Question Marks Surround Madagascar’s Covid-19 Miracle Cure

On April 29, 10 African heads of state met via video chat. The meeting was presided over by South African president Cyril Ramaphosa, in his capacity as chair of the African Union. Also present was AU Commission chair Moussa Faki Mahamat and John Nkengasong, the director of the Africa Centres for Disease Control and Prevention (Africa CDC).

The purpose of the meeting was to assess Africa’s response to the coronavirus pandemic and determine what should happen next. Broadly speaking, they were all on the same page — until Andry Rajoelina began to speak.

Rajoelina, the 45-year-old president of Madagascar, was the youngest person in attendance. He came bearing what he said was good news: Madagascar had discovered a cure for Covid-19.

This was not the first time Rajoelina had made such a claim. He has been aggressively touting the benefits of Covid-Organics, a herbal drink invented by the Malagasy Institute of Applied Research. Rajoelina says the bitter drink can both prevent and cure Covid-19, and has distributed it to schoolchildren across Madagascar.

Rajoelina — a former DJ who first came to power in a military coup in 2009 – has released no evidence to support his claims.

At the meeting, Rajoelina urged his fellow African heads of state to embrace the herbal remedy. The other presidents did not push back, even though most had deep reservations. “You know how it works at the African Union. Once people say such a thing, his peers are supposed to compliment him,” said one source who was party to the discussions.

Grand claims 

The Malagasy Institute of Applied Research occupies a tree-lined plot on the outskirts of Antananarivo, Madagascar’s capital. It was established in 1957 by Albert Rakoto Ratsimamanga, one of the country’s pre-eminent scientists, to research how local plants and traditional practices could be used to treat disease. Among its successes is Madeglucyl, an anti- diabetic drug derived from the Eugenia jambolana plant, widely used in Madagascar and abroad.

Covid-Organics is its latest formulation. The primary ingredient is artemisia, indigenous to China, imported to Madagascar in the 1970s, and now widely grown on the island.

Like chloroquine (also controversially touted by a head of state — Donald Trump — as a Covid-19 treatment), the plant’s active compound artemisinin is a recognised antimalarial treatment. But the World Health Organisation (WHO) advises against the use of the artemisinin compound as a preventative, and of the artemisia plant altogether, because the short half-life of the former and its low concentration in the latter accelerate resistance to treatment in active cases, rendering it useless against malaria.

President Rajoelina has made grand claims about the efficacy of Covid-Organics. It has healed two people who had Covid-19, he said. It has the “potential to change the course of history”. Ata glitzy launch event in April, he said: “All trials and tests have been conducted and its effectiveness in reducing and elimination of symptoms has been proven in the treatment of Covid-19 patients in Madagascar.”

But this cannot possibly be true, said Shabir Madhi, professor of vaccinology at the University of the Witwatersrand in Johannesburg. Madhi is also a founder and director of the African Leadership Initiative for Vaccinology Expertise. “There is absolutely no evidence that it has cured anything,” he told the Mail & Guardian.

Madhi noted that Madagascar only has a small number of confirmed coronavirus cases (158 as of 7 May). “That’s definitely not enough for a trial. Citing these sorts of numbers is a meaningless exercise.”

He dismissed President Rajoelina’s claim that two people had been “cured” by the herbal remedy. “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.”

History repeating itself? 

This is not the first time Professor Madhi has witnessed politicians make grand claims at odds with established medical evidence. He lived through that dark period in South Africa’s history during which its leaders — principally former president Thabo Mbeki — disputed the science on how to treat HIV/Aids. At one point, cabinet minister Manto Tshabalala Msimang suggested beetroot and garlic were more effective treatments than antiretrovirals — despite all evidence to the contrary. A Harvard University study found in 2009 that this misguided policy may have caused more than 300,000 premature deaths.

Both Africa CDC and the WHO are concerned about history repeating itself — and that using an untested herbal remedy such as Covid-Organics could have the opposite of the intended impact.

“We would caution and advise against countries adopting a product that has not been taken through tests to see its efficacy against Covid-19 and its safety in different population groups,” said Matshidiso Moeti, the WHO’s Africa region director. “We are concerned that touting this product as a preventative measure might make people feel safe to do other things [against medical recommendations, such as neglecting social distancing].”

The WHO and Africa CDC have offered to partner with Madagascar to test Covid-Organics in a proper medical trial. So too has South Africa. John Nkengasong, the director of Africa CDC, told the Mail & Guardian: “I heard the briefing the president of Madagascar made … [we] look forward to seeing the data and the design of the study.”

So far, Madagascar has not shared the data underpinning its claims. Both the government and the Malagasy Institute of Applied Research declined to be interviewed for this story.

Clinical trials are critical 

A lack of evidence has not deterred several leaders from embracing Covid-Organics. Last week, Madagascar dispatched 1.5 tonnes of the herbal drink to Equatorial Guinea. Another shipment went to Guinea-Bissau. President George Weah personally greeted a plane as it delivered samples for Liberia. And Tanzanian President John Magufuli — who has claimed three days of prayer can cure Covid-19 — said he would send a plane to Antananarivo to collect a consignment.

But sources within the AU suggest most leaders remain unconvinced — even if diplomatic protocol is preventing them from saying so publicly.

One of the few institutions to speak out is West Africa’s regional bloc Ecowas, which distanced itself from claims it had ordered Covid-Organics. It said although it recognises the importance of traditional and plant-based medicine, “we can only support and endorse products that have been shown to be effective through scientific study”.

The WHO has taken a similar line. This week, it said: “Many plants and substances are being proposed [as Covid-19 cures] without the minimum requirements and evidence of quality, safety and efficacy. 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.”

This article was first published in The Continent. Access it here.