The Use of Ivermectin to Prevent or Treat COVID-19: A Story of Politicised Endorsements, Unregulated Prescriptions, and Rampant Self-Medication
Ivermectin can be considered a “good drug” if used properly. It is cheap, widely available, easy to administer, usually as a single dose, well tolerated, and benefits both animals and humans. Ivermectin happens to be a broad-spectrum anti-parasitic drug, which paralyses and kills a wide range of parasites- both endoparasites, which live inside the host, and ectoparasites, which live on the skin of the host-making it the first known endectocide. It is commonly used in the developing world, in both oral (tablet) and topical (cream) formulations, and features in the World Health Organisation’s list of Essential Medicines for basic health care systems. But the COVID-19 pandemic has changed all of this, as the unauthorised and unsafe use of the drug has proliferated, leading to worldwide shortages for those in genuine need, both animal and human, and subjecting humans to the adverse effects of the administration of medications originally reserved for animals.
The Ivermectin story begins with the isolation of a soil-dwelling bacterium from Japanese soil samples being studied at the Kitasato Institute in Tokyo in 1974. Avermectin was then identified as the active anti-parasitic ingredient in this bacterium by scientists at the Merck Research Labs in Rahway, New Jersey, in 1975, followed by the synthesis of Ivermectin the same year. This new drug was first used as a veterinary treatment in 1981, and then as a human treatment, for river blindness, from 1988 onwards. The original work on Avermectin and its derivatives led to the award of the 2015 Nobel Prize for Medicine to William C. Campbell (of Merck) and Satoshi Omura (of the Kitasato University), in recognition of the benefits to billions of people around the world from this new class of drugs. Over the years, Ivermectin has been approved worldwide for the treatment of certain nematode (round worm) infections of the eyes (onchocerciasis, or river blindness) and intestines (ascariasis, strongyloidiasis), as well as for skin infestations with arthropod ectoparasites ( lice, mites, ticks) in humans. It has also used as a dewormer in livestock and domestic pets. At the usual doses recommended for humans, it is a safe drug, with few side-effects.
Ivermectin is currently not approved by the FDA, the NIH, the WHO, and the EMA (European Medicines Agency), among other responsible bodies, to either prevent or treat COVID-19, outside of randomized controlled clinical trials. Laboratory studies have, however, suggested that the drug may inhibit the attachment of the spike protein of SARS-CoV-2 to human cell membrane receptors, thereby suppressing viral replication. Knowledge of this “in-vitro” antiviral activity has spawned a number of small clinical trials around the world, with varying results, some in support and some not.
Ivermectin is currently being investigated as part of larger ongoing trials, such as the Oxford University-led PRINCIPLE (Platform Randomised Trial of Treatments in the Community for Epidemic and Pandemic Illnesses), which began on 23 June 2021. Some earlier studies have employed flawed methods, including issues with patient selection, and data collection and processing. A preprint study from Benha University in Egypt, which claimed that Ivermectin can reduce Covid-19 deaths by more than 90 per cent, was thus withdrawn by preprint server Research Square from its platform on 14 July 2021 after unspecified “ethical concerns”. This study was first published in November 2020 and was widely cited, including in a supportive meta-analysis published in the American Journal of Therapeutics, a peer-reviewed journal published by Wolters Kluwer.
Along the way, Ivermectin has become a politicised medication, being promoted as an alternative to vaccination, especially by anti-vaxxers, as well as a silver bullet for the treatment of COVID-19. Demands to be treated with Ivermectin against medical advice have even led to litigation. For example, on 6 September 2021, Judge Michael A. Oster of Butler County in Ohio, overturned an earlier court order forcing doctors at West Chester Hospital to treat Jeffrey Smith, in intensive care since 1 August, with Ivermectin that had been prescribed by a founding member of the Front Line COVID-19 Critical Care Alliance.
Ivermectin has been endorsed by many across the world, and prescribed over-the-counter in South America, Asia, and South Africa. In America, conservative politicians and commentators, along with sections of the right-wing media have publicly endorsed Ivermectin with great vigour, leading their followers to demand treatment with the wonder drug. There has been a sharp rise in “off-label” prescriptions of the drug during the pandemic, leading to bans on unauthorised use in several countries.
Self-medication with veterinary formulations of Ivermectin has been reported from the US, depleting stocks meant to be used for animals and leading to many calls to poison control centre hotlines and visits to emergency rooms. These highly-concentrated animal medications are dispensed in pour-on, injectable, and paste forms and can cause serious side effects in humans, as well as interact with other medications. The FDA has thus had to release an advisory statement for consumers advising against the use of these animal formulations of Ivermectin for COVID-19.
The Ivermectin story once again testifies to the continued politicisation of the COVID-19 pandemic. Distrust in official sources of guidance has led to a proliferation of unconventional and unverified treatments, and Ivermectin is but one of several unproven medications being touted to both prevent infection with SARS-Cov-2 as well as to treat established infections. This unsatisfactory state of affairs cannot remain unchallenged forever, and the truth will eventually triumph.
Ashis Banerjee