The uncontrolled use of ivermectin means South Africans don’t trust the pandemic response and feel they need their own measures.
That’s the word from public health and communication specialist Dr Warren Parker, who was a panellist on a University of KwaZulu-Natal (UKZN) webinar on Thursday that delved into “What the ivermectin debate has revealed to us in a time of pandemic”.
The discussion comes in the week a group of South African medical practitioners launched an urgent court application seeking wide-ranging orders to enable them to personally use and prescribe ivermectin.
The group of 55 “front-line workers” initially attempted to join other applications seeking similar relief, but say those did not address the dire situation faced by doctors and patients who want effective access to the drug.
They say their applications to the South African Health Products Regulatory Authority (Sahpra), under its “compassionate-use programme”, have not been approved and, to their knowledge, none have been.
Last week, during an address to parliament’s health portfolio committee, the regulatory body warned there was not enough scientific evidence around the use of the drug, for safety and efficacy, to treat or prevent Covid-19. The authority said there were only 10 medical practitioners approved to use ivermectin for Covid-19, but there were not enough data to prove whether it was safe or harmful.
The drug, hailed as revolutionary in the 1980s and working by paralysing and killing parasites in livestock, has been gaining traction as a “miracle cure” for Covid-19 patients.
However, Sahpra prohibited it for human consumption on December 22 last year after it was promoted on several social media platforms as having “cured” people of Covid-19. It is, therefore, illegal to dispense the drug in the country.
Parker, who pushed for the use of masks early on in the Covid-19 outbreak, believes people are “justifiably worried about the state of the pandemic”.
“We’ve also seen that because of that there has been an uncontrolled public use of ivermectin.
“It means people don’t trust the pandemic response and feel they need to take measures themselves.
“The uncontrolled public use of ivermectin poses health risks, people are using a veterinary product, there is no control over the dosing and it can be unsafe if the incorrect doses are used or the incorrect product or fake products are used.
“There are people exploiting the situation, making money out of it.
“There is a lot of stress in the health-care system. I’m on discussion groups made up mainly of doctors.”
He said there was a “huge sense of frustration around ivermectin as a therapeutic option, particularly in low-resource settings.
“A lot of unnecessary deaths are occurring in a low-resource setting and it makes sense to have a wider range of simpler options, such as therapeutics or drug therapies.”
Parker said ivermectin fitted the rationale for repurposing it in a Covid-19 context.
“It fits the bioethical rationale for Covid-19 treatment and is justifiable for compassionate use.
“There are numerous peer reviews and other studies that have confirmed positive effects and this positive trend continues.
“As part of the work that we are doing on ivermectin, every couple of days we pick up the next paper and they all seem to be going in the same direction.
“Whether or not they are the perfect randomised controlled trials, the body of evidence just continues on the same trend.
Ivermectin is just an add on therapeutic to Covid-19, but some people see it as a huge threat.
— Dr Warren Parker
“It can be safely administered under medical supervision and Sahpra has approved compassionate use based on research and other inputs into the registration of the product.”
He said there was an elitism when it came to research into drugs such as ivermectin.
“It appears that only randomised controlled trails and peer reviews count as added evidence. There is a lot of scepticism about research that is out there.
“We need some other rules for responding to Covid-19 as a pandemic. We can’t use the same exact rules in a non-pandemic context.
“Ivermectin is just an add-on therapeutic to Covid-19, but some people see it as a huge threat.
“I would say popular response deviates from policy response.
“People aren’t stupid. They understand things are out there, whether they are informed by social media or other things, there are very real reasons for people to gravitate to particular types of solutions.
“Compassionate use of ivermectin means immediate use for treatment. So access must be as easy as any other treatment.”
Parker said if there were impediments, “it’s not really compassionate because healthcare workers, patients and families are frustrated and people die”.
Prof Colleen Aldous, webinar facilitator and a health-care scientist at UKZN’s School of Clinical Medicine said: “We have a drug which won a Nobel Prize and it is showing good promise in treating a disease and is also being misused and abused.
“There is a lot of misinformation and disinformation going about it, but there is still a lot of research coming out regularly, all [pointing in] the same direction, that there is an efficacy.
“What we need in the 21st century is a new way of looking at the body of research, not just insisting on doubled-blinded randomised controlled trials.
“We need a paradigm that takes into consideration the scientific and ethical rigour. But we don’t need it to hobble us.
“Medicine is for the people and regulatory authorities are there to protect the people and are not there to be swayed by politics and/or pharma.
“Scientists must respond at this time for the people, with an open mind and with humility.
“We need a new way of thinking about research under these emergency medical conditions,” said Aldous.
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