Many who oppose vaccinations cite Naturopathy, or the practice of holistic and natural lifestyle changes and supplements, to combat disease. The emphasis of developing natural immunity is a critical factor in the field of Naturopathy. There are reports of some countries reaching herd immunity due to extensive vaccine roll out. As said in our earlier article, we wish to reiterate the fact that modern Naturopathy is not against vaccination. This isbecause Naturopathic principles are deeply rooted in Public Health; a fact, many people do not know. We believe in the principle of prevention which is enshrined in public health as well and many others.
Herd immunity occurs when a large portion of a community (the herd) becomes immune to a disease, making the spread of disease from person to person less likely. As a result, the whole community becomes protected; not just those who are immune.
Often, a percentage of the population must be capable of getting a disease in order for it to spread. This is called a threshold proportion. If the proportion of the population that is immune to the disease is greater than this threshold, the spread of the disease will decline. This is known as the herd immunity threshold.
The interesting question is what percentage of a community needs to be immune in order to achieve herd immunity? This varies from disease to disease. The more contagious a disease is, the greater the proportion of the population that needs to be immune to the disease in order to stop its spread. For instance, measles is a highly contagious illness, thus, it is estimated that about 94% of the population must be immune to measles in order to interrupt the chain of transmission.
There is one sure means by which mankind can achieve herd immunity against COVID-19; that is by vaccinating as many people as possible, as has been stated by the World Health Organization (WHO). However, we believe that for successful implementation of Ghana's Covid-19 National Vaccination Program, the Government needs to engage the services of Naturopathic Practitioners.
We are motivated to write this article as a result of a recent Supreme Court ruling in India, which tasked all qualified practitioners of Alternative Medicine to join the fight against COVID-19. The Supreme Court ruled that, AYUSH doctors(homoeopathy, Ayurveda, Siddha, Unani and naturopathy)can prescribe government-approved tablets or mixtures as immunity boosters for COVID-19 patients,but warned them not to advertise asupposed COVID-19 cure.
The practitioners have also been asked to understand that these medicines are being prescribed as add-on drugs along with conventional treatment for the novel coronavirus disease. This is a major boost for qualified doctors of alternative medicine in India to be part of the management of COVID-19.
The order of the apex court was passed as an appeal filed against the August 21, 2020 decision of the Kerala High Court holding that AYUSH doctors should not prescribe tablets or mixtures as cures for Covid-19, but only as immunity boosters.The Kerala High Court order had asked the state government to use alternative medicine only as immunity boosters. The Court had further ordered that alternative medicine such as homoeopathy, Ayurveda, Siddha, Unani and naturopathy be used to enhance immunity to resist the disease.
As a result of the Supreme Court ruling, the government of India, has issued an advisory for induction of trained AYUSH human resources for clinical management of COVID-19. Ayush Ministry has stated that a pool of eight lakh qualified AYUSH professionals will become available for COVID- 19 duties. The Ministry said AYUSH doctors are institutionally qualified professionals and are well-trained in various aspects of medical care. It went on to state that the All-India Institute of Ayurveda, New Delhi which functions as a COVID-19 Care Centre, is efficiently managing Covid-19 cases as of now. The Ministry will support States and Union Territories in the development and conversion of AYUSH hospitals into COVID appropriate facilities. This will add 50 thousand beds, 750 AYUSH hospitals and 86 clinical facilities to the COVID-19 infrastructure.
Considering the current situation in the wake of resurgence of COVID-19, the State and UT Governments have been advised to reach out to all qualified AYUSH practitioners and persuade them to join the COVID - 19 workforces in this hour of dire need. The services of these AYUSH doctors can be utilized in the management of COVID- 19 at appropriate levels. The deployment of AYUSH physicians, Post Graduate students and interns in clinical set ups for COVID management may be done under the supervision of medical doctors and specialists.
The Ministry said, all such professionals who complete a minimum 100 days of COVID-19 duty will be given the Prime Minister's Distinguished COVID-19 National Service Samman from the Government of India.
What is Naturopathy?
Naturopathy or Naturopathic Medicine is the general practice of natural medicines. It is a distinct system of medical practice. Naturopathy is well grounded in the field of alternative medicine. It was developed in the late 1800s in the United States. Today, both naturopathic doctors and traditional naturopaths practice naturopathic medicine. A licensed naturopathic doctor (ND) attends a 4-year, graduate-level naturopathic medical school where he or she studies basic sciences and therapies such as herbal medicine, homeopathy, and bodywork. Naturopaths may attend training programs that vary in length and content, but they usually aren't licensed.
