THE DEBATE ON THE USE OF IVERMECTINE IN COVID-19 TREATMENTS AND ITS IMPACTS TOWARDS HEALTH SECURITY
- By Malvinder Mann (UNIMAS Intern)
As of August 2021, there are about nine notably used COVID-19 vaccines, BioNTech/Pfizer (Germany & United States), Moderna (United States), AstraZeneca (United Kingdom), Johnson&Johnson (United States), Novavax (United States), Gamaleya Sputnik V (Russia), Sinopharm, SinoVac (China) and Bharat Biotech (India). Each of these vaccines have different efficacy rates to battle the various variants of the COVID-19 coronavirus, (Alpha, Beta, Gamma, Delta, Delta + and Lambda). As we dive into the recent statistics of the pandemic globally, we can see that, the COVID-19 pandemic has been responsible for at least 203,295,170 confirmed cases and 4,303,515 deaths, as reported by the World Health Organization. Nonetheless, since the availability of Covid vaccines, at least 199 nations have started vaccination individuals against the coronavirus, with at least 4,033,274,676 doses of the vaccine provided thus far. Gibraltar leads the world in vaccine administration, having given out enough doses to cover 116% of its population, if each individual requires two shots. However, recent clinical trials have tested the possibility of using Ivermectin as a treatment drug to combat the coronavirus, some researchers even claiming it as a “miracle cure”.
CAN THE USE OF IVERMECTIN CURE COVID-19?
Ivermectin is a major breakthrough for treating veterinary treatments, and in some instance, tropical diseases such as onchocerciasis, strongyloidosis, scabies and cutaneous larva migrants among humans. Researchers at Australia's Monash University examined with the medicine and discovered that a single dose might stop the COVID-19 virus from multiplying in cell culture within 48 hours, according to news reports from April 2020. Another research done by the National COVID-19 Therapeutics Advisory Panel in the United Kingdom concluded that evidence basis and plausibility of ivermectin as a COVID-19 treatment were insufficient to warrant further research. The subject of using Ivermectin for COVID-19 treatment has been conflicting among world renowned researchers, with several clinical trials have produce a vast of results. Therefore, the question rises, how has Ivermectin became a possible choice as a cure to combat COVID-19?
All things considered, antiviral dosages far exceeding the maximum permitted or safely attainable for use in humans would be required. This contradicts the very nature of the whole subject, as apart from the logistical issues, such high doses are not covered by the drug's current human-use licenses and would be harmful. Therefore, the basis for testing ivermectin in COVID-19 appears to be inadequate. The current evidence on the use of ivermectin to treat COVID-19 patients is inconclusive. Until more data is available, the World Health Organization (WHO) recommends that the drug only be used within clinical trials, WHO has stated that, “to the rising international interest in ivermectin as a viable treatment for COVID-19, a guideline development group was formed. This group is comprised of an independent, multinational panel of experts that comprises clinical care experts from a variety of professions, as well as an ethicist and patient partners”. As a result, various organisations have openly said that the proof of Ivermectin in fighting COVID-19's is insufficient. Merck, the drug's developer, stated in February 2021 that there is no substantial evidence that the use of Ivermectin is effective against COVID-19. Moreover, major nations namely the United States and the United Kingdom have stated that applying the use of Ivermectin as a COVID-19 treatment drug is unsafe and the evidence of its efficacy and usefulness appears to be too limited and insufficient.
THE POSSIBLE SHORT- AND LONG-TERM IMPACTS OF THE USAGE OF IVERMECTIN IN COVID-19 TREATMENTS AND ITS EFFECTS TO HEALTH SECURITY
Due to the small sizes and implementation details of available trial data, including the small number of events, clinical studies and research had determined that the evidence on whether Ivermectin reduces mortality, need for mechanical ventilation, need for hospital admission, and time to clinical outcomes in COVID-19 patients is of very low certainty. Some of the short-term effects of the Ivermectin if not used in correct dosages can cause nausea, vomiting, diarrhea, low blood pressure, allergic responses (itching and rashes), dizziness, ataxia (balance issues), seizures, coma, and even death. The possible idea of including Ivermectin into the COVID-19 treatment framework raises several worries. The issues of health and security concerns (black markets), public health safety and lack of public awareness takes precedence over the use of Ivermectin into combatting the COVID-19 pandemic. Despite several clear-cut clinical trials being conducting on the efficacy and immunity rate the drug possesses, a common ground on the decision in using Ivermectin has not been finalized. In Central and Eastern Europe, Latin America, and South Africa, misinformation, a lack of trust, a sense of loss of control, and despair over the rise in the number of cases and deaths led to an increase in the use of the drug and the emergence of a black market, raising concerns about self-medication, safety, and the feasibility of future clinical trials.
MALAYSIA’S STAND ON THE USE OF IVERMECTIN IN COVID-19 TREATMENTS
Despite the lack of elevated evidence and guidance to the contrary, a few nations have allowed it to be used off-label for COVID-19 research and therapy. As the COVID-19 have reached various mutations and waves, it is only fair that every country moves hand in hand with the WHO’s official advise on the possible use of Ivermectin as a COVID-19 treatment drug, which is to strictly limit it to usage in clinical trials to treat COVID-19. According to the National Pharmaceutical Regulatory Agency (NPRA), the use of Ivermectin in Malaysia is restricted to “off-label” use to help in clinical trials and research, as per the Ministry of Health. The Ministry of Health has also stated that “the importation, manufacturing including compounding and sales of Ivermectin raw materials or products containing Ivermectin for other purposes should stop immediately”. However, there has been concerns raised on the lackluster effort shown by the Malaysian government on the policy of banning the sales of Ivermectin, as the drug are still being sold in pharmacies, online webstores (Lazada, Shopee) at the expense of the Malaysian citizens. Furthermore, the Malaysian National Poison Center reported two death cases of Malaysians taking Ivermectin pills to treat COVID-19. The first case involved a user taking one pill of Ivermectin, and symptoms experienced was shortness of breath that lasted for five days. The second case however involved an elderly person who was found unconscious after allegedly taking 15 pills of Ivermectin. Furthermore, the Malaysian Pharmacists Society (MPS) and the Malaysian Medical Association (MMA) have called for an end to the illegal sales of Ivermectin. Furthermore, these associations also expressed concern that many Malaysians are illegally sourcing the drugs after hearing of its supposed efficacy against COVID-19. The Malaysian government need to firmly implement stricter policies and regulations including increasing public awareness in combatting this issue on the illegal sales of Ivermectin, as it could propose a threat to the health security of Malaysians.
Every nation should rapidly propel their vaccination programs to ensure that every citizen in their country are vaccinated, as vaccines have been proven to be absolutely safe and efficient to combat COVID-19. As the WHO has stated that the use of Ivermectin for COVID-19 treatments should only be within the lines of clinical research and trials, governments around the world should make sure that policies implemented should be on par with WHO’s stance on the use of Ivermectin. As the world is currently battling the latest wave of the COVID-19 pandemic, it is wise that every nation, alongside policymakers put in the focus towards getting everyone vaccinated, as vaccines are indeed proven completely safe and efficient in combatting COVID-19.