As Covid-19 cases in Peru rose rapidly during the early months of the pandemic, public interest in the drug ivermectin surged.
Misleading information suggesting the drug, used to treat parasites in humans and livestock, had been proven effective against coronavirus reached many Peruvians online, doctors told the Guardian.
With vaccines still in development, desperate physicians soon began administering ivermectin to patients and, despite a lack of evidence of the drug’s effectiveness in treating Covid, Peru’s government included it in treatment guidelines in early May 2020. A frenzy ensued.
“We ran out of ivermectin in all the pharmacies,” recalled Dr Patricia Garcia, the country’s former health minister. “Then there was a black market, and that’s when things got even worse because the veterinary ivermectin use started.”
Like several other Latin American countries, Peru in 2020 experienced a dire Covid emergency that overwhelmed its underfunded health care system. Many residents turned to self-medicating with ivermectin, Garcia said. Local politicians and television hosts told audiences to take the drug. Some Peruvians began taking ivermectin that was formulated for livestock and administered through injections, and images of people with necrotic tissue on their skin from shots made their way to Garcia’s desk. Evangelical groups touted ivermectin as equivalent to a vaccine, sending volunteers to inject thousands of people in indigenous communities while referring to the drug as a “salvation”.
Peru’s experience with ivermectin was an early indicator of things to come. Over the past year, the international hype over the drug has led to runs on livestock suppliers, a boom in illegal trafficking and rampant misinformation in several countries.
Clinical trials are still under way to determine if ivermectin has any benefits against Covid. But in the meantime, US and international health authorities have cautioned against using it for the virus and have stressed that vaccines are a safe and effective means of preventing the disease. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have put out advisories warning against using ivermectin as treatment or prevention for Covid. The National Institutes of Health (NIH) stated in February there was not enough evidence “either for or against” recommending the drug. The World Health Organization (WHO) similarly advised in March that the drug should only be used in clinical trials, as did the European Medicines Agency (EMA).
Still, a global network of profiteers, advocacy groups and online communities have sprung up around it. Ivermectin proponents in multiple countries have touted the drug as a solution to the pandemic, leaving public health officials scrambling to correct the record.
The ivermectin boom
Ivermectin was created in the 1970s to treat parasites in livestock, but the drug gained new life in recent decades as an inexpensive and effective anti-parasitic when formulated for humans. When researchers and doctors early on in the pandemic looked at repurposing a plethora of existing drugs to see what might be effective against Covid, some turned their attention to ivermectin.
One March 2020 peer-reviewed study involving in vitro laboratory tests on cell cultures in Australia showed promising results against the virus in the cultures, kicking off a wave of interest among researchers and doctors looking for anything to slow the pandemic. A non-peer reviewed, pre-print study released online one month later claimed to find the drug also reduced mortality in humans.
The problem, medical experts say, is that the studies had serious flaws or lacked evidence that the drug could work in humans. Doctors evaluating the Australian study have criticized it for using extremely high concentrations of the drug that are likely not achievable in human blood plasma, saying that even using a dose 8.5 times higher than what the FDA approves for use in humans resulted in a blood concentration still vastly below the level that showed antiviral effects. Experts have also pointed out that the study’s findings were limited to a laboratory setting rather than in humans, and that using ivermectin even at regular doses can have significant side effects.
“If Nobel Prizes were handed out for curing life-threatening diseases in a petri dish, then I (and virtually every translational research scientist) would have one,” said Dr Jorge Caballero, co-founder of Coders against Covid, an organization that analyzes Covid data.
There were even more concerns with the second study, as researchers found that it was based on flawed data from a now discredited healthcare analytics company called Surgisphere. The Surgisphere discovery led to prominent scientific journals retracting several studies based on the data, as well as the retraction of the ivermectin pre-print.
But the studies prompted desperate governments across Latin America – where ivermectin is commonly found as an over-the-counter medicine – to add the drug to their therapeutic guidelines, even as some medical experts pushed back.
In Peru, ivermectin’s use proliferated in the spring and summer of 2020. Rampant misinformation about the drug’s abilities spread through social media and online messaging platforms, giving people a false sense of what the drug could do.
Garcia first saw ivermectin mentioned in relation to Covid in a WhatsApp group in which someone shared an article that falsely claimed the FDA had approved the drug for treating coronavirus.
Similar misinformation about unproven treatments circulated on social media and messaging platforms across Latin American countries. In Bolivia, one Facebook account posted a video claiming ivermectin could “save you from Covid-19” that was shared at least 285,000 times.
Bolivia’s government announced in May 2020 that it would distribute 350,000 doses of ivermectin, even though the country’s health minister, Marcelo Navajas, stated that same month that ivermectin was “a product that does not have scientific validation in the treatment of the coronavirus”.
In Brazil, too, sales of ivermectin exploded, said Dr Silvia Martins, an associate professor of epidemiology at Columbia University. “Early on in Covid people began to look for a miracle medicine,” said Martins.
Social media and messaging platforms became rife with falsehoods and rumors about Covid treatments such as ivermectin, she continued. “Even medical doctors spread that kind of misinformation, which to me is appalling,” she said, adding that some physicians have prescribed the drug indiscriminately without evidence to support its effectiveness.