In jurisdictions where Naturopathy is well regulated such as North America, Latin America, Canada, UK , India, and many others, titles such as Naturopath, Naturopathic Doctor or Doctorof Naturopathy are protected by law and it is an offense to use any of these titles without graduating a four year program from an accredited Naturopathic Medical School. Schools with standardized curricula are well recognized by the World Naturopathic Federation (WNF), Canada, as they follow the World Health Organization's (WHO) benchmark for Naturopathy training.
In Ghana, the training of Naturopathic doctors or Naturopath is at the embryonic stage at the Nyarkotey College of Holistic Medicine, which is recognized by the World Naturopathic Federation(WNF). The danger is that, there are many people in the Ghanaian Health System who refer to themselves as Naturopathic Doctors or Naturopaths, but are not true "Naturopaths".
Traditional Naturopaths demean biomedical sciences and believe Naturopathy has nothing to do with conventional procedures. They do not understand what goes into standardized Naturopathic education. The curricula for Modern Naturopathy follow strict biomedical approaches, with Public health being a core component of such curricula. In some jurisdictions, Naturopathic Doctors are allowed to perform minor surgeries.
Why Naturopaths are integral part of successful Vaccination Programs?
In a jurisdiction such as Ghana where there is no legislation on Naturopathy with many people claiming to be natural medicine doctors, it is very important that the Government takes every effort to reach out to these practitioners. The reason being that these practitioners are very influential in convincing the public against vaccines. In Ghana, those who have not studied true Naturopathy are numerous and have relatively minimalist ideas,thus, it will be suicidal to neglect them in time like this. It is prudent that such people are contacted through their various associations or leaders, to explain the idealsbehind vaccination and how important it is for Ghana to reach herd immunity. Interestingly, most of these traditional Naturopaths are also religious leaders.
Recently, a research by the University of Southampton on vaccine acceptance in Ghana has shown that 43.4% of Ghanaians are hesitant towards receiving the Covid-19 vaccineand believe the serum is dangerous and could affect their health.The research also shows 54.3% of this category of respondents say the vaccines may have harmful side effects.However, 82.8% of Ghanaians also say they are willing to take the vaccine when offered the opportunity.
The interesting thing about the study is that, "Among those who said that they were not willing to be vaccinated, reasons included believing that they would experience harmful side effects from the vaccine (54.3%), believing the vaccine to be dangerous (43.4%), and government mistrust (40.0%). Other reasons included not having enough information about the vaccine (23.2%), pharmaceutical mistrust (19.9%), believing that they would be allergic to the vaccine (17.2%), and believing that the vaccine would not work (16.6%)," results revealed.
From the perspective of Naturopathic community, Wilson et al., (2004) conducted a study to determine the attitudes of students of naturopathic medicine towards recommended pediatric vaccines. The researchers sampled all 4 years of students at the Canadian College of Naturopathic Medicine (CCNM) and obtained a response rate of 59.4% (312 of 525). The study revealed that only 12.8% (40 of 312) of the respondents would advise full vaccination; however, 74.4% (232 of 312) of the respondents would advise partial vaccination. Importantly, both willingness to advise full vaccination and trust in public health and conventional medicine decreased in students in the later years of the programme. Their findings suggest that public health and conventional medical supporters of vaccination need to identify mechanisms for engaging in discussion with this population of complementary and alternative medical professionals at an early stage in their careers.
A study by Caulfield et al., (2017)agrees that hesitancy to vaccinate is a complex phenomenon, but there is little doubt that complementary and alternative medicine (CAM) providers have played a role. Their study examines websites of naturopathic clinics and practitioners in the provinces of British Columbia and Alberta, looking for (1)the presence of discourse that may contribute to vaccine hesitancy, and (2) recommendations for 'alternatives' to vaccines or flu shots. Of the 330 naturopath websites analyzed, 40 included vaccine hesitancy discourse and 26 offered vaccine orflu shot alternatives. Using this data, they explored the potential impact such statements could have on the phenomenon of vaccine hesitancy. Their second objective was to consider these misrepresentations in the context of Canadian law and policy, and to outline various legal methods of addressing them. They concluded that tightening advertising law, reducing CAM practitioners' ability to self-regulate, and improving enforcement of existing common and criminal law standards would help limit naturopaths' ability to spread inaccurate and science-free anti-vaccination and vaccine-hesitant perspectives.
Another recent study by Filice et al., (2020) also revealed that in order to address Vaccine hesitancy amongst Naturopaths, guidelines and standards of practice address a number of issues, including vaccine administration, counsel, education and marketing. Hence, as Naturopathy and other alternative organizations further evolve in Ghana, we believe that, as part of a broader "professionalization" initiative, greater attention will need to be directed at their role in shaping providers' beliefs and practices that both support and undermine vaccine promotion efforts.
