Notes taken by ICRAF staff – Sammy Carsan. Alexious Mutua, Roeland Kindt, Najma Dharani and Jonathan Muriuki

Sammy Carsan

Opening Remarks: Dr. Dennis Garrity, Director General, ICRAF (see full presentation)Dr. Garrity observed the timeliness of the herbal antimalarial workshop and reiterated the importance of the topic to Africa as it is the most affected continent. Human mortalities especially for children was noted to be the highest in Africa. Garrity observesd that ‘If we are to suppress the dreadful burden of malaria on Africa and other tropical regions we must involve the private sector more’.

Following on the various continental declarations such as the Abuja declaration in 2001 and the Global Roll Back Malaria (RBM) partnership in 1998, several antmalarial goals are found to suffice. These include:

Potential for combination therapies Use of herbal treatments such as Artemisaia annua, germplasm adapted to African

conditions and novel opportunities to combines Artemisia cultivation with growing of other anti-malarial trees such as Annickia, Cryptolepsis, Trichilia, Vernonia, Warburgia and Zanthoxylum to produce what we call a herbal combination therapy (HCT).

The need to target home cultivation for such herbal treatments.

However, if we are to suppress the dreadful burden of malaria on Africa and other tropical regions we must involve the private sector more. It is a privilege in this meeting for ICRAF to team up with Centre for Development of Enterprise of the EU.

ICRAF has for 10 years been engaged in work on medicinal plants, and contributed significantly to the scientific body of knowledge in species such as Prunus africana, Pausinystalia johimbe, Baillonella toxisperma, Annickia chlorantha and Warburgia ugandensis. Our interest in medicinal plants can be seen by the fact that 2/3rds of all medicinal plants are woody, and many of the roots and bark of these woody species are used to treat malaria.

Opening Remarks: H. Dodet-Malenge, CDEShe thanked ICRAF and staff for contributing to hosting the herbal meeting.A background of CDE was given. She observed that the CDE is an institution of the ACPP group of states and the European Union in the Framework of the Cotonou Agreement. The CDE works in cooperation with development partners in local, public and private sector. Highlights on CDE include:

CDE headquarters is in Brussels with at least 60 persons. There are field offices in Nairobi, Garborone and Senegal

It’s funded by the European development fund estimated to be $20 Million/year.

Beneficiaries: All small scale, medium size and large scale enterprises that are technically sound. They must meet minimum criteria such as: assets of €50,000, employees- 5 persons

A company undergoing expansion and diversification project could access direct or indirect gains.

CDE also helps intermediary associations such countries chamber of commerce CDE’s range assistance range from subsidies to non refundable support Beneficiaries could seek complementary support. CDE also operates a network of associate consultants CDE operates in selected priority areas for instance plant and medicinal is a

priority sector. CDES Herbal project aims at: improving herbal health productivity, and improve income through herbal products trade.

Participants were challenged to raise proposals to benefit from the CDE funding.

Remarking on the Africa Herbal Antimalarial Workshop Mme Dodet, observed that, the meeting is targeted to gauge financial resources mobilization. Other important issues at hand include:

Addressing standard development issues and herbal products regulation. The meeting needs to seek integration of the private sector and help with product

development, good agricultural practices and planning processes.

In the 2006/7 promotional activities for products within the EU has objectives such as: Assist many Artemisia based projects Assist African Standard Association to complete technical aspects usable as trade

standards An ACP producer to produce ‘Karate’(?) and assist in development of a range of

products

Sustainable sales of products and income generation: The strategy will be: To manufacture and sell African herbal products Safe making

Opening Remarks: Dr Judith Bwonya, Deputy Director For Medical Services – Kenya (see full speech)

Dr. Bwayo, noted that malaria was great social and economic problem in Kenya. With over 200 million infections and 2.7 million deaths annually worldwide all approaches need to be mobilized to control this disease with urgency. It was noted that Kenyans are especially at a risk of the deadly highland malaria type. Kenya recognizes the role and contribution of herbal medicine in fighting the pandemic and now the use of combination therapy. There is need to change first line treatments in hospitals and health centres from quinine formulations in accordance with WHO recommendations.