Ivermectin’s popularity in Brazil was aided by its contrarian president, Jair Bolsonaro, who contracted Covid in July 2020 and refused to be vaccinated against the virus. Bolsonaro repeatedly promoted unproven Covid treatments such as ivermectin over policies like mask-wearing, social distancing or vaccination. Brazil spent millions of dollars producing and distributing “Covid kits” filled with cocktails of pills including ivermectin as part of its public health campaign, despite criticism from medical experts that there was no compelling evidence such kits were effective.
By June 2020, health officials and organizations across Latin America started pushing back against the use of ivermectin in the fight against Covid. That month, the Pan American Health Organization, an arm of the WHO, advised against using the drug for Covid. Brazil’s National Health Surveillance Agency, which regulates pharmaceuticals, issued a statement in July 2020 stating there was no conclusive evidence that ivermectin worked against coronavirus. Peru’s health ministry removed part of its recommendation for using ivermectin to treat Covid in October 2020, before cutting it altogether this year.
But much of the harm had been done, said Garcia. Ivermectin had given people a false sense of security against the virus, making it difficult for public health officials to later dispel unproven claims about the drug.
Many Peruvians still embrace ivermectin, said Dr César Ugarte-Gil, an epidemiologist at Cayetano Heredia University who ran a clinical trial of ivermectin along with Garcia. “Someone told me a few weeks ago he just got two doses of the vaccine, but he felt safe because he used the ‘correct’ dose of ivermectin,” said Ugarte-Gil.
Ivermectin goes global
As a second wave of infections hit last October, misinformation about ivermectin began to spread to more and more countries. Many started to see echoes of what happened in Peru and elsewhere in Latin America.
Pro-ivermectin organizations began to promote the drug in several countries, gaining attention with the help of politicians and prominent media figures who questioned the safety of vaccines. Anti-vaccine and anti-lockdown groups latched on, too, claiming a global conspiracy to suppress information about the drug.
Hungarian health officials reported receiving accounts from veterinarians about demand for ivermectin last November. The public interest and online misinformation was prevalent enough that it caused authorities in the country to issue a statement out of concern that citizens might start taking drugs formulated for horses and sheep. “We asked the veterinarians to emphasize the risk and to remind people about the dangers of treating themselves with veterinary medicinal products,” Hungary’s National Food Chain Safety Office said.
In Australia, the country’s drug regulator moved to ban medical practitioners from prescribing ivermectin for “off-label” uses such as for treating Covid, after prescriptions increased between three and four times. Ivermectin had prolific and controversial boosters in the country, including Craig Kelly, a member of parliament, who became a champion of ivermectin and other unproven treatments for Covid. Kelly has routinely shared anti-lockdown, pro-ivermectin messages to his more than 40,000 followers on Telegram. In September, a man claiming to be affiliated with an anti-lockdown medical activist group targeted one small town, with a largely Indigenous population, to try and push ivermectin, telling the Guardian he viewed the town as a “petri dish” to test the drug.
In the US, the CDC reported in August that prescriptions for ivermectin had spiked in recent months, reaching around 88,000 in a single week in mid-August. Six months before, the Republican senator Ron Johnson, a known proponent of vaccine misinformation, held a hearing in which Dr Pierre Kory, an ivermectin advocate, called the drug “the solution to Covid-19”. A YouTube video of Kory’s testimony went viral and received over a million views before the platform removed it for violating its policies on the disease. Kory later appeared on Joe Rogan’s top-rated podcast, praising ivermectin to millions of listeners. The drug became a rightwing rallying point, with Fox News anchors airing segments suggesting that it was being hidden from the public.
Livestock supply stores in the US and in Canada have faced runs on veterinary ivermectin. Iceland’s directorate of health told citizens in August not to eat a topical cream containing ivermectin after one patient was hospitalized. Authorities in South Africa, Northern Ireland and other nations seized millions of dollars in illegally trafficked ivermectin intended for sale on the black market.
The Malaysian Medical Association, the main representative body for the country’s medical practitioners, warned against the use of ivermectin outside clinical trials in July, after seeing troubling reports of illicit sales and online misinformation. “MMA feels it has a responsibility to the public and the profession to speak out about the ethical and professional dangers involved in promoting unproven treatments without warning of the physical dangers,” Dr Koh Kar Chai, president of the Malaysian Medical Association, told the Guardian.
‘I see the same story’
In recent months, several researchers and analyses have found further issues with the poor quality of studies that examine ivermectin’s use to treat Covid. In July, one medical journal retracted a major pro-ivermectin study from November 2020 after researchers raised concerns over plagiarism and data manipulation, but not before it was widely cited and viewed over 150,000 times. The authors of a review of 14 existing studies on ivermectin found that current evidence did not support using the drug for Covid outside well-designed randomized trials. A rigorous clinical trial at the University of Oxford is also under way to evaluate the efficacy of the drug.
Garcia and Ugarte-Gil said their research into ivermectin in Peru was hampered because so many potential trial participants had already self-medicated. A potential lesson for future pandemics, Ugarte-Gil says, is that the use of drugs without strong evidence behind them risks making it harder for researchers to evaluate whether such drugs should be administered in the first place.
Garcia argues that far from proving a “miracle cure”, ivermectin use has not stopped countries such as Brazil and Peru from having some of the world’s highest Covid death tolls per capita.
Instead, she says, it’s been baffling to see other countries rushing to embrace ivermectin after Peru’s experience. “I see the same story in the US,” Garcia said. “I think this is crazy.”