Note that views expressed in this opinion article are the writer’s personal views and not necessarily those of TrialSite.
Australia has thus far fared well in the COVID19 pandemic, with fewer than 1000 (910) recorded deaths attributed to COVID 19 and about 30,347 recorded cases among its 25 million inhabitants. This has been achieved with stringent application of test, trace, isolate, social distance, mask, and quarantine practices and compliance of most citizens who have been subject to lockdowns, and facilitated by the nation’s island status and ability to control incoming international travel. Its rollouts of AstraZeneca and Pfizer vaccines have encountered several problems, necessitating repositioning and reordering; at this point, 22% of the population has received one dose, 3% two doses, and considerable vaccine hesitancy is reported.
Against this background, since April last year (2020), interest has grown worldwide in the antiviral potential of repurposed drugs to improve survival in severe disease, to reduce severity of early disease and to reduce transmission of, and susceptibility to, COVID infections. Such drugs include ivermectin, favipirivir, fluvoxamine, quercetin and metformin. The amount of data gathered on ivermectin especially, is immense. Cheap, well tolerated, with a 40 year safety record, reports of its benefit in prophylaxis as well as for treatment have continued to accrue, most of it known to this audience. However, the use of ivermectin has not gained traction with the authorities in Australia, because the WHO does not recommend the use of the drug outside clinical trials, citing lack of evidence. The arguments of humanitarian use in the severely ill, and huge potential benefit at little cost in the preventative scenarios, have not gained traction.
Politicians who advocated for such early treatments have been ridiculed, academics speaking out have been admonished, deliberations of scientific experts advising governments are not fully disclosed and discussion in both the traditional media and social media is largely censored. It seems the “Trusted News Initiative” has been warned off the topic, with great effect. The dawning suspicion that the opposition of WHO and other agencies is based more on vested interests than on deficits in scientific evidence is devastating. Most health care providers just cannot believe that a safe, cheap, available agent with a high likelihood of benefit is still seen as needing further trials 18 months into this ongoing battle.
Australia’s Therapeutic Goods Administration (TGA) points out that, in fact, practitioners in Australia can already prescribe ivermectin, although it is assumed that the indication is for worms, parasitic infestations, tropical diseases and scabies. In reality, most practitioners have never used this drug, are unaware of its potential application to COVID19, are wrongly informed about that potential, have witnessed the related political antics, or are fearful that ivermectin’s use for this purpose might have professional consequences. As a result, few will prescribe it for COVID indications.
In the last few days another wave of Covid has been sweeping the nation, much of it the delta variant. Many areas are in various states of alert, and several in lockdown, and regions, states and territories are closing their borders. Social and economic costs will be significant.
In an article on June 27, the Australian Broadcasting Commission (ABC) said: “ The Premier [of New South Wales] also issued a dire warning for household contacts, saying that COVID positive cases can potentially pass the virus to all those under the same roof. “Previously it was around 30 per cent of household contacts, we are seeing in this example, families of five or six, everybody getting it,” the Premier said. “So one person takes it home and then previously one or two people in the household may have had it, now we’re seeing everybody get it. This is different to what we’ve seen before.”
This is another opportunity to persuade authorities to deploy ivermectin for prophylaxis for close contacts of cases and for early stage treatment. The case must be made to individual state or territory governments, each of which determines its own health, travel and border policies, albeit with national guidance.
Shouman and his team at Zagazig University in Egypt made one of the early reports in the subsequently burgeoning literature on efficacy of COVID prophylaxis. We have known about of this work for about 9 months, although it was finally published in in February. (Journal of Clinical and Diagnostic Research Feb. 2021, https://doi.org/10.7860/JCDR/2021/46795.14529). It concluded: “Among 203 asymptomatic close family contacts who received ivermectin, only 15 (7.4%) were noticed to develop the infection, while, in 101 contacts who didn’t use ivermectin, 59 (58.4%) developed the disease. The protection was of high value in both uni- and multivariate analysis. This means an R0…of 0.3 in ivermectin group and 2.46 in the non-ivermectin group. …All the studied contacts were first degree relatives including their husbands, wives, brothers, parents and their off-spring. Ivermectin reduced significantly the probability that a contact can catch the disease. This means that it may help as a powerful efficacious pre- and post-exposure chemoprophylaxis management of COVID-19.”
There is also a nasal spray therapy from Aref and team at Egypt’s South Valley University, just published. (Clinical, Biochemical and Molecular Evaluations of Ivermectin Mucoadhesive Nanosuspension Nasal Spray in Reducing Upper Respiratory Symptoms of Mild COVID-19. Int J Nanomedicine. https://doi.org/10.2147/IJN.S313093
This followed work by Carvallo and team published in November 2020. (J.Biomed.Res.Clin.Invest. https://doi.org/10.31546/2633-8653.1007).
Suggestions about ivermectin, designed to have an immediate impact, have been put to Australian federal and state authorities in various forms on many occasions, to complement the vaccine rollout and other containment strategies. We wait to see if this time around ivermectin will be given a trial, using it in critical control points, as the extra arrow in the quiver in this monumental struggle.
Dr Wendy E. Hoy, Brisbane
Geoffrey A. Taylor, prof. (retd), Perth