Nigerian COVID-19 response highlights cultural trust in ethnopharmacology

During COVID-19, ethnopharmacology became prominent in Nigeria due to affordability, accessibility, and cultural trust, but evidence for safety and efficacy remains limited. This review examines ethnopharmacology's integration into Nigeria's COVID-19 response, evaluating strengths, constraints, and future pathways. Common remedies included ginger, garlic, lemon, turmeric, and bitter kola. NAFDAC listed 14 herbal medicines based on toxicological safety, but efficacy requires rigorous trials. Some formulations showed promising preliminary results, but evidence was constrained by small samples, lack of RCTs, and insufficient pharmacokinetic data. Strengthening resilience requires research investment, IP frameworks, and transparent communication.

Introduction

COVID-19, first reported in Wuhan in November 2019, caused over 500 million cases globally within three years. Nigeria's first case was on February 27, 2020. The pandemic exposed healthcare inequities and renewed interest in ethnopharmacology. In Nigeria, ~80% rely on herbal remedies. Common plants included ginger, garlic, lemon, and neem. NAFDAC and NIPRD accelerated evaluation of 14 herbal medicines.

Traditional medicine used during COVID-19

Common plants: ginger (respiratory), garlic (antiviral), turmeric (anti-inflammatory), sweet wormwood (anti-SARS-CoV-2), neem (antiviral), and herbal teas. Key phytoconstituents: gingerols, allicin, curcumin, artemisinins, azadirachtin. Globally, China used TCM, India used AYUSH, Madagascar promoted COVID-Organics, and South Africa used local herbs.

Regulatory listing in Nigeria

NAFDAC listing confirms safety based on toxicology, not efficacy. Listing is valid for two years; cure claims require RCTs. Commonly used remedies included lemon, ginger, garlic, turmeric, neem, pawpaw, guava, lemongrass, scent leaf, bitter leaf, detox tea, anise, and wormwood.

Gaps during the pandemic

Most herbal mixtures lacked clinical studies, pharmacokinetic data, and toxicological evaluation. Safety concerns arose for high-risk patients. IP laws inadequately protect traditional knowledge. Some avoided hospital care, and high doses may have increased toxicity. Misinformation on social media undermined evidence-based measures.

Addressing COVID-19 through ethnopharmacology

Herbal remedies with trial progress:

• IHP Detox Tea (Andrographis, Garcinia, Psidium): Pilot RCT (n=72) showed no deaths (vs. 3 placebo), faster viral clearance. Sample too small for definitive conclusions.

• Niprimum (Andrographis capsule): NAFDAC-listed as safe; trials planned.

• FORTE1 (Moringa, Terminalia, Bridelia, Scoparia): In vitro activity shown; no clinical trials.

HIV: α-Zam (Nigella + honey) and Jobelyn (Sorghum) showed symptom/CD4 improvement in observational studies without control groups.
AMR: Plants with antibacterial properties include Bacopa, Andrographis, Hibiscus, and others.

Limitations

Narrative review with potential selection bias. Most evidence is preliminary or observational. High-quality RCT data are limited. Some indigenous knowledge may be undocumented.

Future directions

Key priorities: scientific validation (phytochemical, toxicogenomic, clinical studies); collaborative research involving traditional healers and scientists; policy and IP protection; digitalisation of traditional knowledge; and exploration of African medicinal plants against SARS-CoV-2, Ebola, and other viruses.

Conclusions

Ethnopharmacology played a culturally important role in Nigeria's COVID-19 response. Some remedies showed promise, but gaps in research, regulation, and integration remain. Future efforts must invest in scientific evaluation, regulatory policies, public awareness, and partnerships. With the right framework, Nigeria can integrate traditional wisdom with modern science to combat emerging diseases.