It was observed that the Kenya Medical Research Institute (KEMRI) has taken great strides in herbal and traditional medicine work, with a great deal of research on the same.

There is need to put in place product regulations and the meeting was well placed and timely in discussing the cultivation and preparation of herbal products.

Several challenges affecting malaria treatment were observed to include: Logistics of distribution: poor rural accessibility was hampering drugs reaching

the population that needs it most. Government related bureaucracy: ‘we know what we should do, but yet

something hampers us from doing it’She observed that Kenya is at an advantage to develop learning experiences from developed countries that have contained sufferings of related pandemics.

We further need assistance in developing regulations for herbal treatments How do we access products from Ghana, china, S. Africa, Uganda

How do we coordinate the supply chains? There is need for enhancing the capacity of training institutions, processors and

herbal users.

Alexious Mutua

Malaria in Africa, present drug status

- It is more prone in the Sub-saharan Africa- Price – the drug has to be affordable

The researchers or scientists should assist African Traditional herbalists to put the medicine where it is needed. This should be done faster and it should be cheap.

- There should be direct assistance to the people so as to give targeted support- The level of counterfeit antimalarials in the market must be taken seriously so that

the researcher’s work is not futile

African medicinal plants against malaria – RITAM

- The traditional medicine should be used with caution on;i) Pregnant womenii) Children under 5 years of ageiii) Non-immune patients

- Use of low doses may lead to resistance- Neem tree is also used to treat malaria, though there’s no evidence of 100% cure- Other uses of medicinal plants against malaria are;

i) Insect repellantii) Vector controliii) Treatment

Problems of commercialization of herbs in Africa

- Bureaucracy – takes long to reach the target- No effective way of registering herbals- Safety is a fundamental issue- Whenever good results are produced, they should be tried immediately. People

should not be left to die

Cultivation of Artemisia annua – links to the market

- Artemisia annua tea is efficacious – the dosage is 7 ltrs per day to treat malaria. This is a problem especially for children considering that it is bitter.

- Herbal tea is used for other kinds of fevers, but the artemisinin is used to treat malaria

- Artemisia annua is a tiny seed – it should be handled carefully- Artemisia annua grows in temperate and sub-tropical areas. It requires 700 – 1000

mm of rainfall- It needs good drainage and moderate fertility PH over 5.5- It should be transplanted- Harvesting is labour intensive

- It can be intercropped with a range of crops eg ginkgo

AAMPS, developing use and economic potential of African medicinal plants

- Get people from all over Africa, and especially from West Africa for ideas about the species involved

- Priority plans for involving specific countries is obtained by the growers’ and exporters’ potential among others

WHO’s position on combination therapy- Formula consists of traditional medicine, therefore if there’s no formulae, it is not

a traditional medicine.- WHO provides technical and financial support to the researchers- The pharmaceutical dimension - must look for safety in the traditional medicine.

This should be done from scratch, go through all the process until you finally get the pharmaceutical design

Roeland Kindt

1030 Review (Rukunga) Summary is provided in booklet in everybody’s bag, already reported

Random selection is not comparable to ethno-medical basis of selection in terms of safety

IC50s: figure to use whether compounds are active or not

In most screeners, safety is very important, therefore CC50

The higher the selectivity, the more promising the product (1 is not good)

It is a big problem to find the active compounds

The toxicity is a big problem after in vitro assays

All brands in the booklet mention the IC50s.

Sometimes organic extracts of category 2 become category 1 and other way around. You should select from the families that were shown in category 1 and 2.

Warburgia: category depends on plant part – bark is different from leaves. This is the case with most species

DiscussionQ: Methodology. Many plants have IC50s tested in many publications of different types. For neem, there is a large range of IC50s. How did you select the value?

