On the first international meeting of the
Research
Initiative on Traditional Antimalarial Methods
(RITAM)
A partnership between
The Global Initiative For Traditional Systems (GIFTS) of Health,
University of Oxford
&
The Tropical Disease Research Programme (TDR)
of the World Health Organisation
Held at Tumaini University
of the Health Sciences, Moshi, Tanzania
8-11 December, 1999
Executive
Summary
The first international
meeting of the Research Initiative on Traditional Antimalarial Methods (RITAM)
was held at the Regional Dermatology Training Centre (RDTC) of the Tumaini
University of Health Sciences, Moshi, Tanzania.
This Inaugural Meeting of
RITAM, jointly hosted by the Global Initiative for Traditional Systems of Health
(GIFTS) at Oxford University and the World Health Organisation (WHO), was
designed to develop a strategy for more effective, evidence-based use of
traditional medicines that can also inform malaria control policy decisions.
RITAM was established during 1999 as a network of researchers and others active
or interested in the study and use of traditional, plant-based anti-malarials.
Malaria is one of the key
health issues affecting developing countries, particularly in sub-Saharan
Africa and Asia. With increasing drug resistance and high cost of
pharmaceutical drugs, the use of herbal antimalarials is popular.
The conference was attended
by biological and social scientists, clinicians, traditional healers, and
policy makers from Africa, Asia, Europe and the Americas. The meeting was
funded by the Rockefeller Foundation, the Nuffield Foundation, WHO's Tropical
Disease Research (TDR) Programme, and direct support to delegates was provided
by other funders.
The meeting addressed the
need for research and policy on the prophylactic and therapeutic effects of
medicinal plants as well as on vector control and repellance.
There were five main outputs from the meeting:
1. Targets
for making a significant contribution to the control of malaria through the use
of traditional anti-malarial methods.
2. Methods
for achieving these targets, including ethical guidelines.
3. An
implementation strategy for moving this field ahead quickly and soundly,
and for putting research findings into practice.
4. Linkages
established between researchers working on traditional antimalarial methods,
based on agreed research priorities, and designed to avoid unnecessary
replication.
5. Strengthening the RITAM database of current knowledge on traditional herbal anti-malarial
methods.
Four
specialist groups were established to develop the above:
1. Policy, advocacy and
funding
2. Preclinical studies
3. Clinical development
4. Repellance and Vector
Control.
These
will be coordinated by an executive committee managed by GIFTS. Two meetings
are planned in 2000: a natural products chemistry meeting at WHO in Geneva in
June, and a symposium at the World Congress on Tropical Medicine in Cartagena,
Columbia, in August.
Contents
Executive
summary Page
2
Contents Page
3
Background Page
4
Overview
Page
6
Objectives
Page
7
Summary
of small group discussions Page
9
RITAM
specialist groups Page
18
Summary
of outcomes Page
21
Appendix:
Members of RITAM specialist groups Page
22
Background
Malaria
is recognised as one of the key priorities for the World Health Organisation.
The programme of research that was drafted from the initial meetings on malaria
in Dakar, Senegal, in 1997 included research into herbal antimalarials.
However, while research has progressed in other areas of malaria control,
research into herbal antimalarials has yielded few - if any - results that can
be implemented by malaria control programmes. Discussion of this topic has been
absent from international meetings on malaria.
This
Inaugural Meeting of the Research Initiative on Traditional Antimalarial
Methods (RITAM) was designed to develop a strategy for more effective,
evidence-based use of traditional medicines that can also inform malaria control
policy decisions. The aim of this meeting was to bring together experts on
research and policy on herbal medicines for malaria, to formulate a research
strategy that will make a significant contribution to malaria control
programmes. It will be followed by a natural products chemistry meeting at WHO
in Geneva in the Spring of 2000.
RITAM
The
purpose of RITAM is to facilitate exchange and collaboration among those
studying and using plants in the control of malaria with a view to developing a
coordinated strategy for more effective, evidence-based use of traditional
antimalarial methods.
