Madagascar’s president made headlines this week after claiming that his country’s potential COVID-19 cure will be rejected on the basis that it comes from an African country. Although part of me wants to disavow anything that could be coronavirus pseudoscience, colonialism and COVID-19 have a complex relationship, and President Rajoelina has a point. Coronavirus in developing countries is being ignored by many in the West, whether it is about tragedy or discovery.
I conducted a very un-scientific study on my Instagram story a few days ago. On it, I asked my friends how much news coverage (if any) they had seen of coronavirus in developing countries. 80% of my friends, including avid travelers, med students, and politicos, said they hadn’t seen anything. Among the other 20%, there were those who messaged me with caveats, saying that their news came from paywalled resources like The Economist or Foreign Policy, or that they live abroad and their local media has been responsible for this coverage.
From them, I received tons of links on the state of the pandemic. I’ll link some of the most interesting ones below this article. Although I absolutely could write about many of these stories and the different challenges faced by those in developing countries as a result of COVID-19, I want to take a more positive approach. Enter Madagascar’s proposed COVID-19 cure.
The Cure
Madagascar President Andry Rajoelina has had multiple press conferences with French-language media over the past month. He is pictured sitting at a desk, surrounded by boxes and bottles of the tonic, speaking directly into the camera while he claims Madagascar has found a COVID-19 cure thanks to an herbal tonic called COVID Organics.
According to Rajoelina, the tonic is responsible for the 105 patients (out of 171) in Madagascar who have been cured, the vast majority of them having only taken the tonic. Although it hasn’t been clinically tested, COVID Organics has already been shipped to other African countries including Nigeria, Guinea-Bissau, Equatorial Guinea, and Liberia.
Andry Rajoelina- DJ, President, Sharp-Dressed Man
Rajoelina has an unconventional background, having left his studies at the age of 19 after finishing high school to pursue a career as an entrepreneur.
In his early twenties, he spent a lot of time DJ-ing around Antanarivo (no SoundCloud link but I did find this, which appears to be a campaign song, and it definitely slaps). From his success, he launched a radio station and an advertising firm. Eventually, he purchased other TV and radio stations in Madagascar.
At the age of 34, he became the youngest president in Africa, in a political move that is called a coup by some, after a charter approved the new constitution with 74% of the vote.
He has been noted for his sharp style and press appearances. As a speaker, Pres. Rajoelina is very convincing. He was described by Le Monde in 2009 as having “unrivaled charm” and being “always available” for the media.
Madagascar’s Cure for COVID
Rajoelina appeared on France24 yesterday to speak with the media about the COVID Organics line. He first thanked Didier Raoult, the French scientist responsible for the study of hydroxychloroquine as a treatment. Rajoelina quickly goes on to site the potential side effects of hydroxychloroquine, and that Madagascar’s plant-derived cure is a way to avoid these downsides.
In addition to the COVID Organics tonic, he is proposing a 3rd procedure to test an injectable under the supervision of a regional scientific committee and in tandem with doctors/researchers in the United States.
He failed to state which US researchers would be supervising this injectable, and I couldn’t find anyone claiming to study the active compound in COVID Organics other than a team at Max Planck in Germany.
He also failed to explain potential active ingredients in the injectable, stating that while it was 62% artemisia, the rest was comprised of other Malagasy medicinal plants.
Rajoelina concluded his interview stating that the problem with their cure was that it came from Africa, and others couldn’t accept the fact that the 63rd poorest country in the world created a formula that could save the world.
This last claim of Rajoelina’s is…well, valid. Many immediately jumped on Raoult’s hydroxychloroquine train despite the lack of a control group and the discovery of copy-pasted data from other research. Was this because media and others were more likely to legitimize research that came from a western country?
The COVID-19 Cure: Artemisia
The WHO came out against using untested remedies like COVID Organics, but if effectively tested, artemisia, the plant Rajoelina has cited, could have some potential.
The active ingredient, artemisinin, can be isolated from the plant and has been used against parasites (like those causing malaria), as well as shown potential anti-cancer activity in-vivo. However, artemisinin content in 1 liter of tea made from the plant only contains about 20% of what is contained in a 500 mg pharmaceutical dose.
The WHO doesn’t recommend non-pharmaeutical artemisinin for malaria, and it’s largely because of this discrepancy. There is no guarantee that it will kill all parasites, and if it is used excessively could result in artemisinin resistance.
Feel free to ignore the next two paragraphs if you don’t care about how artemisinin works against malaria.