A: Sometimes plants are in categories 1 -3, because different plant type, different extract, … I tried to place them in one category.

Q: You have used IC50 values. Why not take the selective index? Maybe the toxicity may be caused by other factors, but could you have used another parameter. Either look at highly active in moderate amount, or at other options. Make selective index with limits that excludes products with moderate activity. A: it is valid, but it is difficult to find it in the literature. Therefore the baseline IC50 was used. What you suggest should be the next step. Only 20-30 publications would provide that information because of limited funds for most studies. Most journals now want to see the phytotoxicity, but this was not the case in the past.

Comment: Many people killed the patient before the toxicity. If a certain taxa has a low IC50, it is promising. Now we need to look at the stability of the product, because the shelflife may determine the active ingredient.

Comment: When you measure phytotoxicity. It is better to combine several criteria. You should discriminate between IC50 and phytotoxicity. Sometimes you have high IC50 and high toxicity, so you need to be very careful with fraxination.

Q: If you have additional information, this would be very useful. Maybe we as business people need to get the top-10 species, this would be very useful. Are we anywhere near there? A: What is contained in this group is the baseline. Now we need to select the top-10 from the data that we have as a next step.

1050 DR Congo (Kahunu) DR Congo takes up a big space in the centre of Africa

Four vegetation zones

It is the biggest country in the area of the world with highest incidence of malaria (savanna with 90%)

CQ: chloroquin

SP: sylfaphatoxin

Q: Quinine

AQ: ammoniaquin

Tests in Rutshuru were exceptional in being very high for failures

Criteria for selection of 124 medicinal plants, involving tests of therapeutic efficacy: (you should cure and not kill) and on ease of cultivation. Only two candidates were selected for standardised preparations that will be tested in clinical studies according to WHO protocols.

Comment: DRCongo remains a key underinvestigated area

Q: Which part of the plant is used of Cassia (?) occidentalis?

A: These are the leaves. When you would use the bark, you will also destroy the trees. It is better to use the leaves and not destroy the tree.

1110 Kenya (Yano) In 1957 Kenya was not independent yet, we inherited the act. It is disappointing to

me as a lawyer that we have not modified it yet. We may want to start piecemeal.

The act is affected by a lot of other acts.

For herbal preparations, all that we do when there is no significant claim on the medicinal properties is to simply give a bill of no objection. There is no legislation. The practitioners of traditional knowledge do not have a curriculum, but they are administered under the ministry of culture. It is considered tradition and historical inheritance. We can not discard it as rubbish since it helped people for a long time. The traditional medicine therefore needs research and standards. Registration is difficult because of trials, post-market investigations… This is not practical for traditional medicine. It has a lot of secrets and borders to withcraft (which it is not). You should not appear to be stealing knowledge. We need to be open. The Nigerian example is quite good.

Counterfeits are a major problem here. If we as an international community address this, then we may find out that chloroquin is not failing, but counterfeits are.

The vision is for the regulatory authority. We want to safeguard the people.

The major problem in terms of regulation during fast tracking of preparations. WHO suggests that monotherapies are faced out. If we do this, we risk of being sued. There are intellectual property issues.

Q: Authorization of other products. The no objection issues. Is there any stimulation of local manufacturing. Are there some guidelines for complementary products, so that new regulations may come into place (some things drafted 5 years ago). I am from a bioscience institute.A: Special letters are given to local authorities, you need a no objection-letter. The guidelines that were published had some stringencies, so that the stakeholders resisted. There were rules under section 43 and the AGs did not sign. They could not meet the draft, so maybe we have something before the end of the year.

Comment: We can not verify everything. I was in a debate on the BBC World Service last week. We need to define what traditional medicine is. Witchcraft is often involved, so we need to move forward and need to separate what is verifiable from what is not.

C: This could be the topic of a fourth working group.

A: I did not want to give the impression that they are the wrong people. I only said that only if they are open enough that we can accommodate them. At the ministry of culture, they do not verify anything now.