RITAM
was established during 1999 as a network of researchers and others active or
interested in the study and use of traditional, plant-based anti-malarials.
This has grown steadily from an initial symposium held at Oxford University in
September 1995 on plant-based antimalarials held at Oxford University. This
symposium was part of an international conference on traditional medicine and
public policy organised by the Global Initiative For Traditional Systems
(GIFTS) of Health. A subsequent selection of papers on this topic was published
as part of the GIFTS special issue of the Royal Society of Medicine's journal
TROPICAL DOCTOR (Supplement 1, 1997).
The
establishment of a network of
researchers and others in this field resulted from an undertaking given by
GIFTS at the Symposium on “Plants as Medicines” at the European Congress on
Tropical Medicine in Liverpool in September 1998. The intention to establish
this network was further reaffirmed and developed at the Multilateral Initiative on Malaria
(MIM) African Malaria Conference in Durban, South Africa, in May 1999. In May
1999, a formal partnership between GIFTS and the World Health Organisation's
Tropical Disease Research Division (TDR) was agreed in Geneva with a view to
hosting two related meetings to inaugurate the initiative - the first in Africa
and the second in Geneva.
Traditional
Medicine Use
Utilization of traditional medicine is
widespread in non-industrialised countries. The efficacy of many traditional
treatments have been well documented, including in the area of skin disorders
and allied fields, malaria and other parasitic disorders. Currently, modern
pharmaceuticals are not available in constant supply in those areas most
affected by malaria - particularly in sub-Saharan Africa and in South and SE
Asia.
Furthermore, resistance to major drugs for
treating bacterial and parasitic
diseases has significantly reduced treatment options. Finally, the cost of
drugs, if available and effective, is so high that institutions and patients
are increasingly unable to afford them.
Reports from clinics and NGO’s in Africa, where 80% of the world’s
malaria burden exists, indicate that the poorer members of society are now
using traditional medicine at least for economic reasons.
Herbal
Antimalarial Methods: Developing a research and policy agenda
Malaria
is one of the key health issues affecting developing countries, particularly in
sub-Saharan Africa, but also in Asia. Malaria causes many deaths, much
suffering, and delay in economic development. At present, the cheapest drugs
for the treatment of malaria are becoming ineffective as malaria parasites
evolve mechanisms to resist them. Alternative drugs are often too expensive for
the poor to afford, so in some areas the use of herbal remedies is popular.
The
two most effective drugs for malaria originate from plants: quinine from bark
of the Peruvian cinchona tree, and
artemisinin from the Chinese antipyretic Artemisia
annua. It is probable that other plants contain as yet undiscovered
antimalarial substances. Much research has focussed on trying to isolate and
purify these from plants. However, there has been almost no research into the
clinical effectiveness of herbal remedies as they are used in real life.
National malaria control programmes have largely ignored the potential of
traditional healers, even though they are more numerous and culturally accepted
than conventional health care workers.
Overview
Delegates
The
conference was attended by biological and social scientists, clinicians,
traditional healers, and policy makers, with a wide range of scientific and
professional experience. From Africa, there were 28 delegates from 11
countries. There were 16 delegates from eight European, Asian and American
countries. Delegates were invited because of their work or interest in
plant-based means of controlling malaria.
Sponsors
The
conference was made possible through the generous support of the following
funding bodies. The Rockefeller Foundation contributed US$25,000 to fund
participants from Europe, America, West Africa and Tanzania, and to fund the
organisation and administration of the conference. The Nuffield Foundation's
Commonwealth Countries Programme gave BP£10,000 to fund ten participants from
Commonwealth countries in Central and Southern Africa. The Tropical Disease
Research (TDR) programme of the World Health Organisation (WHO) gave US$10,000
to fund the attendance of five developing country delegates. In addition, three
delegates obtained funding from existing MIM grants, and two delegates were
funded by the International Foundation for Science in Stockholm. Other
delegates raised funds from personal and institutional sources.
