Conflict of Interest in WHO Recommendation Against Ivermectin

Conflict Of Interest in WHO recommendation against Ivermectin

Note that views expressed in this opinion article are the writer’s personal views and not necessarily those of TrialSite.

Andrew Bannister

All dangerous diseases are best treated early. A major failure of the global COVID-19 strategy has been to wait a week for the disease to become dangerous, when breathing becomes a problem. Early treatment of COVID, even for those with mild symptoms, prevents later hospitalization. There are several early treatment drugs showing promise but ivermectin leads the pack regarding safety, effectiveness and price. Unfortunately, the biggest players in Western mainstream media are members of the Trusted News Initiative (TNI). The TNI is a story for another day but it’s remarkable that big media companies barely report that they have agreed to promote global vaccination and to make sure any “disinformation myths are stopped in their tracks”[i]. Unfortunately, as a result early treatment seems to be seen as a disinformation myth and is not mentioned. Early treatment is vital in treating serious diseases and COVID-19 is no exception. 

Considering the human and economic cost, the avoidance of early treatment with a very safe, effective and off-patent drug is a criminal tragedy of immense proportions and a winning lottery ticket for some pharmaceutical companies that are designing and selling novel patented drugs that could not compete with ivermectin in a free market. Mercks’ molnupiravir, for instance, is seeking an Emergency Use Authorization (EUA) from the FDA and “Merck will receive approximately $1.2 billion to supply approximately 1.7 million courses of molnupiravir to the United States government.”[ii] 

Ivermectin doesn’t need an EUA because it passed trials in 1986. It just needs to be recommended to treat COVID-19. However, if ivermectin was officially recognized as an effective treatment, it would legally prevent molnupiravir’s EUA until it passes trials and thus delay or endanger the $1.2 billion deal. An aggravating factor is the fact that molnupiravir (EIDD-2801) could cause harmful genetic mutations. [iii] 

In the face of a public health crisis such as the COVID-19 pandemic, government authorities and international organizations have traditionally looked to the World Health Organization (WHO) for guidance – trusting that the WHO is free of commercial interests. Originally funded entirely by member states, the organization now receives less than 20% of its budget from these states and the rest from donors[iv] with their own financial and strategic agendas. Margret Chan, the previous Director General of the WHO, said in 2015: “I have to take my hat and go around the world to beg for money and when they give us the money [it is] highly linked to their preferences, what they like. It may not be the priority of the WHO, so if we do not solve this, we are not going to be as great as we were”. [v] 

Veteran journalist Robert Parsons explains that “the Smallpox eradication program was funded entirely by donors. That may have led to the problem that for special projects it [the WHO] has to raise the funding. But the private sector is unlikely to get involved unless it shows profit … Consequently, there is little independent public health research”.[vi]  Since then, the undue financial influence of private stakeholders has further grown at the WHO. Donations come with caveats so that the organization is compromised on a number of issues that involve the interests of its donors. 

In 2010, for instance, after the H1N1 flu pandemic, an investigative inquiry by the British Medical Journal (BMJ) and the Bureau of Investigative Journalism found that “key scientists advising the World Health Organization on planning for an influenza pandemic had done paid work for pharmaceutical firms that stood to gain from the guidance they were preparing. These conflicts of interest have never been publicly disclosed by WHO, and WHO has dismissed inquiries into its handling of the A/H1N1 pandemic as ‘conspiracy theories’.” [vii] These advisors managed to convince the UK government to spend more than $7 billion on a vaccine that was never needed.[viii]

As of 2021, conflicts of interest such as these continue to be a problem – the undue influence of private stakeholders being a prime example. The Bill and Melinda Gates Foundation (BMGF) is the second largest funder of the WHO after the USA. Gates, however, also founded and funds The Vaccine Alliance (GAVI). In the period 2018–19, their combined voluntary contribution to the WHO was 27%[ix] greater than the US voluntary contribution, making Gates’ influence pervasive. As funds by the Gates conglomerate are earmarked for specific projects, the WHO doesn’t decide how the respective money is spent, Gates does. 

