Ahead of the results of a clinical trial on the effectiveness of controversial drug Ivermectin to treat Covid-19, Between The Lines traces the growing lobby for what is essentially a veterinary drug for human use and the issues that contributed towards the fervour behind it. ZURAIRI A.R. investigates.
This is part 1 of a two-part collaboration with #BeritaBaruNakUp
In barely 18 months, Malaysia has undergone two changes of government, a state of emergency, and various lockdowns — but Covid-19 didn’t care about any of that.
As of Sept 11, nearly 2 million people have been infected, with the virus showing little signs of slowing down.
While the country’s vaccination rate has been ramped up tremendously, finally outpacing most other countries in the region, many Malaysians have chosen a different route.
They’ve pinned their hopes on returning to relatively normal life on a drug usually used to treat parasites in animals, namely dogs and horses, but rarely humans: Ivermectin.
A growing list of advocates want the contentious drug to be included as part of the country’s arsenal to treat early stages of Covid.
This month, the Ministry of Health’s (MOH) Medical Research and Ethics Committee is set to release the results of a trial to test the drug’s efficacy.
Dubbed Ivermectin Treatment Efficacy in Covid-19 High-Risk Patients, the trial began in May and involved some 500 patients in 18 public hospitals.
Since it was announced, public pressure over the trial even led newly minted Health Minister Khairy Jamaluddin to vow to address the contentious issue “once and for all” in his first 100 days in office.
But how did we get to this Ivermectin frenzy? Between the Lines takes a look at the growing advocacy for the drug over the past year and the political missteps that fanned its popularity along the way.
How it started
Ivermectin first became a buzzword worldwide in December 2020, after Milwaukee-based pulmonary and critical care specialist Dr Pierre Kory testified before the United States Senate Homeland Security and Governmental Affairs Committee.
Describing it as a “wonder drug” with anti-viral and anti-inflammatory properties, Kory’s testimony, later uploaded on YouTube, became a viral hit.
Its so-called “miracle” status and cheap price made it perfect fodder for conspiracy theorists who bought into pharmanoia — the extreme distrust of pharmaceutical or drug companies — and other wacky claims about Covid vaccines — which range from 5G monitoring chips to the resurgence of Pharaoh zombies by way of DNA propagation.
“The misinformation on Ivermectin here started in earnest around the end of Dec 2020, just after the mRNA vaccines received their Emergency Use Authorisation from the US Food and Drugs Authority (FDA),” says Dr Adrian Wong, a technology and science educator who’s been writing for the site Tech ARP since 1997.
Wong says his site, which has run extensive debunking articles against forwarded text messages on Ivermectin, had started getting requests for such explainers after Kory presented his claims to the US Senate.
It was also at this time that the first batch of the Pfizer/BioNTech vaccines arrived and Khairy was made the coordinating minister of the immunisation programme. The second movement control order (MCO), which started in January, had continued into February. A conditional MCO would later continue until March.
Incensed with the extended movement restrictions, criticism towards Noor Hisham’s handling expanded into his reluctance to accept the yet-untested Ivermectin.
“It’s safer, cheaper and more effective than Pfizer, and the MOH should make it a choice besides vaccines,” demanded a pro-Umno blogger who became one of the more vocal proponents of the drug, in a popular Facebook post in February.
“What’s the point when one can still get infected by Covid even after a Pfizer dose?”
To be clear, there has yet been any evidence the drug is “more effective” than any vaccine in addressing Covid, as claimed by the blogger. Also, a vaccine’s role is not to treat the virus but to reduce the risks of getting infected by building the body’s immunity.
When the lobbying really began
Two lobby coalitions emerged that month.
The Malaysian Association for the Advancement of Functional and Interdisciplinary Medicine (MAAFIM), a group of alternative medicine practitioners, submitted an open letter co-signed by 136 doctors in support of the drug. The letter was run in several news outlets.
MAAFIM member, Dr Zulkafperi Hanapi’s so-called self-medication routine involving Ivermectin and vitamin C has since been widely shared online, driving underground sales of Ivermectin on popular e-shopping platforms, and illegal sales by general practitioners.
At the same time, a mish-mash alliance was formed between vaccine-sceptics in the police and military veterans’ group Persatuan Patriot Kebangsaan (Patriot), led by Dr Wong Ang Peng, and the Malaysian Muslim Consumers Association (PPIM). The group is heavily aided by the so-called Covid Research Centre by Asian Heritage Museum Sdn Bhd that runs Carcosa Negara.
Much like MAAFIM’s Zulkafperi in the first group, Prof Dr Mustafa Ali Mohd, who is the medical director of MAHSA University, provided the intellect and scientific credentials for this renewed push for Ivermectin in the second group.
Both doctors would be widely cited by proponents.
Dr Suhazeli Abdullah, a government family medicine specialist and health communicator popular on Facebook, tells Between The Lines many of those who jumped onto the Ivermectin bandwagon had been against vaccines even before Covid hit, even opposing inoculation against measles and polio.
“So when Ivermectin was advocated by a more vocal and organised group, they rallied behind it… I see some of them are prone towards alternative, complementary and functional…fringe branches of medicines. They want to profit from selling supplements and so on,” he says.
“They want to run away from vaccines, so they will find other alternatives that also look scientific,” he adds.
Police would later explain that they dismissed the report as no crime could be ascertained. However, Noor Hisham later announced that the clinical trial for Ivermectin had commenced.
His announcement, just weeks after seemingly refusing to endorse it, was seen by proponents of the drug that the police report had done its job.