Organisers
The
conference was organised by RITAM, as a partnership between the Global
Initiative for Traditional Systems (GIFTS) of Health at the University of
Oxford, and TDR at WHO. The conference chair was Dr Gerard Bodeker of GIFTS.
The conference was generously hosted by Professor John Shao, Vice-Chancellor
and Professor Henning Grossmann, Director
of the Regional Dermatology Training Centre, of the Tumaini University
for Health Sciences, Kilimanjaro Christian Medical Centre, Moshi, Tanzania. The
programme coordinator was Dr Merlin Willcox, and the conference administrator
was Ms Gemma Burford.
Meeting Format
The
meeting consisted of seven sessions on
different topics. Each session had 40-60 minutes of plenary talks, which were
brief summaries of work so far, and key issues to consider in discussions about
future research. The full programme with abstracts is available as a separate
document. These presentations were followed by small group discussions. The
emphasis was on discussion and debate of priorities for future research, research
methodology, ethics, and implementations of findings. At the end of each
discussion, the chairman of each group fed back to the plenary about the
group’s recommendations. These are summarised later in this report.
Objectives
The
meeting was structured according to sets of objectives developed for a range of
themes on research, policy and product development. The purpose of focussing
presentations in this way was to generate a coherent action agenda by the end
of the meeting.
Opening Session
·
Keynote addresses, to introduce the conference format and aims
Session 2: Herbs for
the Prevention of Malaria
·
Do some traditional anti-malarials have a prophylactic effect?
·
Are there equivalent local agents for vector control?
·
What should be the key research targets in this area, and how can these
be achieved?
Session 3: Herbal
Treatments for Malaria
There
were three separate subsections for this session:
a)
Ethnobotanical
and Sociological studies
b)
Pharmacological
studies
c)
Clinical
studies
Each
addressed the same fundamental questions:
·
In the face of resistance to conventional antimalarials, are there
local treatments that appear to work?
-
What are the key research targets for developing the
use of medicinal plants as effective and acceptable treatment options for
malaria?
-
What are the best means to establish efficacy and
safety?
-
Can a methodology be developed for simple application
by rural hospitals, doctors, NGOs?
-
What important ethical issues are involved, and how
should these be addressed?
-
What are the intellectual and cultural property rights
considerations?
Session 4: How to
implement research findings?
·
Can herbal treatments be grown, prepared and used locally?
·
Can larger scale production be developed for servicing national needs?
·
If safe and effective, can local herbal anti-malarials be used as
traditionally prepared?
·
How can herbal antimalarials be incorporated into malaria control
programmes?
·
What ethical and regulatory issues need to be addressed, and how?
·
What are the intellectual and cultural property rights considerations?
Session 5: Networking
·
How to set up research links between different institutions and
researchers?
·
How to develop and disseminate a database of research on herbal
antimalarials?
Closing Session - Summarising decisions made
by the meeting and agreeing on a format for presenting them.
Five main outputs
from Meeting
1. Targets
for making a significant contribution to the control of malaria through the use
of traditional anti-malarial methods.
2. Methods
for achieving these targets, including ethical guidelines.
3. An
implementation strategy for moving this field ahead quickly and soundly,
and for putting research findings into practice.
4. Linkages
established between researchers working on traditional antimalarial
methods, based on agreed research priorities, and designed to avoid unnecessary
replication.
5. Strengthening
the RITAM database of current knowledge on traditional herbal anti-malarial
methods.
Summary of small
group discussions
A.
