After India finally gets somewhat of a grip on its deadly second wave, one of its health regulators just took away one of its main lines of defense.
India’s Directorate General of Health Services (DGHS) has executed a policy reversal that could have massive implications for the battle against covid-19, not only in India but around the world. Hundreds of thousands, if not millions of lives, could be at stake. The health regulator has overhauled its COVID-19 treatment guidelines and removed almost all of the repurposed medicines it had previously recommended for treating asymptomatic and mild cases. They include the antibiotic doxycycline, hydroxychloroquine, zinc, ivermectin and even multivitamins. The only medicines that are still recommended for early treatment are cold medicines, antipyretics such as paracetamol and inhaled budesonide.
“No other covid-specific medication [is] required,” say the new guidelines, which also discourage practitioners from prescribing unnecessary tests such as CT scans.
“Patients are advised to seek tele consultation; and Covid-19 appropriate behaviour must be observed such as mask, strict hand hygiene and physical distancing… [Patients are also advised to maintain] a healthy diet with proper hydration… [and] to stay connected [with family] and engage in positive talks through phone, video-calls, etc.”
The decision to remove ivermectin, multivitamins and zinc from the treatment guidelines is hard to comprehend given the current state of play in India — unless one assumes foul play. After suffering one of the worst covid-19 outbreaks since the pandemic began, resulting in the loss of hundreds of thousands of lives, India is not just flattening the curve, it is crushing it. And the widespread use of ivermectin, a potent anti-viral and anti-inflammatory with an excellent safety profile, appears to have played an instrumental role.
Other countries in the region have already taken notice. Indonesia just approved the use of ivermectin in Kudus, a local contagion hotspot.
This is the last thing the World Health Organization (WHO) and the pharmaceutical companies whose interests it broadly represents want. As such, it was no surprise that WHO was delighted with the DGHS’ policy reversal. “Evidence based guidelines from @mohfw DGHS – simple, rational and clear guidance for physicians,” tweeted WHO’s chief scientist Soumya Swaminathan, of Indian descent. “Should be translated and disseminated in all Indian languages.”
As I posited in my recent article “I Don’t Know of a Bigger Story in the World” Right Now Than Ivermectin: NY Times Best-Selling Author, there are three possible explanations for global health regulators’ opposition to the use of a highly promising, well-tolerated off-label medicine such as ivermectin:
- As a generic, ivermectin is cheap and widely available, which means there would be a lot less money to be made by Big Pharma if it became the go-to early-stage treatment against covid.
- Other pharmaceutical companies are developing their own novel treatments for Covid-19 which would have to compete directly with ivermectin.
- If approved as a covid-19 treatment, ivermectin could even threaten the emergency use authorisation granted to covid-19 vaccines.
It’s worth noting that while India’s DGHS has dumped most cheap off-patent treatment options against Covid, including even multivitamins, more expensive patented medicines continue to get the green light. They include Gilead’s prohibitively expensive antiviral Remdesivir, which DGHS continues to recommend for “select moderate/ severe hospitalised COVID-19 patients”, even though “it is only an experimental drug with potential to harm.” It has also authorised the use of the anti-inflammatory medicine tocilizumab, which costs hundreds of dollars a dose.
Crushing the Curve
The DGHS began recommending the widespread use of ivermectin as early as April, in direct contradiction of the recommendations of the World Health Organization. Treatment packs were assembled in many states and distributed to patients testing positive for Covid. In at least two states — Goa and Uttarakhand — the medicine was distributed as a preventive. As has already happened in over 20 countries where ivermectin has been used — from Mexico, the Dominican Republic and Peru to Slovakia, the Czech Republic and Bangladesh — case numbers, hospitalizations and fatalities have fallen in almost vertical fashion. On Monday the country recorded its lowest number of new cases in 61 days.
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