In addition to the undue financial influence exerted by the BMGF, there is also an overlap of personnel between the WHO and Gates’ endeavors. Tedros Adhanom, the current WHO Director General, has previously served on the board of GAVI and as the chair of the Gates funded Global Fund.[x] Arguably, he is still influenced by his previous employer’s ideology and financial power.

Gates’ priorities have become the WHO’s. The main priority of Gates is global COVID-19 vaccination, not public health systems providing early treatment. He has been pushing vaccination onto the global agenda since 2012. The power of Gates Foundation funding has dictated a drive towards vaccinations and away from other essential public health measures, a move which has been criticized for years by international NGOs involved in the health and development field. 

Generally, Gates also believes that capitalism is more efficient than public health agencies when it comes to reaching his goals in the area of global health.[xi] Capitalism is usually more efficient than government but it values profits above people. Accordingly, Gates as well as the pharmaceutical companies his foundation is invested in and whose products he is pushing globally are making billions from their endeavors. Morgan Stanley believes that Pfizer, for example, could earn $100 billion from vaccines developed with public tax money from the US, Germany and other places in the next five years.[xii] Pfizer is partnered with BioNTech. The Gates Foundation has investments in both companies, putting $ 55 million into BioNTech alone in September 2019. The Gates Foundation also owns shares in Merck which is positioning the drug molnupiravir on the market hoping to make billions from it.

When it comes to ivermectin – in its off-patent form, Gates is funding work on a patentable, injectable form.[xiii] Organizations tied to Gates have taken an antagonistic stance thus far. Notably, GAVI has been going all out by running paid google ads against the use of ivermectin in COVID-19.[xiv] 

Given the significant financial and ideological conflict of interest of its main donor, the WHO recommendation on early treatment with an off-patent, highly efficient, safe and cheap drug such as ivermectin needs to be critically examined. In the WHO ivermectin guideline, despite showing a reduction of deaths by 80%,[xv] the organization puzzlingly recommends against ivermectin’s use. 

The WHO’s guideline document is “based on a living systematic review and network meta-analysis from investigators at McMaster University”.[xvi] McMaster University (including any of its direct affiliates) should have excused itself from conducting the guideline, given it has several objective conflicts of interest when it comes to ivermectin. For one, McMaster itself is designing and producing second generation COVID-19 vaccines.[xvii] It intends to produce hundreds of thousands of doses. It is likely that these experimental products would receive greater scrutiny if there is a viable safe prophylactic and treatment option for COVID-19. Secondly, McMaster University, like the WHO itself, receives millions in funding from the Gates Foundation. Additionally, McMaster, again like the WHO, shares personnel with the Gates Foundation. 

Edward Mills, for example, is both a McMaster associate professor and the clinical trial advisor for the Gates Foundation. In addition he has recently been appointed as the principal investigator of the Gates-funded Together Trial that is currently evaluating repurposed drugs such as ivermectin for their use in COVID-19[xviii]. Asked for comment, Mills denied that the Gates Foundation was having any “say on the conduct of the trial” even though he himself is it’s principal investigator and employed by the Gates Foundation. As past experiences show, no product should ever be tested in a trial funded by those gaining or losing financially or ideologically from it. Thus, ivermectin trials are best not done by anyone with a financial and ideological investment in competing drugs and vaccines. No reputable organization or government agency should be basing their opinion of ivermectin on trials conducted by the Gates Foundation or any other party with a conflict of interest. 

The recently announced Oxford University trial of Ivermectin shares a similar conflict as Oxford is profiting from the sales of the AstraZeneca vaccine and questions have been raised about the proposed trial possibly sabotaging the result by admitting elderly people already sick for 14 days but limiting the Ivermectin dose to three treatments.

