Ivermectin: not the silver bullet

With over 400 days into the pandemic, Filipino citizens are divided yet again by a claimed ‘wonder drug’ that can cure and prevent COVID-19: Ivermectin. As active cases are going over 200,00 and death tolls are reaching almost 16,000 as of April 19, hospitals are overrun by patients and are in need of more resources, however, for the case of Ivermectin, its foundations based on testimonials and premature assumptions could not be the silver bullet as most people claims it to be.

Ivermectin and COVID-19. Photo was taken from Rappler.

Senate President Vicente Sotto III just admitted last Saturday, April 17 that he too was also taking Ivermectin for protection against COVID-19.

“Ako rin eh. Ako umiinom ako eh (I am also taking it). Prevention. Once every two weeks,” he told DWIZ.

Not only has a public servant actively endorsed the use of Ivermectin, but also justified its use since Sotto heard that lots of people infected with COVID-19 claimed that they got cured by using the drug. With politicians already expressing their leanings on the drug, the public, exposed to claims of non-experts, are prone to misinformation about Ivermectin and its effects.

Ivermectin tablets are approved by the US Food and Drug Administration to treat people with intestinal parasitic worms. In addition, some topical (on the skin) forms of the drug are approved to treat external parasites like head lice and for skin conditions such as rosacea. Despite being able to treat parasitic diseases, Ivermectin is yet to be proven effective against COVID-19.

Some forms of Ivermectin are used in animals to prevent heartworm disease and certain internal and external parasites. It’s important to note that these products are different from the ones for people, and safe when used as prescribed for animals, only.

This confusion between animal or human use has also been subject to the Ivermectin debate in the Philippines. Due to the demand for Ivermectin and the consequent buying by the consumers, the Department of Health (DoH) and Philippines FDA had to step in and warn the public that Ivermectin sold online is for animals, and the only suitable drug for human use is only available in topical forms and must be prescribed first.

However, as early as March 31, World Health Organization (WHO) has found inconclusive evidence for Ivermectin use in COVID-19 treatment; WHO advises limiting its use only in clinical trials. No evidence has also been found for its support for COVID-19 prevention as well.

Even Merck, the company producing the vaccine, has said in a statement that “[there is] no scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies;

no meaningful evidence for a clinical activity or clinical efficacy in patients with COVID-19 disease; and concerning lack of safety data in the majority of studies.”

As international bodies and even the corporations producing Ivermectin have spoken out against its treatment on COVID-19, this did not stop regulating agencies in the Philippines to green-light the use of the drug.

The Philippines FDA has not shied away from giving nods to hospitals to use the unapproved Ivermectin. A second hospital has received the go-signal to use the antiparasitic drug on its COVID-19 patients, Food and Drug Administration Director-General Eric Domingo confirmed on April 16 despite the medicine's unproven efficacy against the disease and going against WHO guidelines.

"Yes, a second hospital applied for CSP (compassionate special permit) for Ivermectin and approved," he told CNN Philippines.

The fast-tracking of the drug in hospitals is due to pressures from medical and legal bodies to the Department of Health and Philippine FDA, urging them to hasten the process of approving them. WHO Representative Dr. Rabindra Abeyasinghe was able to quickly point out that this could plant false confidence of protection to the public. He advises that the Philippines need more clinical trials and research as current studies suggest that the results are too insignificant to be deemped effective

By also allowing the prescription of Ivermectin, users also run the risk of overdose which can cause nausea, vomiting, diarrhea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma, and even death. Additionally, other medications could interact with Ivermectin, producing unintended consequences.

Due to the troubling nature of Ivermectin, medical and scientific communities find themselves in a schism where physicians swear the efficiency of the drug and go as far as prescribing it in varying doses as a prophylactic to prevent COVID-19. Although repurposing Ivermectin is not novel, Dr. Satoshi Omura, the 2015 Nobel laureate for medicine for discovering the use of the drug for river blindness and elephantiasis, told Nikkei Asia in an interview in April 2020 that Ivermectin “appears effective in treating COVID-19 patients.”

These scenarios wherein celebrated experts and lauded scientists believed in a drug that has still yet to prove its efficacy just proves that even scientific giants can fall to their own biases in their research. It is important to note that science thrives not through individual success but through peer-reviewed and statistically sound data, both approved by institutions ran by communities of experts. It is vital for scientific communities to dig deep and be aware of the ideological, political, and social factors at play, to fully criticize and understand its influence on scientific pursuit and research (READ MORE: Awareness of Our Biases Is Essential to Good Science)

Clearly, the first remedy for the Ivermectin dispute is to conduct more research and clinical trials as recommended by the WHO. Assumptions and prescribing the drug freely would provide false security among the public, making them less prone to practice social distancing and thus more susceptible to actually getting infected by the virus.

However, clinical trials are tedious and expensive as shown by the vaccine development process that took almost a year to finish. Additionally, there are already past and proven drugs that are suggested by WHO like Remdesivir and Corticosteroids that the Philippine could invest in instead.

Ivermectin has also steered the national discussion away from other important sectors of public health, like testing and vaccinations. With hospitals fully occupied and the emergency budget running its last stretch, the Philippines cannot afford to ride all their hopes on a drug that currently has found insignificant data in COVID-19 treatment.

The Philippine pandemic response is riddled with snake oil merchants. With products like masks with holes, air-ionizing necklaces, and inconclusive drugs, misinformation and pseudoscience has repeatedly scammed a nation that is in dire need of better governance, protection, and education. It is important for the Filipino people to be more informed and critical than ever and need not to rely and believe on information from Facebook, Viber, and non-experts.

Other countries need not worry about clinical trials of Ivermectin because other countries around the world are wrapping up their pandemic chapter as mass vaccination programs have effectively herd-immunized the population, allowing them to have businesses and schools re-open.

On the other hand, the Philippines is still in the middlegame. It is vital that all resources should be directed towards proven and cost-effective measures of testing and vaccination, as well as increasing the support and capacity for public healthcare. It has been one year since the community quarantine and the Philippines cannot afford to go another round of lackluster administration.

Ivermectin, despite its efficacy against parasites, is still yet to be concluded for COVID-19, but it is definitely not the silver bullet that will end the pandemic. The drug has only served as the public health system’s unhealthy coping mechanism under incompetent governance and lacking expertise in pandemic response. It is clear that the current administration is grasping straws and out-of-touch for their late and ineffective COVID-19 task force, and it is time that the Filipino people should voice out and not settle for antiparasitic drugs for treatments against a virus.