Ivermectin Doesn't Work: Why is it Part of India's COVID Protocol?
Why is Goa using Ivermectin as a preventive COVID treatment, when the drug's developers themselves warn against it.
The Goa government has announced that it will be giving the anti-parasite drug, Ivermectin, to everyone over the age of 18 irrespective of their COVID status, as a prophylaxis (preventive) treatment, effective immediately.
On Monday, 10 May, Goa Health Minister, Vishwanath Rane, took to Twitter to make the announcement.
This decision, however, hasn't gone down well with doctors, researchers and health experts who assert that the drug has no scientifically proven prophylactic property when it comes to COVID.
Speaking to FIT, Dr Chandrakant Lahariya, epidemiologist, and public health and policy expert says, "We need to remember that any medical decision should be based on scientific evidence, which seems to not be the case here.
"Going for a public administration of a medicine when there is not enough scientific evidence is not something I would recommend. "Dr Chandrakant Lahariya, Epidemiologist, and Public Health and Policy Expert
"With the rise in cases, there is certainly a concern in the state, as it should be, for a policy response. But the question is, is it (Ivermectin) the right drug to be used in this situation, and why are we using it in the absence of sufficient evidence?” says Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University.
In a previous article, FIT detailed why Ivermectin should not be used as a prophylactic to prevent COVID.
Even at the time, all major health authorities of the world, including the World Health Organisation (WHO), the US Food and Drug Administration (FDA), and the European Medicines Agency (EMA) had discouraged the use of Ivermectin for the treatment of COVID.
What is Ivermectin?
Let's back track a bit.
Ivermectin is a deworming drug used to treat and prevent parasites in animals, particularly in horses.
In humans, it is used to treat certain intestinal and topical parasitic worms and skin conditions.
How did this deworming drug come to be used for the treatment of COVID?
At a time when little was known about the infection and no effective treatment was available, the drug became one of the many experimental drugs prescribed around the world by doctors based on some anecdotal evidence to help alleviate severe symptoms of COVID
But with time and further investigation, Ivermectin's effectiveness in treating or preventing COVID was refuted, and in the context of COVID, its use has been discouraged since.
According to Dr Lahariya, prescribing treatments based on individual evidence would have been acceptable at the beginning of the pandemic, "but now, large scale studies have been done, and that is the evidence that must be used."
“So far most health authorities that have examined evidence have not found anything substantial to indicate that Ivermectin should be used either for treatment purposes nor as a prophylactic," adds Dr Bhan.
However, Ivermectin remains one of the more sought-after COVID drugs, and the situation is only made worse by the government's COVID management guidelines that continue to list it as an option for treatment of mild COVID on days 3-5.
'Ivermectin Doesn't Help in COVID Management'
Doctors, scientists and health authorities have been reiterating this for months now.
The Goa government's prophylaxis treatment plan, however, has once again prompted them to come forward and clear the air.
Dr Soumya Swaminathan, Chief Scientist, World Health Organisation, responded on Twitter saying the WHO recommends against the use of Ivermectin for COVID.
In March of 2021, the WHO had once already said that the current evidence on the use of ivermectin drug to treat COVID-19 patients is inconclusive, and recommended that the drug only be used within clinical trials.
Dr Chandrakant Lahariya explains, "scientifically we know that ivermectin is an antiparasitic drug, whereas covid 19 is a viral infection. So there is no plausible explanation for how an antiparasitic drug can treat covid."
Furthermore, amid claims of the 'wonder drug' early in 2021, Merck—Ivermectin's parent company—themselves released a statement in February, warning against the use of the drug for treating COVID.
In its statement Merck emphasises that based on their analysis, there is,
No scientific basis for the potential therapeutic effect of Ivermectin against COVID-19 from pre-clinical studies
No meaningful evidence for a clinical activity or clinical efficacy in patients with COVID-19 disease
A concerning lack of safety data in the majority of studies.
"But its mechanism of its work isn’t fully understood," says Dr Lahariya, "so even if there are studies to show they work, it will need to be analysed further before any claims are made."
Dr Bhan agrees, adding, “We are not totally excluding the possibility of its utility, but to use it at a state level without sufficient study to prove that it is useful, is problematic.
“We’ve seen this happen before with plasma therapy and hydroxychloroquine, which were also at one point advocated for mass prophylaxis but we have seen that systematically there was no evidence to support either.”Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University
He goes on to say, “there are problems with the way in which some of these treatments have been mentioned in the guidelines. This was also the case, even with the hint that plasma therapy or HCQ could help. We should not be recommending treatments that are not evidence-based in guidelines that apply on a national level."
Not Worth the Risk
“When the drug is being distributed at a mass level, you're not going through a medical process, you're not going to a doctor, your medical history is not being looked at, so there is always a chance of mishaps. We don’t have any evidence for the usage of these drugs, so why unnecessarily risk it?”Dr Anant Bhan
Dr Bhan also warns of the risk of polypharmacy—using too many medicines, and the potential of side effects that can be avoided.
Adding to this, Dr Laharia says, "something else we need to ask is whether the possible benefit, that’s yet to be verified, is worth the risk of the side effects especially when administered to healthy people."
"Every drug has a side effect, which is especially worrisome if the drug is being administered as a mass prophylaxis," he says.
"Mass administering of any medicine should be done very carefully. The proportion of people who benefit may very well be very less as compared to those who develop severe side effects. This could lead to further debilitation or the need for further medication."Dr Chandrakant Lahariya
Another concern that Dr Bhan brings up is that if people are under the misconception that Ivermectin will prevent COVID, it could lead to laxity in the actual dependable COVID appropriate behaviour and preventive care.
"The FDA also warns that Ivermectin, in large doses can be dangerous, causing anything from nausea, dizziness, and an allergic reaction, to seizures, coma and even death.
“If they are interested in exploring the use of Ivermectin as a prophylactic, then it should be done through a proper study, which should be then put out in the public domain so others can also examine and judge the evidence.”Dr Anant Bhan
“In the interim we should stick to interventions for which there is enough evidence," he adds.
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