Plants for Insect Repellance
and Vector Control
Targets for research:
1. Non-pyrethroid insecticides
(long-lasting, no offensive odour)
2. Larvicides (when and where
breeding sites and human populations are concentrated)
3. Repellant plants grown
around houses (but danger of diversion of mosquitoes to unprotected families)
4. Insect growth regulators or
chemosterilants of plant origin (toxicity testing needed)
5. Plants with anti-insect and
anti-plasmodial effect (e.g. Neem, Ocimum)
6. Integrated control (test
each component to check whether each is contributing to control)
7. Test for nuisance vs.
disease control
Methods:
1. Standardised testing
procedures
2. Commercialisation without
preventing “low technology” use
(qv Mitscher et al 1996,
Pure and Appl Chem 68 (2): 2325-32).
B.
Botanical Prophylactics
Targets for Future Research:
1. To find botanical agents
widely used in different places, by lay people as well as traditional healers,
and used in food as well as for prophylaxis.
2. To further evaluate such
agents through
a) Basic safety and toxicity
studies
b) Controlled clinical trials
of potential botanical prophylactics
3. To feed back results to the
relevant communities and the formal health sector
Methods:
1. Epidemiological studies of malaria in different
subgroups, according to:
·
daily activity and behavioural patterns,
·
diet and food taboos (cf diet in the prevention of cancer).
·
NB: Need to control for strain virulence (molecular epidemiology)
2. Sociological studies:
·
planting traditions, “lost crops”
·
“consensus” plants
·
household measures (as well as herb sellers and traditional healers)
·
what is the threshold between prevention and treatment?
·
Rapid assessment ethnographic techniques – but how accurate are they?
3. Ethnobotanical studies, looking at plants with
particular properties:
·
oxidants
·
bitter taste
·
inactive in vitro (IC50 >100ng/ml). This IC50 may be too low for
treatment, but sufficient for prevention of malaria.
4. Case reports of herbal prophylactic
agents:
·
São Tome: some traditional healers take herbs every day and never get
malaria
·
India: some families take the bark of a particular tree before the
monsoon to prevent malaria
·
Nigeria: some people take plants
regularly in order to prevent malaria; others take plants as part of their diet
which may prevent malaria, but without the explicit intention of doing this.
5. Safety and Toxicity:
·
basic safety tests
·
national bodies should accept “customary use” as a basis for going
directly to clinical trials
6. Clinical studies:
·
using students: comparing term-time vs holidays, controlling diet
·
using ex-patriots who are unable to take standard prophylactics because
they travel frequently or go abroad for
a prolonged time.
7. Research Implementation
·
Nutraceuticals could be introduced into food (eg fortifier in
children’s cereal, salt, tea bags)
·
Public health campaigns for people to cultivate and use certain plants
(NB need for correct identification of plants)
·
Commercial product development eg for ex-patriots
·
Traditional healers may wish to promote the use of certain botanical
prophylactics which they strongly believe to be effective even before
scientific proof of efficacy is obtained.
C.
Ethnobotanical Studies on
Herbal Treatments for Malaria
Targets
for Future Research
1. Record existing knowledge
before it dies out
2. Clarify the definition of
malaria in a particular community
3. Search for potential
prophylactic agents
4. Look for plants used
together with western medicines
5. Look for other traditional
medicines / treatments for malaria not involving plants
6. Confirm what is known, add
what is incomplete and correct what is distorted
7. Assess feasibility of wider
cultivation of Artemisia annua and
other antimalarial plants
8. Develop guidelines on the
integration of traditional and orthodox medicine to inform government policy.
Methods need to:
1. clarify the definition of
malaria, and ask about plants used for all symptoms related to malaria
2. interview lay people as well
as traditional healers
3. involve traditional healers
as partners, and ensure that they benefit from the research, for example, by
developing research partnerships and career structures.
4. involve local scientists in
the team
5. build capacity in taxonomy,
and train lay people in differentiating between similar plants with different
activity and toxicity.
6. ensure information is passed
on to pharmacologists and clinicians for further research, so that existing
research results are implemented.
7. feed back relevant
information to the local community where the study was conducted.
8. continue monitoring use of
herbal antimalarials over time, as this is a dynamic process.