Unsurprisingly, in a recent interview, Edward Mills seemed to be downplaying the effect of ivermectin. “The evidence on prophylaxis use of ivermectin is not very convincing”, Mills doubts, even though ivermectin is not being evaluated as a prophylactic in his own trial. Data from different clinical trials clearly shows that ivermectin is exceptionally effective, specifically as a prophylactic. Bryant et al. (2021) who analyzed the existing data from clinical trials according to conservative Cochrane meta-analysis standards – a gold-standard in science – found that “ivermectin prophylaxis reduced covid-19 infection by an average 86%” with the best-dosed study reaching an effectiveness of 91%.[xviv] There have been several studies that show that the regularity of the prophylactic dose is important with a weekly dose being more effective than bimonthly. Edward Mills curiously doesn’t find the prophylactic data interesting. The big money is not in running generic repurposed drug trials but in pharmaceutical company trials fighting for market share. 

Mills also suggests ivermectin might be efficient as a treatment but emphasizes the need for other drug interventions. “I am very optimistic that it will – it will just be one component of the interventions that we need.“[xix] While other components can be useful additions, downplaying the effect of ivermectin is not warranted. An expert meta-analysis by Karale et al. (2021) including researchers from the renowned Mayo Clinic comes to the conclusion that when given early in mild or moderate COVID-19, ivermectin reduces mortality by 90%.[xx] The findings further corroborate the results of the scientific review conducted by Kory et al. (2021) that has been published in the American Journal of Therapeutics and shows ivermectin to be significantly effective in the treatment of COVID-19.[xxi]

Given the conflicts of interest of McMaster University as well as the dubious interrelations between McMaster personnel and private stakeholders such as the Gates Foundation and other industry-related companies, the WHO should not have accepted McMaster’s involvement in the guidelines on ivermectin. Further, the WHO should ensure that no undue influence is exerted by its own donors – a task it has not yet been able to achieve. 

Questions sent to the WHO Ethics Office, asking for clarity about its recommendation against the use of ivermectin, were answered. However the organization refused to supply minutes of the meeting on ivermectin. It further declares that no interview will be granted. It does “not consider an assessment of ivermectin for prophylactic use in COVID-19 to be warranted”. It also does not consider trials by drug companies to be “biased per se” even though major pharmaceutical corporations have been repeatedly convicted of substantial fraud, manipulation and concealment of evidence and paying billions of dollars in fines. There was also an intimidatory confidentially clause in the WHO correspondence despite the author stating that they are writing about ivermectin. 

The WHO needs to prove that it followed a scientific and ethical process in its recommendation against the use of ivermectin. Public trust is crucial to beat the pandemic. We cannot continue to have the Gates foundation determining the WHO decisions on Ivermectin given the large conflict of interest. The minutes of the meeting in which the recommendation against ivermectin was taken need to be made public. The public needs to be told and shown invoices with regards to who paid for the steps that informed the WHO ivermectin guideline. The conflicts of interest of major WHO donors and the employer (McMaster University) of the scientists that are responsible for the guideline need to be made transparent. Without this, the recommendation against the use of ivermectin, remains mired in suspicion of corporate overreach. 

Few incidences make the general problem more apparent than the following: The WHO’s Chief Scientist, Soumya Swaminathan, was on Twitter recently warning Indian nationals in the midst of a deadly COVID-19 wave not to take ivermectin citing Merck marketing material.[xxii] As a reminder, the pharmaceutical giant Merck is hoping to make billions with its potentially mutagenic molnupiravir which won’t happen if off-patent ivermectin is a standard of care. Swaminathan’s statement went against the official Indian recommendation in favor of ivermectin issued by the most highly regarded health association in India after the country had been confronted with a new COVID-19 variant and regions were seeing improvement with early Ivermectin treatment. In the aftermath, the Indian Bar Association served Swaminathan a legal notice for spreading dangerous disinformation and causing a significant number of deaths by discouraging the use of a life-saving drug.[xxiii] Swaminathan’s tweet has since been deleted. The legal notice for aggravated offences against humanity concerning ivermectin has by now been extended to the WHO Director General Tedros Adhanom.[xxiv]

The once noble idea of a global public health system working for mankind’s best interests has been replaced by an organization largely driven by the financial and ideological interests of private stakeholders. This is not a new phenomenon. International groups have long called for a reform of the WHO. In a global pandemic, the disastrous consequences of these pervasive organizational issues become even more apparent. 