Comment: I want to advise that before you give a no objection-note, you should send the products to KEMRI. So you are sure that the product is safe for the product. It is also advisable to come up with a law that recognises traditional medicinal practice, so that a council can be established that will regulate the practice of traditional medicine. We have such structures in place in Ghana. Things need to pass trough the centre of plant medicine before a product is registered and can be marketed. In this way, confidence can be build onto products.

A: Our regulatory role with KEMRI would need an MOU, so that you do not have competing organisations

Q: How much does it cost to register one product?

A: We do not register herbal medicine, it is illegal. We charge 1000 dollars for other products.

A: If you have any products, bring it to us and we will either give a letter of no objection of not. We are having some wars with the Kenya board of standardisation which do not have all the capacity.

1130 Uganda (Kyeyune) I come from an institute that is about biodiversity primarily

Here I will only talk about herbals

We are a small department, but that are plans to formulate the Uganda National Health RO

We are coming up with a approach to link with various colleagues so that we minimize resources

The ministry of health has recognised traditional medicine. We follow WHO regulations. We have 20,000 healers each for 100 patients, this is better than 1 doctor for 20,000 patients.

There is a caption of making announcements.

Only 40% of Ugandans used synthetic medicine.

The WHO suggests that if you add a synthetic that the combined product is no longer a herbal medicine

The WHO has a lot of guidelines, so all you need to be is under the Ministry of Health as the right ministry.

The witchcraft act is only for bad people, not for people that do healing.

Most Ugandans are in levels 1-3, imports are in level4 (50 USD per import; only to let us know that you are there). We had a problem of many products from China or South Africa (for example for slimming) in the past, now we have a policy.

Nutrition and malaria linkages are important to us

Comment: Last time that Grace was here, she was very full of some products. Grace used to comment on racehorses in her previous life.

Q: Can we get a copy of your guidelines?

Q: Are you registering products?

A: We work in partnership. We assist people to fill in forms and have a laboratory. There is only 20,000 UShs registration.

Q: Maybe there is a conflict of interest. You work with people and advise.

A: We only give guidance to the herbalists, if they are not sufficient.

Q: What are the criteria to differentiate witches and others?

A: The colonialists made the witchcraft act. Now we see that there is good in it such as biodiversity. The council will have various councils. The healers are registering themselves as NGO. When the regulations come, they will be ready.

1150 Ghana (Dery) I threw away my presentation after what I saw yesterday. I had spent a week on

making it. It tried to find a lot of information and prepared the paper. I ran to the ministry of health, other bodies such as food and drugs boards, traditional medicine practice council, even contacted research organisations. So why did I throw away such a good paper.

The paper was not good enough. It did not bring the diverse perspectives that Dennis Garrity mentioned in the opening remarks. Therefore I do not have a paper.

However, I will ask only one question. Maybe it will lead us in a different perspective. This question is: how many of you do not know about the poverty reduction strategy papers? Show your hands. (four people raised their hands). This now gives me the confidence to start the discussion from the PRPs, this is another opportunity to discuss the PRSPs.

One more question: what are these PRSPs? The PRSP of Ghana like many countries reviewed the second-generation PRSP. I have the copy here. I was in parliament last week to listen to the debate. The document for Ghana is a strategic policy framework, the blueprint for development of Ghana. It is linked to the budget of Ghana. It is linked to the multi-donor policy support programme, for all the donors except for Japan.

The question is what we hope to get out of the PRSP? (read out from it) Malaria is mentioned in the PRSP. So the question is whether there is a window of opportunity for malaria research? There is nothing in the document about herbal anti-malaria products. However, also in 5 PRSPs that I saw, genetic resources were also not mentioned. The essence of what we do should be linked to poverty reduction. We should therefore use the national frameworks and see how we can do this. Should we leave it to the politicians, or can we influence the debate.

Comment: Bruno wrote a book on 300 medicinals from Uganda. Africa gets 8 billion dollars of total 30 billion dollars aid money. Uganda’s budget gets most from overseas. If we need to capture the development money, we need to follow the documents. We are not doing a good job in getting in the documents? What should we do to change the documents?