Ethics
1. Need to protect intellectual
property rights (An issue here is conflict between IPR considerations and the
prevailing research emphasis on publishing lists of species.)
2. Need informed consent from
the community
3. Need to devise ways to share
benefits, and return findings to the community
4. Need to conserve
biodiversity, for example by encouraging cultivation - rather than collection -
of useful but rare plants.
5. Need to boost product development at local,
commercial and international levels.
6. Traditional healers must be
empowered to articulate their own priorities.
D.
Pharmacological Studies on
Herbal Treatments for Malaria
Targets
for Future Research
1. To confirm the efficacy and
safety of traditional antimalarials
2. To evaluate remedies reputed
to potentiate existing drugs or act as resistance reversers
3. To standardise the crude
extracts produced by healers
4. To prioritise development of
drugs against the pathogenic erythrocytic stages, but also look for
anti-hepatocytic drugs, which would act as a useful prophylactic for the
individual.
5. To develop Standard
Operating Procudures (SOPs) for safety and toxicity testing prior to clinical
trials.
6. To look at ways of improving
herbal preparations by finding ways of standardisation and preservation.
Methodology
1. Clinical observation with
traditional healers before extensive pharmacological tests.
2. In vitro and in vivo (in rodents
infected with sporozoites) safety and toxicology tests should precede human
trials
3. Query usefulness of WHO
microtest kit for rapid assessment of herbal medicines’ activity against
malaria.
4. Need to develop methods for
demonstrating synergism between different components of herbal medicines
Ethics
1. To integrate traditional and
western doctors
2. Need to change policies in
herbal medicines to allow clinical trials with minimal safety and toxicity data.
E.
Clinical Studies on Herbal
Treatments for Malaria
Targets
for Future Research
1. To verify safety and
efficacy
2. To find treatments giving a
good clinical response
3. To find new drugs to
overcome resistance
4. To develop standard
operating procedures, not guidelines
Methods
1. Observation of symptoms and
parasitaemia
2. Randomised trial of
chloroquine vs. chloroquine + herbal resistance reverser.
3. Studies of herbal
prophylactic (locally acceptable herb)
4. Cooperation between
physicians and pharmacologists. Need to define level of safety required and
design protocols.
5. To monitor standardisation
of herbal medicines
F.
Production and Dispensing of
Herbal Antimalarials
Can herbal medicines be
grown, prepared and used locally?
What are the ethical and
regulatory issues?
Can larger scale production
be developed for servicing national needs?
G.
Protection of Intellectual
Property Rights (IPR)
Problems:
-
The Process is expensive (applications for patents, legal fees);
-
It is based on alien, not traditional values;
-
Requirements for patents (novelty, innovatiion, application /
usefulness) favour the ‘single compound’ ideology, not traditional medicine.
Suggested solutions:
1. National Laws to regulate:
a) access to genetic resources
b) equitable benefit sharing
c) regulation of land tenure
system, harmonised within regions
2. Active involvement of
communities in formulation of laws and regulations
3. Empowering the community to
participate in matters relating to regulation of access and benefit sharing
(e.g. form legally recognised local associations)
4. Advocate regulations to take
the interests of indigenous and cultural knowledge at the regional and
international levels.
5. Develop national expertise
in negotiating on IPR related issues (genetic resources).
6. Multidisciplinary technology
transfer bodies.
7. Benefit sharing based on
process and/or products.
H.
Integration of Traditional
and Modern Services
There is a
need to:
1. Better inform doctors about
traditional medicine, through:
a) data collection and
documentation
b) report extent of utilisation
by patients
c) continuing medical education
on traditional and complementary medicine
2. Document safety and efficacy
of traditional antimalarials
3. Standardise methods
(optimising use), while still providing choice
4. Develop a herbal formulary,
giving priority to herbal antimalarials
5. Recognise and promote the
values of the holistic approach (spiritual and body healing), through a
three-way collaboration between the patient, traditional healer and modern
doctor
6. Support the establishment of
traditional healers as a profession, allowing for the development of:
-
trust
-
high standards
-
choice between services, and mutual referral
-
improvement in practice through learning from past
experiences
7. Establish policies (and laws
to support them), through commitment by policy and decision makers, involving
all parties concerned, and prioritising the best interests of patients.