Distinguished scientists and frontline physicians from all over the world without conflicts of interest have called for the immediate use of ivermectin against COVID-19. Numerous randomized controlled trials (RCTs) and expert meta-analyses performed according to the highest standards of science have proven ivermectin’s effectiveness and reaffirmed its safety. Yet, a front of organizations including a significantly compromised WHO as well as wealthy private stakeholders with financial and ideological conflicts of interest have blocked the usage of this life-saving medication. Some observers have called this a crime against humanity which should be subjected to public scrutiny and an official criminal investigation. Ivermectin, meanwhile, should be used immediately to save lives as it has already been done successfully in a number of places worldwide.

[i] https://www.bbc.com/mediacentre/2020/trusted-news-initiative-vaccine-disinformation

[ii] https://www.merck.com/news/merck-announces-supply-agreement-with-u-s-government-for-molnupiravir-an-investigational-oral-antiviral-candidate-for-treatment-of-mild-to-moderate-covid-19/

[iii] https://www.sciencemag.org/news/2020/05/emails-offer-look-whistleblower-charges-cronyism-behind-potential-covid-19-drug

[iv] https://www.who.int/about/funding/assessed-contributions

[v] https://vimeo.com/ondemand/trustwho/260921911

[vi] https://www.youtube.com/watch?v=mBz5FR8Mf5c

[vii] ] https://www.bmj.com/content/340/bmj.c2912.full

[viii] https://www.theguardian.com/business/2010/jun/04/swine-flu-experts-big-pharmaceutical

[ix] http://open.who.int/2018-19/contributors/overview/vcs

[x] https://thegrayzone.com/2020/07/08/bill-gates-global-health-policy/

[xi] https://www.wsj.com/articles/SB1021577629748680000

[xii] https://www.businessinsider.co.za/pfizer-could-sell-96-billion-dollars-covid-vaccines-morgan-stanley-2021-5?r=US&IR=T

[xiii] https://trialsitenews.com/gates-foundation-funded-french-research-group-commences-ivermectin-clinical-trial-targeting-covid-19/

[xiv] https://trialsitenews.com/my-favorite-conversation-starters/

[xv] https://app.magicapp.org/#/guideline/5058/section/67421

[xvi] WHO Therapeutics and COVID-19 Living Guideline. 31.3.2021.

[xvii] https://urbanicity.com/hamilton/city/2021/02/mcmaster-university-is-developing-two-covid-19-vaccine-candidates/

[xviii] https://brighterworld.mcmaster.ca/articles/mcmaster-researchers-leading-international-study-to-test-three-widely-available-drugs-for-early-covid-19-treatment/

[xviv] https://osf.io/k37ft/ (peer-reviewed and accepted for publication in the American Journal of Therapeutics)

[xix] https://www.halifaxexaminer.ca/featured/whats-the-deal-with-ivermectin-and-covid/

[xx] https://www.medrxiv.org/content/10.1101/2021.04.30.21256415v1

[xxi]https://journals.lww.com/americantherapeutics/fulltext/2021/06000/review_of_the_emerging_evidence_demonstrating_the.4.aspx

[xxii] https://timesofindia.indiatimes.com/india/who-warns-against-use-of-ivermectin-to-treat-covid-19/articleshow/82546558.cms

[xxiii] https://trialsitenews.com/indian-bar-association-serves-legal-notice-upon-dr-soumya-swaminathan-the-chief-scientist-who/

[xxiv] https://drive.google.com/file/d/1dZLKvOib6PjhEGXOLIdGod2ZQNGPnkoW/view?usp=sharing

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