TrialSite was able to touch base again with research Ondrej Halgas with the University of Toronto. Back in late January of this year, we reported that Slovakia was the first EU-based nation to formally authorize the use of ivermectin for both prophylaxis and treatment for COVID-19 patients. A biomedical researcher, Dr. Halgas has been active in the Slovakian community and provided important insight for that update. TrialSite caught up again with Halgas to learn more about how the administration of ivermectin in Slovakia was coming along. On March 23, TrialSite did report on the situation based on another expat interview and updates from various press sources. There were reports that at least by late January and early February, many Slovakians were mail ordering supplies of ivermectin, which were stopped at customs, never released to the individuals that made the order. Halgas reports that supplies of ivermectin have improved somewhat and that depending on pharmacy, there was more access, but nowhere near enough to satisfy, the demand based on the recent COVID-19 spike in this part of Europe. In a dynamic and unfolding situation, now as more supply found its way into the country (often severely marked up from say, entrepreneurial Austrian pharmacists), generally, the numbers are now way down, and the hope here is that the country heads toward normalcy.
Slovakia Goes Way Back
Slovakia only has 5.4 million people and this beautiful and interesting country can be considered a bridge, or a gateway, or possibly more likely a crossroads between central Europe and the far east of Europe in the Ukraine. With a name literally meaning “Land of the Slavs,” human activity here goes far back into prehistory. In fact, more recently but still approximately 20,000 years ago, this land was, according to archeological evidence, a strategy province for trade between the cultures of the Mediterranean and the rest of Central Europe. Since then, many dominant cultures have called Slovakia home, from Celtics to later Dacian and the Roman settlement—in fact, perhaps part of these lands were within the empire and part were considered “Germania.”
But after successive Hun invasions, Slavic settlement started about the 5th Century. Successive societies evolved leading the Great Moravian Empire to Hungary taking over the lands for hundreds of years. After World War 1, Slovakia of today became part of the consolidated Czechoslovakia amid the breakup of the Austro-Hungarian Empire. Set by the Treaty of Saint Germain and Treaty of Trianon, this new sovereign European state then fell to the Soviet Union after Nazi aggression and the end of World War 2. The end of Communist rule in 1989, part of the peaceful Velvet Revolution leading to split ups and today’s Slovakia finally becoming completely independent in 1993 (Velvet Divorce). To this day, however, Slovakia remains close with the Czech Republic neighbor.
A fascinating, diverse place representing thousands of years of different peoples moving through and living in this area the place is generally considered relatively wealthy as compared to many parts of the world.
A relatively rich economy, GDP per capita is about 78% of the average of the EU by 2018. Regional imbalances remain, not surprisingly the western region known as Bratislava on the Austrian border can be considered a region more aligned with Germanic Europe and GDP per capita is 188% of the EU average making it very rich. While the eastern regions are far poorer, generating 54% GDP per capita as compared to the EU average. By 2017, the OECD reported on the whole country, “The Slovak Republic continues exhibiting robust economic performance, with strong growth backed by a sound financial sector, low public debt and high international competitiveness drawing on large inward investment.”
The Ivermectin Debate
As the COVID-19 pandemic first spiked here in October 2020, with successive spikes in November and January, the conditions degraded, marked by infighting and divisions between political parties as TrialSite discussed in March.
The pandemic here has been severe—for its small population, the country was experiencing an enormously high infection rate, with a reported 371,062 cases with just 5.4 million people. A reported 10,565 people have died here due to the pathogen.
It was under this growing stress that the ivermectin story emerged. With a lack of widespread access to vaccines by end of 2020 and growing cases, TrialSite reported the embrace of ivermectin there culminating in the formal authorization of use off label by January, 2021. Additionally, the country’s head authorized what was a secretive Russian vaccine purchase riling oppositional parties as there was a growing push for transparency here.