8. Promote the development of a
local industry to produce herbal antimalarials, repellents and vector control
agents.
9. Prevent the extinction of
endangered species, by
-
starting plantations to cultivate medicinal plants
-
creating reserves to protect wild plants
10. Enhance research in
traditional medicine, generating useful knowledge on traditional antimalarials
11. Create a permissive
environment for the continued use and development of traditional medicine
12. Develop training curricula
in traditional medicine, including evidence on the value of its use for
specific conditions such as malaria
I.
Establishing Research
Collaborations
Formal
Collaborations should aim to:
1. Maximise complementarity
2. Transfer technology
3. Share knowledge and
information
4. Define common interests, and
develop research interests together
5. Define equitable sharing of
resources and benefits
6. Find sources of funding
together
7. Set strategies for solving
common problems
8. Obtain results efficiently,
saving time, energy and money
9. Share responsibilities
Informal
collaborations
1. Local / regional / global networks
2. Consortium / Foundation
Advantages:
-
Increase complementarity
-
Easier to attract funding
-
Enhanced capacity building
-
Cost-effective way of functioning
-
Increased chances of success
-
Prevention of duplication
Requirements for
establishing collaborations through RITAM:
1. Initiative must start
locally and expand outwards
2. Partners must participate
actively
3. Sustainability
4. Favourable atmosphere and
political commitment
5. Institutional recognition
and respect of procedures
J.
Database development and
Interactive Information sharing
It is hoped to develop:
1. Online network of RITAM
members (consider restricted access for members only)
2. Online / e-mail newsletter
(NB this should also be available by post so as not to exclude those without
internet access)
3. Database of research on
traditional antimalarials
K.
RITAM Policy and Network
Management
The Role of RITAM:
1. The foremost priority must
be action and research on traditional medicine to directly combat malaria
2. RITAM Policy should
-
not interfere in national and regional policy
-
work to establish networks at national level
-
advocate strongly at the international level.
3. Building institutional
partnerships and collaborations
4. Linking researchers working
on traditional medicine, with those working on active principles
5. To promote an intellectual
property policy reflecting the current high ground, in consultation with:
-
local models in Africa, Asia, the Americas and elsewhere
-
Kew Gardens model
-
Strathclyde model
Proposed
RITAM activities
1. Generating a political response to the
groundswell of support for R+D in traditional medicine:
-
working with ministers at SEARO, CWG
-
developing national and regional networks of natural medicine research
institutes, to develop policy at national and regional level (eg OAU, STRC)
-
to work at level of Prime Ministers for multi-sectoral change.
Legal
and regulatory issues:
-
structures should be revised
-
policy must have vision, mission statement, proactive participants, and
funding.
2. Work with WHO re their policy and activities:
·
conflict between clinical trial protocols and traditional medicine
guidelines
·
not currently promoting research on traditional medicine
3. Work with the medical establishment on:
-
nutritional aspects of medicinal plants
-
synergistic activity among multiple ingredients in herbal medicines
-
what constitutes evidence
-
traditional medicine as part of medical education
-
policy on drug development and role of industry.
4. Developing a database of
existing research (ethnobotanical, pharmacological, phytochemical,
toxicological, chemical, epidemiological), and disseminating information on
traditional medicine – looking at weaknesses of the current system, and how
messages can get into the right system.
5. Identifying and linking
traditional and biomedical institutions interested in research partnerships.
6. Exchange of information via
:
-
mailing list
-
website / online network
-
newsletter
7. Identification of plant
species and families to be prioritised in research on traditional
antimalarials; this may eventually lead to endorsement of traditional medicines
when sufficient evidence becomes available.