In 2021, we had one and one interview with a community of Naturopathic practitioners in Ghana and interestingly, out of a population of over five hundred, only one took the jab. Others were not ready to accept the jab! Others were also monitoring the side effects of the vaccine for a while before they take their decision. This scenario is a clear case of vaccine hesitancy among Naturopathic Practitioners.Nonetheless, we believe that, to achieve herd immunity, we need a combined effort in Ghana.
Improving Vaccine Effectiveness with Naturopathy
For Naturopathic practitioners and those interested in Naturopathy, there are many factors that can impact vaccine effectiveness and depends on individual patient basis. The primary factor, of course, is a person'simmune status. We know that the health of the gut microbiome has a huge effect on whether or not people respond to vaccines. And that of course is also going to be impacted by their micronutrient status. For those who love Naturopathy, there is compelling data showing enhanced vaccine efficacy with probiotics in the gut microbiome status. Actually, with some of these micronutrients and these vitamins, it was mixed, based on what we found.
In one interview with Heather Zwickey (PhD) in 2021, published by the renowned Natural Medicine Journal, she explained that the first indication that nutrient status impacts vaccine efficacy happened with vitamin A and measles. There were studies in countries with low economic resources that showed that if children did not have a good vitamin A status, they didn't respond well to measles vaccination and as a result, even to this day, children in countries with low economic resources are given a Vitamin A tablet before receiving a measles vaccination.
In the absence of the Vitamin A tablet, the children would not respond to the vaccine.
Further, she agrees that zinc is one of those micronutrients that affect the immune system, and indeed, it does. However, there isn't enough empirical data to suggest that vaccinations are either more or less effective with or without zinc. Dr. Zwickeynotes: "Likewise, with vitamin C and vitamin D, we want those micronutrients to be at good levels in our body so that our immune system functions properly, but more doesn't necessarily mean more immune response. It's not a 1-to-1 dose-escalation sort of thing".
She is further of the view that, one of the most important thingsare probiotics. Probiotics are important because they affect the gut microbiome. "But remember the microbiome and the immune system are reacting in the gut all the time. 70% to 80% of your immune system is in your gut, so if your gut is healthy and your gut is happy, it can respond better to a vaccination. Probiotics appear to be effective because of the metabolites that are present. Thus, probiotics, in addition to there being bacteria in a bottle of probiotics, those bacteria have undergone respiration, and they've eaten food and created metabolites. Also it is actually the metabolites from the probiotics that look like they are impacting the immune status and improving vaccine function".
However, when asked about prebiotic, she notes: "the thing that I like to remind people with prebiotics is that they aren't necessarily ... I mean, while all plants are prebiotics, your strongest prebiotics aren't necessarily the same plants you say are the healthiest. So, we don't go straight for kale or that sort of thing. Prebiotics, we're really talking about leeks and onions and garlic and those foods that have the really long fibers because that's what your microbiome likes to feed on, artichoke, Jerusalem artichokes, sunchokes, all of those sorts of things".
It is rather sad the Ministry of Health, Ghana,has not shown much interest in incorporating practitioners of Traditional and Alternative medicine in this vaccine campaign and COVID-19 management as a whole. Further, just as the IndianGovernment has approved some traditional medicines and brought all practitioners on board under the supervision of medical doctors; Ghana rather looks down on these people; this could cost the government in the long run.
We believe that, government efforts to attain herd immunity is being threatened in Ghana if policy makers fail to engage all the practitioners of Naturopathy, Traditional Herbal Medicine and other alternative medicine practitioners in the Country, as they play an important role in this fight. There has to be engagement with them through the Traditional and Alternative Medicine Practice Council of the Ministry of Health to educate them on vaccination as well as public health issues.
We also recommend that, it is time to pass the pending Traditional and Alternative Medicine bill to help streamline the practice. The bill should further be enhanced with educational requirement to practice Naturopathy and other alternative practices. Public health rules should be enshrined in the bill as well as done in other jurisdictions to avert future public health crisis. We believe that, it is not too late to engage these practitioners in the fight against COVID -19. Indiajust invited all of them on board and we believe Ghana can do this as well, by extending hands to all Naturopathic Medical Students at Nyarkotey College of Holistic Medicine, Medical Herbal Students at Kwame Nkrumah University of Science and Technology (KNUST) and all practitioners to provide the roadmap to reach herd immunity in Ghana. We believe that failure to reach out to these people could be suicidal for Ghana to reach herd immunity. The time to join hands together is now!
About the Authors
Prof. Raphael NyarkoteyObu, is a renowned Naturopathic Doctor, Chartered Management Consultant, and honorary Professor of Naturopathy, Nyarkotey College of Holistic Medicine, Tema Community 7 , and LawrenciaAggrey-Bluwey, is a Clinical Nurse, Health Services Manager and an Assistant Lecturer with the Department of Health Administration and Education, University of Education, Winneba. She is also a PhD student in Health Policy and Management, at the University of Ghana, Legon. Contact: 0541090045.