A black market amid the pandemic

AS at July 19, 7,148 Covid-19 patients in Malaysia have succumbed to the virus while the number of infections does not seem to be coming down to pre-Emergency levels.

Although more than 95% of the cases comprise those who are asymptomatic or show mild symptoms, the mounting number of daily deaths is scary.

A total of 153 deaths – the highest in a single day since the start of the pandemic – was recorded on July 18. Over the past 10 days, the fatalities have been between 102 and 129 people.

With patients fighting pneumonia, needing oxygen support or in critical condition with ventilators stretching the limits of frontline medical staff and operating capacities of hospital wards and intensive care units, the figures are set to remain high.

On the plus side, close to 800,000 people have recovered from the infection and 14,772,221 vaccines have been administered to those who had registered so far. A total of 9.8 million people (41.9%) have received at least one jab of a Covid-19 vaccine while 4.5 million (19.4%) have taken both shots.

Against the daunting backdrop of spiking infections, including the highly aggressive Delta variant of the virus, the government is speeding up its Covid-19 National Immunisation Programme with the aim of getting all adult Malaysians fully inoculated by October.

It is also targeting 100% of adults in Selangor and Kuala Lumpur to get at least one dose by Aug 1. It has also decided that people who could not register or were not given appointments to get their jabs, could just walk into any of the 56 vaccination centres in the state and Federal Territory from the specified date.

Can the October target be met? Perhaps so, based on the expedited national programme and the expected availability of 14.4 million doses of Covid-19 vaccines – 6.43 million from Pfizer, 1.59 million AstraZeneca and 6.38 million Sinovac.

But the number of Malaysians having doubts and hesitations about the vaccines and opting for alternative treatments is also rising. This is evident by the growing acceptance for Ivermectin as a radical repurposed drug to prevent or treat Covid-19 even among those who have already taken their first shots or both.

An anti-parasitic drug, Ivermectin has been widely and safely used for nearly 50 years in both animals and humans against diseases like lymphatic filariasis (elephantiasis) and onchocerciasis (river blindness).

Like elsewhere in the world, Ivermectin has not only found a strong following here but has also caused a fissure in the medical community. While most doctors follow accepted treatment protocols, there is a vocal group behind the Malaysian Alliance for Effective Covid Control (MAECC), a loose coalition of doctors and consumer organisations, which has been actively promoting usage of the drug for the early treatment of Covid-19.

Last Saturday, MAECC invited MPs and state assembly representatives to hear from the testimonies of experts on the effectiveness of the drug against Covid-19 in a Zoom meeting. Its video of the session, recorded on Vimeo, is being shared widely.

Exactly a month ago, MAECC urged the government to include Ivermectin in its list of drugs used to treat the coronavirus and called for its fast-track usage to curb the spread of the virus and save lives. Much like other proponents of the drug, the alliance has argued that there is little time for large-scale trials when the death toll continues to rise and vaccines are being administered sluggishly.

Since the start of the pandemic, the Health Ministry has been consistent that evidence is inconclusive to recommend routine use of Ivermectin for Covid-19. It has relied on the US Food and Drug Administration’s non-approval of Ivermectin, and the position of the World Health Organisation (WHO) that the drug should only be used in clinical trial settings, under which patients are monitored closely for safety and efficacy.

However, in early June, it initiated a multi-centre open-label randomised controlled trial, called the Ivermectin Treatment Efficacy in Covid-19 High Risk Patients (I-Tech Study), with the Institute for Clinical Research (ICR). The study is led by an infectious disease physician at Hospital Raja Permaisuri Bainun in Ipoh and a team of specialists and clinical research centres from 12 government hospitals.

I-Tech, involving 500 patients from high-risk groups aged 50 and above in hospitals with Category 2 and 3 symptoms, is aimed at determining the efficacy of Ivermectin in preventing the progression to severe disease (Categories 4-5) and mortality outcomes. It is expected to be completed by September.

But the ministry has also said Ivermectin could also be used as an “off-label” drug – on the explicit condition that hospitals must apply to the ministry’s drug control authority to use Ivermectin, including for treating Covid-19 patients.

As such, doctors are unable to easily prescribe Ivermectin even as a prophylaxis. This has led to many of its believers resorting to buying the drug online in spite of the risks of ending up with fake versions or medication meant for livestock or pets.

The ministry must surely be aware of the huge black market for Ivermectin in Malaysia, just like in Indonesia and Thailand, with people paying exorbitant prices to get the drug.

Two local doctors, who highlighted the issue in a viral video, warned people to be wary of counterfeit concoctions and urged buyers to be sure of the manufacturing source.

While waiting for the results of the ongoing trial, perhaps the ministry should consider extending the limits of Ivermectin’s “off-label” use to controlled usage and make it available for doctors to prescribe and authorise pharmacies to sell.

At the very least, this could prevent the risk of desperate people ending up being sick or dead after taking fake drugs.

Media consultant M. Veera Pandiyan likes the wisdom in Hippocrates’ observation: “Let food be thy medicine and medicine be thy food.” The views expressed here are the writer’s own.