Bridging Worlds: Can Evidence, Regulation and Indigenous Leadership Shape the Future of Traditional, Complementary and Integrative Medicine?

BACKGROUND AND NEED: As the WHO Global Traditional Medicine Strategy 2025-2034 encourages countries to consider integrating traditional, complementary and integrative medicine (TCIM) into health systems, there is a need to clarify the principal scientific, regulatory, ethical, and governance challenges involved. Renewed global attention to TCIM, including at the Second Global Summit on Traditional Medicine held in New Delhi in December 2025, has intensified calls for approaches that are safe, effective, equitable, and culturally respectful. OBJECTIVE: This commentary examines the principal challenges that must be addressed if TCIM is to be integrated safely and equitably into health systems, with particular attention to evidence generation, regulation, commercialisation, misinformation, Indigenous knowledge governance, and models of health-system integration. METHODS: We undertook a policy-oriented narrative review informed by an interpretive reading of the WHO Global Traditional Medicine Strategy 2025-2034 and related governance frameworks, including the Convention on Biological Diversity and the Nagoya Protocol. We then conducted iterative, non-systematic searches across major bibliographic databases and policy sources to identify literature and examples relevant to five core domains shaping TCIM integration: evidence and economics, regulation, commercial exploitation, misinformation, and Indigenous knowledge. MAIN FINDINGS AND CONCLUSION: Integrating TCIM into health systems requires more than evidence of clinical effectiveness alone. Progress depends on methodological approaches capable of assessing complex and context-dependent interventions; stronger regulatory and pharmacovigilance systems; safeguards against misleading commercial claims and digital misinformation; and, crucially, Indigenous leadership in the governance, protection, and co-production of knowledge, so that benefit-sharing and research priority-setting rest on community authority rather than consultation alone. Integration should be understood as a spectrum, from coexistence and referral to co-location and fully blended models, with implementation shaped by local health-system capacity and patterns of real-world use. Advancing TCIM will therefore require coordinated action grounded in evidence, ethics, equity, and culturally respectful governance.