, or stave off the threat of mounting death tolls.
The launch of Covid-Organics (CVO for short) in Madagascar last month was no different. Within days, multiple African nations, as well as Haiti, were asking about shipments. And while CVO is not yet available for export, Rajoelina acquiesced by sending samples for free. The promotion of an untested cure sparked consternation among the medical community in Africa, and provoked an unusually sharp rebuke from the WHO, which noted in a statement on May 4 that, “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 such untested products, it continued, “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.”
Back in Madagascar, the international uproar was met with bafflement. The use of traditional remedies there is so deeply ingrained that most Malagasies, as they call themselves, would just as likely reach for an herbal cure to treat a headache or a stomach-ache as they would a western pharmaceutical product, says Tiana Andriamanana, the executive director of local conservation NGO Fanamby. Andriamanana’s work often takes her to poor and rural areas where hospitals and pharmacies are hard to find, and conventional medicine is often unaffordable. “A lot of times there isn’t really a choice,” she says. “Traditional medicine is how we roll.” Nor are Malagasies alone in their reliance on traditional medicine: according to the WHO, 87% of African populations use it.
And the establishment that developed CVO, the Malagasy Institute of Applied Research [IMRA], is well-respected in the country for its work refining those remedies: some of that research has led to the discovery of internationally recognized pharmaceutical treatments such as Madeglucyl, which can help with diabetes management. It also helped identify the Madagascar periwinkle’s potential in cancer treatment; compounds isolated from the flower are now being used in treatments for breast, bladder and lung cancers.
When news first emerged in January of a mysterious influenza-like disease in China that didn’t respond to conventional treatment, IMRA’s director general, Dr. Charles Andrianjara, got to work. Since its founding in 1957, the institute’s researchers have catalogued thousands of medicinal herbs used by Madagascar’s traditional healers. Andrianjara wondered if some of the institute’s herbal knowledge might help fight the emerging viral illness. “Our hypothesis was that if we could treat the cough, the respiratory difficulties, the aches, the fever, then we could treat the virus.” He combed the database, seeking herbs with antioxidant and anti-inflammatory properties, as well as natural cough suppressants and fever reducers.
The institute had also been studying artemisia annua, or sweet wormwood, a common anti-malarial that had shown promising signs in the treatment of severe acute respiratory syndrome (SARS), another respiratory disease caused by a coronavirus, which emerged from China in 2002. “COVID and SARS are very similar in terms of their genetic structure,” says Andrianjara, “so our hypothesis was that artemisia might have an effect on COVID-19.”
Andrianjara’s team combined artemisia with other ingredients to create an herbal tea, and offered the decoction to patients who had tested positive for the disease. “We started with one, two [patients] and we found that it really reduced their symptoms,” he says. “They recovered quickly.” IMRA has not conducted any formal trials or tests; Andrianjara’s assessment comes only from observing the reactions of a handful of patients outside of a controlled setting. While he says that the patients were not receiving any other treatments at the same time, there is no formal documentation. When President Rajoelina made his announcement, fewer than 20 patients had received the remedy.
Such low numbers are meaningless when it comes to a disease that is still so poorly understood and whose effects can range from asymptomatic to massive organ failure, but Andrianjara argues that the remedies themselves can do no harm. “They have been thoroughly tested for toxicity, and they have been on the market for 30 years, so we already know their efficacy.” He likens CVO to common Western treatments like painkillers, which some studies show do not work on everyone. “You can give 20 people paracetamol. It won’t harm any of them, but it won’t cure all of their headaches either. If CVO can cure 60% of the population, to me that’s good. It’s not the best, but it’s good.”
It’s impossible for doctors and scientists to validate any of these claims; other than saying that CVO contains 62% artemisia, IMRA has not released the names of the other ingredients, for fear that the formula could be stolen. While President Rajoelina promotes CVO as both a cure and a preventative, it hasn’t been cleared for distribution as a drug by Madagascar’s National Academy of Medicine, which warned in a statement that “It is a medicine for which the scientific evidence has not yet been established and which risks damaging the health of the population, in particular that of children.”