After a review of press and various positions and another interview with Ondrej Halgas, TrialSite concludes that the country’s elite “chatter” class is relatively divided over the use of ivermectin. But the general population is far more pragmatic—at least half of the country is for the use but some polls as discussed below indicate widespread support of ivermectin use.
The demand for the drug was led first by pragmatic physicians that apparently had read reports of studies around the world, first staring with the in vitro investigations at Monash University but then, of course, the numerous human studies from an important observational effort in Florida to dozens of studies in South Africa, the Middle East (including Israel) to India and Bangladesh. TrialSite’s library of articles serve as reference as can this important reference research site listing all ivermectin studies.
Local doctors grew increasingly interested with the crisis worsening, and in parallel other regional interest emerged, including the Balkans where Macedonia authorized the use of ivermectin but also interest among at least some major academic medical centers in the Czech Republic, an influential neighbor. There the University Hospital of St. Peter’s and affiliated University Hospital Bnra purchased 20,000 doses of ivermectin as a distribution hub to deliver doses other clinics and pharmacies.
Authorization in Slovakia But…
By late January, even through the government here authorized the use of the drug, there was no central plan nor efficient market apparatus in place to efficiently and effectively allocate supplies of ivermectin. Consequently, TrialSite’s interview back in late March touched on experiences early in January and February of shortages of the product in pharmacies—where many scared residents checking local pharmacies found little to no supply.
Local mayors and village leaders also got into the middle of things, working to broker deals to help local residents.
During this time, medical providers as well as clinics and hospitals sought products from places like India and more recently Austria where the entrepreneurial spirit of that country perhaps turned predatorial as pharmacists near Vienna compound the product, then severely marking up the price for sale back into Slovakia.
And there are reports that even some individuals sought creatively to access the drug by procuring it on holiday, for example, in Egypt and other places.
Dr. Halgas confirmed the dearth of supply in February followed by greater import activity by March. For example, one hospital was able to secure 150,000 packages of the product for distribution there and to others providers. To date, Halgas estimates that perhaps 10,000 Slovakians have been fully treated with an ivermectin regimen, perhaps more.
There are reports that the drug is working. Halgas reported one physician who reported treating at least 80 individuals, tracking their progress thereafter. Local physicians that are using the drug report positive general trends but none of this is based on scientific study. Consequently, there is no way to really measure if the authorization of ivermectin here is actually contributing to the fight against COVID-19.
A Divided Press
In the meantime, the ivermectin discussion caused clashes of opinion here. While mainstream press tended to avoid the topic or, if they did address any interview, would involve physicians with dismissive positions, citing the recent European Medicines Agency (EMA) or the World Health Organization (WHO) stance on the topic, while others were quite favorable. Halgas was interviewed on a local media there to discuss the topic. Moreover, he shared that at least one local poll revealed that 70% plus of the population was willing to take ivermectin to treat COVID-19.
While the formalized central guidance hasn’t been strong in the country, perhaps this contributed to delegitimizing the use of the drug, at least for those that were on the record against usage targeting the coronavirus.
Interestingly, even though the drug has been approved for use in Slovakia, some of the mainstream press (as mentioned) has bought on guests highly dismissive of ivermectin use. Moreover, Slovakians that have gone to Facebook as a way to communicate, especially with expats abroad, such as Halgas himself, are routinely censored and even shut down.
That’s right: even if the drug is authorized in that country, Facebook can and has shut down groups discussing the topic among people that reside in that country. An unprecedented power, an American company literally controlling the discussion, and perhaps even the thought of people in a land halfway around the world.
COVID-19 on the Wane
Thankfully, the residents of Slovakia count declining numbers of cases now throughout the country. Since early March, the numbers are going down. With the latest seven day daily average of 836 new cases per day, that’s down from 2,423 on Mach 5 and 2,569 on New Year’s Eve 2020. The hope is that with more access to the vaccine, smart behavior and perhaps even the use of ivermectin that the pandemic will leave this part of the world, hopefully for good.