The African Union award winner for   outstanding scientific  contribution and the Vice Chancellor of Chrisland University, Abeokuta , Ogun State  Professor Mrs Chinedum Peace Babalola whose research interest covers Pharmacokinetics, Pharmaceutical analysis, Pharmacogenetics of drugs including  anti-malarias, in a chat with CEOAFRICA casts light on the proper way of  using Chloroquine for the management of  the novel Coronavirus and proposed the possibility of using quinine in severe cases of the disease.

There is a lot of confusion about chloroquine therapy for COVID - 19. Why some school of thoughts believe it works, others claimed it does not work and in some cases, it proved to be fatal to patients. Could you please explain why there are discordant tones about Chloroquine treatment?

I have carried out research on chloroquine and quinine several years ago.  We all used chloroquine to treat malaria until the malaria parasites became resistant to chloroquine.    When the COVID-19 began and I began to read literature which reported that chloroquine can kill coronavirus, I got interested especially since those studies were carried out many years ago; precisely early 2000. I was able to understand the mechanism of action, and concluded that this drug can work against coronavirus.

How does it work to fight the virus?

To start with, chloroquine can gain entrance into the virus and stop the replication especially in the presence of zinc. Chloroquine can inhibit a pre-entry step of the viral cycle by interfering with binding of the virus to the cell. Chloroquine being basic is toxic to the acidic nature of corona virus.

Chloroquine is actually currently being used to treat what we called auto-immune diseases especially in the Western world.. Coronavirus disease is an auto-immune disease that triggers cytokine storm whereby there seems to be a fight between the virus and the immune system of the body.

 When is it appropriate to apply Chloroquine treatment?

Study has shown that chloroquine will work best at the initial stage of the viral infection or exposure. There are many stages of the viral infection, around four or five stages. Chloroquine has a long  life span  and if taken as prophylaxis, remains in the body long enough to prevent the viral infection and replication.

But, by the time the virus has bombarded the lungs and different body organs, it will be difficult for chloroquine to work effectively.  So, at that stage, you need a drug that is more invasive and that has anti -viral properties as well as combination with anti-biotics.

Why do we have conflicting results about chloroquine treatment?

 Almost 90 per cent of the authors reporting that chloroquine did not work for COVID-19 reported usage of chloroquine at the severe stages of the disease when it is not very effective.  It will be   too late to use chloroquine by the time patients are using ventilators or are in ICU. . 

Another reason why some authors reported that   chloroquine is toxic is because the dosage being used are too high and so could reach toxic levels.  These are higher than doses we are proposing for chloroquine usage.  Granted, the total dosage should be higher than what is being used for malaria treatment where treatment lasts for three to four days, but for coronavirus, its penetrates many organs and tissues hence, Chloroquine should be used  for a longer period of treatment (minimum of five days) is needed . 

How can the appropriate dosage be ascertained or determined?

The only way we can know the exact dose is when we have done what we call the randomized clinical trials (RCT) including pharmacokinetics. Clinical trials are   real research studies, and when these are done, then we then can come up with the right dose regimen for the disease.  .  In actual fact, some of us are proposing that Quinine will work at the severe stages of Corona virus infection, Quinine can penetrate the body including Blood brain barrier different from chloroquine. Quinine is used for treatment of severe malaria. 

Is there no way you can work in group or in collaboration with others on Chloroquine and COVID-19 Pandemic?

I belong to various co-horts groups that are discussing and working on COVID-19 pandemic. , .  We are discussing and writing papers and some have been submitted for publication including use of chloroquine.  The discouraging thing is that the more we are meeting and discussing, the more the Western world are releasing the negative results on chloroquine.  You know it is a political thing, actually when WHO said no to chloroquine use, you will realise that  the Presidential Task Force also said no, but, NAFDAC said yes, saying that it will continue with the ongoing trials. 

I am in contact with Oyo state Task Force and University College Hospital (UCH), Ibadan for us to begin trials for the use of chloroquine. We are talking.    We also plan to sell the idea to Ogun state government. 

When WHO retracted its decision on the use of Chloroquine, we are happy.   

The National Universities Commission (NUC) called for proposals on COVID-19 and Chrisland University submitted four proposals, and  we are still awaiting a response. In University of Ibadan, we have been contacted to carry out the pharmacokinetics of chloroquine for an ongoing clinical trials.  Any collaborative effort between orthodox and herbal medicine practitioners to find cure?

Nigeria, has almost 8,000 medicinal plants. COVID-19 has assisted in opening up better relationship between herbal medicine and orthodox medicine due to ongoing discussions.

With the COVID-19, NAFDAC has already received a number of applications for registration of herbal products. Also, Department of Traditional, Complementary and Alternative Medicine in the Federal Ministry of Health, Nigeria has also received a number of applications of herbal products for COVID-19 treatment. The same goes with Ministry of Science and Technology.

So, COVID-19 has hastened these collaborations, but whether we like it or not, they (herbal remedies) still need to be tested and proved to be effective.

What is the cost implications of testing drugs or herbal medicines?

To carry out the clinical trials involves a lot of money.  It requires millions of Naira and US Dollars. Apart from saying that we can do something about coronavirus, we also need money to do them and do them well. For example If I am to run a pharmacokinetic study now, it may not be less than N10 million for a good study.

For herbal remedies, we know that many of them are immune boosters which are useful for COVID-19 Some may be anti-viral, but we need to test and confirm their  anti -viral properties and this requires specific laboratories which we really don't have.. The National Veterinary Research Institute Vom, Plateau State is the only place with the type of laboratory needed to test anti-viral activities of compounds.  So, these are some of the challenges.

What do you think the government can do to help?

I have heard of so many billions of naira being donated to states and federal government. I can only request that government should support researchers with funds. . I am aware that the Central Bank of Nigeria (CBN) has just released a call for research grants, which is commendable, but some of the conditions need to be more favourable especially with intellectual property and ownership. If government wants to do something about this COVID-19, it should release adequate funds, set up anti - vital testing laboratories; such as one in each of the geopolitical zones in Nigeria.

Government should also recognise specific laboratories and fund them in a sustainable manner. They can also identify key researchers to be supported and you will be amazed at the results. Aren't Nigerians doing wonders abroad? The person that is heading the trial of Remdesivir in COVID-19 in USA   a Nigerian, whom I also collaborated with.