Hoping it could give me some insight into the potential to work on SARS-CoV-2, I wanted to learn more about its mechanism of action. Artemisinin may work by targeting parasite mitochondria (kill the powerhouse of the cell, kill the cell). Another proposed mechanism is complex and not fully understood, but it might take advantage of the malaria parasite’s inherent functioning.
Malaria parasites can reproduce asexually by entering a host red blood cell, eating the hemoglobin, and growing a lot. The parasite has a digestive organelle called the “food vacuole”. As it digests hemoglobin, it turns it into hemozoin, which contains a LOT of iron. Artemisinins have been shown in lab settings to activate vicious cell-killing free radicals when they come in contact with iron. As there is a lot of iron-containing hemozoin in the food vacuole, it could be that all this iron coming into contact with artemisinins means death for the parasite.
Colonialism and COVID-19
Rajoelina’s distrust of the WHO and western countries is warranted. International agencies have famously bungled or acted insufficiently in many health crises on the African continent.
From its founding, the WHO worried French colonial leaders in Africa, who believed that as an arm of the UN, the WHO would undermine their colonial authority. They did not want the UN to intervene, thus aiding African development.
Soon after its founding, the WHO established regional offices, led from Geneva by physicians in Europe. An early leader in the African Regional Office (AFRO) was public health officer Francisco Cambournac, who believed a potential way to discourage decolonization would be to offer expanded services to countries. Although he advocated for more attention to be paid to Africa, others at the WHO stated that it was “premature” to try and implement malaria eradication in a continent on which malaria was endemic and health systems were underdeveloped. Colonizing countries used this as an excuse to continue their occupation of African nations.
France’s initial fears about the WHO aiding decolonization were resolved through an agreement that allowed for France to have continued power through decolonization. Many Africans saw this as a transfer of colonial power with regard to their administration of health rather than true independence.
More recently, the WHO has been criticized by Africans for their response on the continent.
During the Ebola epidemic, the WHO acted in Guinea in March of 2014, but didn’t raise cause for major concern in nearby countries Liberia, Sierra Leone, and Mali until June despite reports of circulating cases. This delay in response and casual reaction resulted in the WHO receiving strong critiques from Doctors Without Borders. The Ebola epidemic had a significant economic impact on West Africa, with loss estimates ranging from $2.8 billion (World Bank), to $53 billion (Journal of Infectious Diseases).
Some state the WHO has even been irresponsible in its indirect actions. In the Somaliland/Puntland dispute over the establishment of two separate states in Somalia, clashes have broken out, resulting in a militarized border and numerous deaths.
But as the WHO does not recognize Somaliland as an independent state, all of their relief efforts are coordinated through the federal government. This has resulted in insufficient aid being delivered to those in Somaliland, as neither the federal government nor Puntland favors the creation of two states.
There have been many other instances of ineffective management or response by the WHO and the UN on the African continent, and even more
Pseudoscience or Paternalism?
I found myself trying to balance my thoughts towards Rajoelina’s comments. I am incredibly mistrusting of anything that hasn’t been tested in clinical trials, and I don’t trust any “treatments” for which there isn’t scientific evidence (that I’ve been able to read and analyze myself).
Pseudoscience has claimed many COVID-19 cures, and these can be misleading at their best but deadly at their worst. Coronavirus in developing countries is being ignored by Western media, and if it is, it’s probably being used to continue to portray an unfavorable narrative of sickness and death. This doesn’t do anything to change our pre-existing stereotype of developing countries as dirty/unclean/filled with the sick.
A Twitter trend was even going around recently about how American media uses a “yellow filter” to portray developing countries. In Breaking Bad, the scenes in Mexico are differentiated from other scenes with this filter. Just imagine the shock of young Americans upon arriving in a country and finding the sun shining brightly! I’m exaggerating a little here, but the way media shapes our perspective is stronger than we may be willing to acknowledge.
The last thing I would want to do is to suggest that African scientists are incapable of inventing a cure. I think it is important that in the interest of science, there is worldwide cooperation to run clinical trials on potential cures. However, this will likely require the meticulous undoing of years of colonial exploitation and subjugation. We cannot expect to have the trust of African scientists when there is a history of mistreatment.
I sincerely hope that Madagascar’s COVID-19 cure leads us to a solution. But I remain skeptical that the purported COVID-19 cure is little more than snake oil with weak science behind it.
For more content from me, make sure to sign up for my mailing list. (It’s only once a week!) For more on coronavirus in developing countries, click the links below.
In Kenya: Murals keeping the slums safe, Isolation not an option for the working poor
In South Asia: Few cases among a large portion of the world’s population
In Afghanistan: The Taliban fighting against COVID-19