Comment: The PRS in Nigeria was a Clinton initiative that was forced upon our countries. This was to spend the money from the debt relieve. It is a new strategy by the

government and has now incorporated the millennium development goals. The investment in malaria was 7.8 billion for HiV, TB and malaria from Nigeria. It is a very good initiative and the money goes into research, procurement, capacity and many others areas. It is a very good window of opportunity. We need to coordinate and impact on it.

Comment: In some countries we have various things, now MDG, later new acronyms. Now there is indicator 28, but nobody in this room has any document that makes the link to this indicator. There was no argument. We had Sachs here two months ago. The philanthropists gave money for the millennium villages. We need to stack up the shelves so that the anti-malaria is available.

1210 Nigeria (Ubale) I am representing my boss who could not be here

The pride of Nigeria in herbal medicine is very large since 2001 after my boss took over (Dora). We have achieved a lot since then.

I appreciate WHO inputs and some of our own people so that we have no regulatory controls.

Since we are diverse, traditional medicine is widely practiced and accepted by our people.

I do not talk about witchcraft, but about spiritual ingredients. It is only traditional medicine within your own country, not when you export it.

Corruption is so high that there is no primary healthcare left

NAFDAC is a parastatal under the ministry of health of Nigeria

Many cases of toxicity in hospitals because of herbal medicine caused an alarm. Then the government started to put things together such as a law for traditional medicine. The law went through a first reading and will be passed soon. After it is passed, you will need to register as a traditional healer. WHO had to support us to get the law together.

Healers do not trust the government or researchers. Researchers take their knowledge, but do not give anything back, so they loose confidence.

We have a law about drugs, which includes herbal drugs as one category of drugs.

It is BDCP, not BDPC

Three categories for all medicinal products. There is another category that is just between one patient and one healer that just stay within the community. We do not see these.

We only look at toxicity and microbiological studies, and do not allow products to leave Nigeria, for listing. For full registration, reports of full clinical trials are required.

Without a NAFDAC number, a product is considered to be counterfeit.

Problem is particularly promotion. There are a lot of bogus products that come on the TV since they claim that anything can be treated from A-Z. We have won in some cases against those making such wrong claims.

New AMD1 product against malaria after phaseII trials now and now ready for phaseIII trials. It will soon be on the selves if it passes.

C: A lot of information here as in the previous ones.

Q: AMD1, is that a new drug?

A: Yes

Q: You have the traditional medicinal council. Under which ministry is that?

A: Under the ministry of health.Q: Could you clarify the protocols to register?

A: The protocols are very clear. For big diseases, we try to encourage. The protocols are not exempt for AMD1. These are developed with WHO and are on our website.

Q: How do you register without a law?

A: We can already register the products, not the practitioners for which there is no law yet.

A: The registration fees are for local entrepreneurs (100 USD), but for import it is 3000 USD. We thus encourage the local entrepreneurs.

Najma Dharani

Kuriga Kunyiha: Providing private equity solutions

Aureos capital – fund manager investing in small scale enterprises

CDC – capital and development

Purposes- how to develop local capacity- how to finance the local capacity

Operations in Far East, Indian sub-continent and East Africa

In East Africa – 72 million (Currency?) fully invested in Uganda, Kenya and Tanzania – representative investments are in Brookside, AAR, Steers etc

PE is medium to long-term risk provided in return for an equity stake in potentially high growth unquoted

PE – around the world

PE – industry well established in US and Europe

Advantages of PE funding- provision of capital- improved corporate governance- access to third party capital

Aureos investment criteria- Experienced management- Regional growth ambitions- Adhere to Aureos Corporate governance standards- Alignment with AEAF on exit rights and shareholder protections- AEAF risk capital package

AEAF target transaction type- Expansion of profitable business of regional scale- Working with large-scale shops- ..- ..