8. Helping with funding applications for
collaborative research projects. Projects wishing to use RITAM’s name must be
approved by the RITAM Executive Committee. This will necessitate a rapid
response.
L. RITAM structure
1. Specialist groups have been
formed on:
a) Policy, Advocacy and Funding
b) Preclinical studies
c) Clinical development
d) Repellants, Vector control
and other preventive measures
These
groups will produce protocols and recommend the levels and types or research
required in their areas.
They
will consist of:
i)
A Chairman: an internationally recognised expert in the relevant field,
enthusiastic, committed, and available for consultation.
ii)
A secretary: an enthusiastic, hard-working member to co-ordinate the
specialist group.
iii)
Members, drawn from the RITAM network, through personal contacts,
and by advertising in relevant journals.
Members can be part of more than one specialist group if they wish.
2. Regional Networks to be formed, eg:
·
Link established with NAPRECA (Natural Products Research in East and
Central Africa)
·
South American and Caribbean Network to be formed at the World Congress
on Tropical Medicine in Cartagena, Colombia, in August 2000
3. National Networks will be
formed in some countries, based on individual RITAM members taking the lead on
this in their own countries. The first such network is being formed in India.
M.
RITAM Management
a) Executive Board, consisting of the chair of each specialist group, and other members
as appropriate, including heads of national/regional networks. Dr. Gerard
Bodeker was elected Chair of the RITAM Executive Board for an initial three
year period.
b) Secretariat, based at the Global Initiative for Traditional Systems (GIFTS) of
Health at the University of Oxford.
c) Partnership with WHO
N.
RITAM Funding
Core
funding is required for:
1. The RITAM secretariat and
administration
2. Website, online network and
newsletter development
3. Database development
4. RITAM staff to attend key
meetings
RITAM
may seek funds from funders of RITAM members’ projects, but must not compete
with those members.
A meeting of donor agencies
is hoped to take place at the spring Geneva meeting.
Agencies
to be contacted for support include:
·
AUPELF
·
CIDA
·
DANIDA
·
European Community: INKO-DC
·
FAO
·
GTZ
·
IDRC
·
Institute for Tropical Medicine (Belgium)
·
Institut de Recherche pour le Développement (France)
·
International Foundation for Science, Sweden
·
IUCN
·
The Medical Research Council of Great Britain (MRC)
·
NIH
·
NORAD
·
Nuffield Foundation
·
Organisation for the Prevention of Chemical Warfare (Sweden)
·
The Pan American Health Organisation (PAHO)
·
SAREC
·
SIDA
·
The Third World Academy of Science (Triesle)
·
UNDP
·
VIH-PAL (France)
·
The Wellcome Trust
·
The World Wildlife Fund
RITAM specialist
groups
1. Policy, Advocacy and Funding
Chair: Dr Gerard Bodeker, Chairman of the Global Initiative for
Traditional Systems (GIFTS) of Health;
Chair, Commonwealth Working Group on Traditional & Complementary
Health Systems
Secretary: Dr Merlin Willcox
Priorities:
-
To implement the recommendations of the working groups made during this
conference;
-
To generate support for meeting the objectives of RITAM, both with
respect to policy development and funding, in WHO and national governments.
Responsibilities:
- Responsible for implementing the Recommendations
in Section K above on RITAM Policy.
- Responsible for RITAM network management/
Targets:
-
To produce the first RITAM newsletter, reporting on the meeting, by the
end of January 2000
-
To produce a special publication on the conference, incorporating
plenary papers, as soon as possible
-
To produce articles and advertisements for relevant publications to
recruit new members, as soon as possible
-
To obtain core funding for RITAM as soon as possible
-
To coordinate a meeting of funding bodies at the Genva conference in
Spring 2000
-
To set up the online network of members, website, and initial database
by June 2000
-
To expand Latin American and Caribbean
membership, and possibly set up a regional network, at the conference in
Cartagena in August 2000
2.
