Even though ATMs, similarly to other traditional medicines such as those from China and India, have been used by African people long before the advent of "modern" medicine, and still continue to be used for the treatment of a range of diseases, most people still do not believe in its value as medicines for serious and chronic illnesses. This might be because of the lack of scientific research behind these remedies, and the dominance of the Western knowledge system and its wide acceptance by younger generations who value more Western values and lifestyles while being oblivious to ATMs. But in Africa, where about 80% of the population are said to rely on traditional medicine for their basic healthcare needs (according to the WHO), ATMs should be given a more prominent role. They should be more visible on shelves in big pharmacies, prescribed by healthcare practitioners beyond just traditional health practitioners (THPs), and should be more mainstreamed than what is currently the case.

UFS Department of Pharmacology made great strides researching ATMs

Over the past few years, the University of the Free State (UFS), through its Department of Pharmacology, has made great strides in researching the possibilities and potential of ATMs. My team and I, together with other role-players in the institution, are in the process of establishing one of the most advanced modern pharmacology GLP-accredited research and development laboratories in the country, and possibly in the region, after receiving a grant of R58 million from the government. The UFS is recognised as a national leader in pharmacology as well as research and development of indigenous knowledge systems (IKS) and traditional medicines. The UFS has developed and built infrastructure in this field of scientific research, and has the best modern equipment for the training, teaching, and development of prototypes and products for commercialisation based on IKS. Interdisciplinary and interfaculty research is undertaken in this study area, and we have an excellent track record of sound community engagement with relevant stakeholders.

The department has also been awarded an annual Technology and Innovation Agency Platform (TIA) grant of R17 million for the next five years. This research and teaching programme, known as African Medicines Innovations and Technologies Development (AMITD), will help to recruit and employ the best skills throughout the research, development, and herbal-medicine manufacturing value chains. We received a DSI high-end infrastructure (HEI) grant to build a laboratory, which will be a centre of excellence for the government, the WHO, and the African Union's Commission for Social Development. The grant will also be used to build a herbal medicines production facility, as well as to pilot a health facility for traditional medicines. I am pleased that a multinational private pharmaceutical company has come forward and will be collaborating with us to realise these plans – joint manufacturing and business development, and joint engagement in the integrated health facility. We are now, together with the WHO and the aforementioned company, entering into a collaboration agreement to work together on key projects in traditional medicine manufacturing and training.

Traditional medicine therapies emerged as possible cures or remedies for COVID-19

As part of the COVID-19 response, traditional medicine therapies have emerged as possible cures or remedies for the deadly disease. The pandemic has certainly helped to improve the profile of ATMs. In Cameroon two complementary therapy products for COVID-19 have been approved by the government, while Madagascar's herbal remedy, COVID-Organics Plus Curative, has been in phase II clinical trials. Encouraging preliminary results have been reported around this clinical trial. Similar trials on traditional medicine products for COVID-19 – conducted according to WHO protocols – are also underway in other African countries, including Democratic Republic of Congo, Nigeria, Uganda and South Africa, according to the World Health Organisation (WHO).

With regard to South Africa, my team and I and FARMOVS received approval from the South African Health Products Regulatory Authority (SAHPRA) to conduct the first multicentre controlled phase II clinical trial of a plant-based product, PHELA, on mild- to moderate-symptom COVID-19 patients.

The main purpose of the clinical trial is to confirm that the product can treat COVID-19 and be registered by the South African Health Products Regulatory Authority. We confirmed in vitro and in vivo that the medication works as an immune modulator to modulate the cytokine storm due to COVID-19, and also restores and normalises the patient's immune system. This pivotal study is based on the modification of the WHO master protocol for clinical trials. The study is ongoing at three sites, and we are considering the addition of two more sites, to make a total of five clinical-trial sites. The development of PHELA has taken place under stringent scientific scrutiny in both preclinical and clinical research. The efficacy of PHELA as both an immune modulator and an anti-SARS-COV-2 treatment has been proven in in vitro and in vivo studies with reproducible results, conducted by three independent research institutions and a science council. PHELA is a herbal product made of four medicinal plants. Traditionally PHELA has been claimed for use for a historical disease called muyaga, but recently it has been scientifically tested and found effective as an immune modulator that benefits persons with a compromised immune system.

African Traditional Medicines Day: a reminder of the value and contribution of traditional medicines

The celebration of African Traditional Medicines Day annually on 31 August reminds all of us of the value and contribution of traditional medicines. This year's theme on the role of ATMs in universal health coverage (UHC) is most befitting, as we know that medicines from natural products are affordable, accessible, have almost no side effects, and are proven enough because they have been advised for many generations, and they have been quite efficient in treating 90% of all currently known human diseases. The annual celebration, therefore, aims to gain more support for the continent to fast-track the research and development, as well as the local manufacturing, of well-researched ATM products, and for them to be made available through our national health systems. This also encourages the training of younger generations in this field of science and research.

Support for local manufacturing of ATMs will help bring traditional medicinal products into mainstream health systems and formal economies, creating jobs and wealth throughout all the ATM-manufacturing value chains – commercial cultivations, research and development, manufacturing, distribution, logistics, and marketing. This will help move the continent from dependency on aid from rich Western countries. Aid has not given Africans any independence, and has never been sustainable. It is, instead, enslaving the continent. If we want to be independent of big Western pharmaceutical companies and their expensive medicines, inequities and discrimination – as seen during the COVID-19 pandemic, African countries were left wanting when it came to access to personal protective equipment, diagnostics, therapeutics, and vaccines – Africa does not need aid. We need technical skills, technology development, and skill transfer. Aid makes African dependent, not independent. We need investment –  financial, research and resources – into developing our own, locally and regionally sourced herbal-based medicine. Africa and her people need African solutions to its health problems –and who could be better suited to create them than the continent's people through its indigenous knowledge systems.

Africa should be a leading force

In August health ministers from Africa met at a special event – the WHO Health Ministers Regional Committee for Africa, in Lomé, Togo. The theme of the meeting was 'Building Back Better: Rethinking and rebuilding resilient health systems in Africa to achieve UHC and health security'. The WHO Africa Regional Office hoped to develop a collective roadmap for building resilient health systems through integrated efforts that coordinated actions across all clusters and teams in the WHO's regional office and country offices, and with national, regional and global partners supporting African countries as they ramp up efforts to recover from the pandemic-induced disruption and build back better toward achieving UHC and being prepared for future health emergencies.

As Chairperson of the Regional Advisory Committee on Traditional Medicine for COVID-19 Response (REACT), I gave a presentation on fast-tracking research and development and local production of herbal medicines during the second session, with the theme 'Lessons to guide strengthening of health product manufacturing in Africa'. I am of the view that COVID-19 helped to prepare the continent for the next major event, and Africa will be better suited to deal with it. We cannot, again, be caught off guard and found wanting, and be at the mercy of the West for donations. I presented ways to put in place systems for supporting local manufacturing of therapeutics, with participation through the African regional economic blocks.

Opinion article by Prof Motlalepula Matsabisa, Professor and Director of Pharmacology, Faculty of Health Sciences, University of the Free State