In a media briefing on May 14, the WHO stated that there was no scientific evidence to support the safety and efficacy of Covid-Organics. The WHO’s regional director for Africa, Dr. Matshidiso Moeti, said that rigorous testing would be vital for credibility, “So that when we celebrate the discovery of this treatment in Africa it is on the basis of evidence that can be shared around the world.” South Africa-based virologist Denis Chopera sees it as a supplement rather than a cure, telling the Voice of America’s Africa broadcast that “I don’t think there’s any harm, but I don’t think people should expect that it will treat them and cure COVID-19 because that has not been proven scientifically.”
Shabir Madhi, professor of vaccinology at the University of the Witwatersrand in Johannesburg, told the Mail & Guardian that he has seen no evidence that the remedy has cured anything, noting that with Madagascar’s low numbers of confirmed cases (405 as of 22 May) it would be impossible to assess efficacy. “The majority of people who have this virus show no symptoms. Of those who develop symptoms, 85% of them have mild illness. You could treat them with water and it would have the same effect.”
President Rajoelina slammed skeptics in an interview with France 24, claiming that more than 100 COVID-19 patients in Madagascar had already been successfully treated with Covid-Organics. “When we are in this period of war, what is the proof we can show or give? It is, of course, the healing of our sick,” he said. “I think the problem is that [the drink] comes from Africa and they can’t admit…that a country like Madagascar…has come up with this formula to save the world.”
IMRA’s Andrianjara also senses an anti-African bias in the international negative reaction to his remedy. After all, he points out, Madagascar isn’t the only country to embrace untested remedies as a potential cure. “In the United States, President Trump has been promoting [the antimalarial drug] hydroxychloroquine, even though the FDA has warned that it is not a proven treatment and it has dangerous side effects.” Many countries are trying out new treatments without clinical trials, he says, “so why is Madagascar being singled out? Because we are offering a traditional remedy instead of a conventional drug?”
Many companies have used the coronavirus pandemic to tout their herbal supplements as immune boosters and health tonics. Few have a president doing their marketing. Rajoelina is rarely seen these days without a bottle nearby, prompting many Malagasies to speculate about where, exactly, the profits are going. But while Madagascar does have one of the largest supplies of artemisia annua in the world, the low cost of the remedy would suggest it is not exactly a goldmine.
Madagascar’s government is now in talks with the WHO and the African Union over how to develop a rigorous testing protocol for CVO. The biggest obstacle they face at the moment is the lack of sufficient patients—without enough infected people, it’s impossible to run a controlled study on the curative effects. “What can we do?” asks Andrianjara. “We don’t want more people getting sick, just so we can do more tests.” Meanwhile, researchers at Germany’s Max Planck Institute of Colloids and Interfaces are testing Artemisia annua extracts to determine its effectiveness in speeding recovery from the virus.
On the streets of Antananarivo, the Malagasy capital, there is no debate. Covid-Organics can be found in nearly every supermarket and corner shop. The recommended dose is two teas a day, for seven days, and it is sold for the equivalent of 20 cents for a single-serving bottle of tea, or $1.50 for a box of 10 tea bags that can be steeped at home.
According to Andriamanana, the executive director of the conservation NGO, it has a mild taste of anise, with a bittersweet finish reminiscent of a strong black tea. Andriamanana is not sure she could drink it twice a day, but a lot of her friends do. “They say it’s working, at least as an immune booster. It invigorates, it takes fatigue away.” Like most traditional remedies, she says, it’s hard to draw the line between science and belief. “Could it work as a cure? Maybe, at least psychologically.” She would love nothing more than to see it put to a scientific test, and pass. “If we can prove that we have the solution, or even a solution, for the coronavirus, we can show that it was not dumb after all to rely on nature and indigenous knowledge.”
Andrianjara, of IMRA, says that even if CVO isn’t proven to cure Covid-19 in scientific studies, there are many of other promising remedies in Madagascar’s traditional pharmacopeia that should be explored. “Instead of researching something new that costs a lot of money that we cannot afford, let’s go back and revisit our traditional knowledge. We have a lot of wealth in our traditions and culture, and maybe we don’t exploit it enough.”