Preclinical Studies
Chair: Professor Phillipe Rasoanaivo, Institut Malgache de
Recherches Appliquées, Madagascar
Secretary: Dr. Maria do Céu de Madureira, Centro de Malária e outras
Doenças Tropicais, Lisbon, Portugal
Research Priorities:
1. To develop good ethnomedical
methods, to obtain good data
2. To standardise methods for
the assessment of the efficacy of herbal
antimalarials (in vitro and in vivo)
3. To standardise methods for
the assessment of the safety of herbal antimalarials
4. To standardise dosage and
form of administration of herbal antimalarials
Targets:
1. To develop a protocol aimed
at the rapid assessment of a traditional antimalarial
2. To come up rapidly with
useful herbal antimalarials
3. Clinical
Development
Chair: Dr Andrew Kitua, Director General, National Institute for
Medical Research, Tanzania
Secretary: Dr Jasper Ogwal-Okeng, Head, Department of Pharmacology,
Makerere University, Kampala, Uganda
Research Priorities:
1. To collaborate with traditional healers and
the preclinical specialist group in quantifying the safety and efficacy of
traditional medicines.
2. To develop herbal antimalarial preparations
that are safe and effective
Targets:
1. To produce, pilot, evaluate
and implement standard operational procedures for clinical trials on herbal
antimalarial treatments, prophylactics and resistance reversers.
2. To establish the safety and
efficacy of herbal antimalarials
3. To encourage the use of
effective herbal antimalarials in their traditional forms
4. To establish a database of
effective herbal antimalarials
5. To establish guidelines for
the use of effective herbal antimalarials (by traditional and modern
practitioners)
6. To promote the integration
of effective herbal antimalarials into primary health care
7. To promote training of
traditional and modern practitioners in the use of effective herbal
antimalarials, and enhance a two-way referral mechanism
8. To ensure that intellectual
property rights are respected at all stages
4. Repellants
and Vector Control
Chair: Dr Bart Knols, International Centre for Insect Physiology
and Ecology, Nairobi, Kenya
Secretary: To be elected
Research Priorities:
1. To develop a database for
plant-based repellents and insecticidals
2. To select candidate plants
(considering geographical distribution)
3. Community sensitisation and
involvement
Targets:
1. To develop standard
operational procedures for evaluating plant-based insect repellents and
insecticides
2. To initiate a database of
plant-based insect repellents and insecticides.
Summary of
outcomes
1. Targets for making a significant contribution to the control of malaria
through the use of traditional
anti-malarial methods:
Each specialist group
developed targets in their areas of expertise. These have been listed on the
preceding pages.
2. Methods for achieving these targets, including ethical guidelines.
There was not enough time to
develop these fully during the conference. However, important debates were initiated
in the small group discussions, and will be followed up electronically by the
specialist groups.
3. An implementation strategy for moving this field ahead quickly and soundly,
and for putting research findings into practice.
The establishment of a structure
for RITAM, with definition of its roles, activities and management was a major
step forward. The specialist group on “Policy, Advocacy and Funding” will
continue this work.
4. Linkages established between researchers working on traditional
antimalarials, based on agreed research priorities, and designed to avoid
unnecessary replication.
The unique opportunity for
personal interaction during the conference enabled the strengthening of
existing contacts, and the establishment of many informal research links,
including:
-
Information sharing between traditional healers in Uganda and Tanzania
-
Collaboration between researchers in Portugal and in Mozambique
-
Collaboration between researchers in Burkina Faso and The Democratic
Republic of Congo
-
A project proposal for a clinical trial of a herbal extract reputed to
reverse chloroquine resistance in Madagascar
-
Scientific support from Northern laboratories for Southern
investigative teams
5. Strengthening the RITAM database of current knowledge on traditional herbal
anti-malarials.
Many delegates generously
provided copies of their published and unpublished work for incorporation into
the RITAM database.
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