Why Aureos- Partnering philosophy- Strong track record of private equity transactions in East Africa- Focus on helping skilled managers build world class companies

- On ground local presence- Packed by a blue chip investor base

Q. How many projects have you funded in Local pharmaceutical or in the natural products industry in Africa?

A. Two pharmaceutical companies but not much in the natural products

Q: What is the minimum rate of investment?

A: Half a million to above. If there is interest to invest we take significant minority stakes and emphasis is on equity funding

Q. In the case of Shelly’s and Beta, what value was added to Beta because Shelly’s was bought by Beta?

A. We invested in Beta

Q. How can one approach you for example in a case of one coming from Central Africa?

A. We have a website which one can visit and get all the necessary information

Dr. Ramesh Pandey: Challenges in the development of herbal products as prescription drugs

I want to draw the attention of the group to the fact that in US, herbal drugs are called food supplements

Definition:- A herbal drug/medicine are phytochemicals or phytomedicine plants

Some facts- Total world drug market = US$ 170 billion- … - …

Factors responsible for resurgence of plant based products – western world is moving from pharmaceutical to phytopharmaceutical

Hurdles in phytopharmaceutical- lack of information- poor harvesting- poor agricultural practices- poor propagation- lack of current manufacturing

To overcome hurdles- good agricultural practices- management- quality control- legal framework

Legal framework- drug regulations- agreement should be legalized so that herbalists from third world countries can

benefit

Ministry of health in Nigeria invited speaker to Nigeria because there was a herb which could cure sickle cell diseaseAbout 4 million sickle cell disease patients die of malaria in Nigeria

NICOSAN TM (NIPRISAN)

Preparation of standardized, optimized

To develop the analytical method

Q. How easy or difficult is it to grow (cultivate) plants useful in the treatment of sickle cell disease?

A. There are two plants one seasonal and one not seasonal

Dr. Mohammed Farah – The WHO Uppsala Monitoring Centre: WHO collaboration centre for international drug monitoring

WHO started from many countriesUppsala monitoring centre developed in Sweden in 1978

Africa in WHO has official members such as SA, Morocco, Tunisia, Tanzania and others and associate members such as the DRC

The herbal market in South Africa has everything labeled with a very sticking feature such as Warbugia salutaris

Artemisia annua plant grows around BelgiumThe clone from China contains 1.1% of artemisininThe Artemisia plant leaves have been used as pesticides and in many other ways of prevention

Artemisinin has got many other activities – Cytotoxic, Neutotoxic and pesticidal

Active ingredients in Artemisia annua – formula has been shown hence one can synthesize the artemisinin compound

WHO record number

Q: Why do we need all these derivatives which you mention and at the end you still come back to artemisinin?

A. Because of solubility issues they take to derivatives. Derivatives are very effective and quick

Q. What about Artemisia tea, have you done any study?

A. No they have not done any research on the tea. Please contact us and we can work together

Nyine Bitahwa and Anke Weisheit – Rukararwe PWRD Uganda

Thank you for giving me this last minute chance to talk about our programme

Let’s talk about the availability of endangered medicinal plant species

The project was established twenty (20) years ago and they use only herbal medicine. They collaborated between scientists and traditional healers. They were enemies but they brought them together

Rehabilitation of the lost forestTwenty years ago, the forest was lost. They planted trees twenty years ago which they are now using for their medicinal purposes.

PropagationCollecting germplasm with the healersGenerating propagation trialsVegetative propagation trialsProduction of tree seedlings

WHO reports about 90 – 200 species disappearing everyday from Africa

Herbal garden establishment

TrainingTo train traditional healersPropagation and tree nursery managementSustainable harvest and handlingDocumentationHarvesting techniques

Herbal medicine processingUsed driers (not fancy ones but basic)

Herbal medicine improvementProduce some products and sold them and the generated money used for tree planting

Prunus africana is one of the endangered species in Uganda used for making charcoal, firewood and making huts

Jonathan Muriuki - General Discussions (after all presentations)

Comment (Ellman): I would like to receive comments from participants of this meeting on the production manual developed by FAO with the good agricultural practices recommendations then I can forward them to FAO

Comment (Yan): Last year after WHO meeting I produced a brochure but it needs to be revised for distribution. It is not difficult to plant Artemisia as it is found all over China. The problem is that the varieties suitable for malaria are not available everywhere and different compound levels are found in different places. The Artemisia with oil compounds is not good for malaria treatment so as Guilin Pharmaceuticals we only select materials from some places

Q (Bitahwe): How big is the problem of malaria in China?

A (Yan): It is only a problem in a small part of China

Q: Movement of plants in Africa between cities and countries is regulated by phytosanitary certification. How does this affect movement of herbal compounds?

Q (Henriette): Besides selection of seeds, does the soil make a big difference to the quality of Artemisia?

A (Yan): Temperature and soil must be considered in selection. It is best in places where day soil temperature is very high and low at night

Q (Dagne): In Africa only Anamed is distributing seeds; is it possible to get the best seeds from China?

A (Yan): The problem is complicated because to export seeds from China one must be permitted by the government

Comment (Tony): ICRAF has an office in China and an agreement with the China Academy of Sciences to ship germplasm from China for trials in Africa

Q (Barney): Where can we find information on new extraction systems because the ones being used are expensive?

A (Chapman): There is no need to reinvent the wheel. There are plenty of systems in the pipeline but they have not been validated. Stick to whatever is expected to deliver

Comment (Pilloy): A study is being conducted in England to compare the pros and cons of different extraction systems and results are expected in July

Comment (Philips): In extraction the key issues to look at in order to select systems should be regulation and costs

Comment (Kyeyune): The problem is that donors are willing to fund systems that have been proved to be credible but not those who conduct research to develop systems. Tax waivers on machines are also an issue in many countries

Q (Icharia): On access to funding, do we have other linkages for support apart from CDE offers?

A (Lore): Bridgeworks Africa supports product development and start up capital in partnership with research institutions to develop viable enterprises. Other funding is available but donors need to dig up information on the prospective enterprises. Tax waivers are available in Kenya if the enterprise model is on EPZ style and incentives will be available soon to support venture capital.

Comment (Giblain): It appears much easier to get funding for bigger scale ventures than smaller ones

Comment (Ndiege): If funding institutions were interested in big business because of guarantees, there ought to be a way support can be channelled through research institutions.

Q (Attafua): Because of WHO recommendations many countries are discounting other antimalaria products. Is it WHO that is to give guidance on these?

A (Ondari): All decision about regulation, distribution and treatment aspects is done at national level. However, WHO recommendations do not rule out multi-combinations as long as they can be monitored at national level.

Q (Phillips): What about the issue of teas and whole plant extracts since the question will not go away?

A (Barney): It is difficult to judge the issue until the question of teas encouraging resistance is resolved. If it is proved to encourage resistance, then teas should be made illegal as it is criminal to subject the only working treatment system to failure and cause people to suffer more.

Comment (Ondari): This validation of resistance research may never be done hence the need to be cautious. Use of teas at household level is OK but commercialisation may lead to bad exposures hence the call for caution

Comment (Omoniyi): Artemisia is a plant that has been used in China for a long time and there is need to continue research in order to identify alternative treatments even from other African plants. It would actually be criminal to close questions on the issue.

Comment (Ndiege): We are already hearing of the parasite developing resistance to artemisinin in places like Vietnam hence there is need to do more research to identify

other options. It would however be more criminal to deny people affordable treatment when it exists.

Comment (Vlietinck): When antibiotics started they were called wonder drugs but resistance has developed in fifty years. It is good to have a cocktail of everything to safeguard against over-reliance on a few which may fail in future

Comment (Yusuf): Regulatory processes should be bottom up with information generated at the bottom and regulations changed as appropriate. In cases that prove accepted procedures wrong then when can change.