The report, which had also named then-health minister, the gaffe-prone Dr Adham Baba as a co-conspirator, was an indicator of increasing cynicism towards the former general practitioner’s competence especially in comparison to his predecessor, toxicologist Dr Dzulkefly Ahmad.
Adham’s gaffes can be counted on one hand, but they were massively embarrassing.
In a live television appearance not long after taking over as minister and soon after Covid hit Malaysia, he wrongly advised that drinking warm water would prevent the coronavirus infection.
Then there was his declaration that the virtual World Health Organisation (WHO) conference involved “500 countries”.
And more recently, before the PM Muhyiddin Yassin government collapsed, he committed a Freudian slip by calling the Spanish Influenza “Spanish Fly” instead of “Spanish flu”. Twice.
That Dewan incident
Led by PKR’s Sungai Buloh MP Sivarasa Rasiah, these lawmakers accused the MOH of stopping medical professionals from using their judgment when it comes to advising their patients on the use of the drug as a purported cure or prophylactic against Covid.
Sivarasa urged Adham to use his executive powers to overrule the National Pharmaceutical Regulatory Agency, which decides whether a drug is safe to use nationwide, so that doctors may prescribe Ivermectin “off-label”.
“Off-label” means use of a drug outside of the conditions by which it is approved.
The Dewan Rakyat Hansard from that day also identified other opposition MPs on Sivarasa’s side: Shamsul Iskandar Mohd Akin (PKR-Hang Tuah Jaya), Sim Tze Tzin (PKR-Bayan Baru), Khalid Abd Samad (Amanah-Shah Alam), Johari Abdul (PKR-Sungai Petani), and P Prabakaran (PKR-Batu).
Despite Sivarasa’s assertion, Ivermectin is not authorised for use on humans in Malaysia, just on animals. Therefore, prescribing Ivermectin — either as a preventative drug or as treatment — would not merely be off-label, but illegal.
The month before in June, a private clinic in Kuala Lumpur had been raided by health authorities after supplying Ivermectin to patients by falsely claiming it can prevent Covid.
While the simmering pro-Ivermectin lobby had to that point still mostly stayed under the radar, thanks to Noor Hisham’s announcement of the trials, opposition MPs’ impassioned insistence for Ivermectin’s use had now given it new ammunition.
“Bringing up Ivermectin in the Dewan Rakyat was a terrible move by the Pakatan Harapan MPs. It gave Ivermectin some ‘legitimacy’, to be even brought up in the august chamber.
“Needless to say, Ivermectin proponents were very happy with that piece of political theatre. And I believe it helped convince more Malaysians to take it seriously,” Adrian Wong says.
He highlights what he calls “a steady deluge” of Ivermectin disinformation that followed not long afterwards. To date, he says, he’s written nearly 40 articles fact-checking numerous claims involving the drug.
“It also didn’t help that it was Adham who spoke up against Ivermectin. It would have been different if it was Khairy or the DG himself who answered the MPs,” he adds.
The Who’s Who of the Ivermectin Fan Club
It was around this time that the two previous pro-Ivermectin coalitions merged into the Malaysian Alliance For Effective Covid Control (MAECC).
Alternative medicine groups under MAECC’s umbrella include MAAFIM itself, the Society for Advancement of Hormones and Healthy Aging Medicine Malaysia, the Malaysian Society of Complementary Medicine, the Society of Natural Health Malaysia, and Naturopathic Medical Association Malaysia.
With it’s new reincarnation, the lobby also found itself a new, powerful ally — tycoon Lee Kim Yew, who became its patron.
Lee founded Country Heights Holdings Bhd, the developer behind the five-star hotel Palace of the Golden Horses and the award-winning Mines Resort City in Seri Kembangan. Its market capitalisation in Bursa Malaysia stands at around RM328 million.
MAECC has since organised a “World Ivermectin Day” event in July, even conferring a “benevolence leadership award” to Kory and his American pro-Ivermectin lobby Front Line Covid-19 Critical Care Alliance (FLCCC).
Lee’s office had initially agreed to be interviewed by this article, but then ignored further attempts to follow up.
On the same day as the Ivermectin debate in Dewan Rakyat, MAECC released a statement urging emergency use approval for the drug, claiming the epidemic would have been brought under control months ago if such a move had happened.
Chastising other medical professionals who questioned the data on Ivermectin, MAECC had cited its own set of experts. Who were these experts? None other than Kory’s FLCCC.
And here we are
The doses “prescribed” through viral social media posts range widely from merely one 12mg tablet every week for four weeks, to two 12.5mg tablets daily for five days. Even FLCCC’s Kory himself has been diligently updating his suggested regime over the months.
Pharmacist and health communicator Fahmi Hassan tells us downplaying the risks of ingesting Ivermectin, such as the false claims made by MPs in Parliament that the drug “has no side effects”, is worrying.
“Medicines are only considered safe when used at the appropriate dose and indication,” he says.
In fact, potential side effects of consuming the drug can range from minor (nausea, giddiness, diarrhoea and stomach discomfort), to severe (causing low blood pressure, lung damage and even death).
The previously recommended dose of Ivermectin for human use to treat onchocerciasis, or river blindness caused by parasitic infection, was 150 micrograms per each kg of patient’s body weight (mcg/kg) once every few months or yearly.
In contrast, Ivermectin proponents now recommend doses up to 400mcg/kg to 1,200mcg/kg daily or weekly, which Fahmi says is “well beyond the approved recommended dose”.
“The safety profile of the drug at this dosage regimen is not yet established. Cases of Ivermectin toxicity have been reported throughout the world including in Malaysia.”
Deviating from Ivermectin’s approved dosage “carries risks and should not be taken lightly.”
At the time of writing, at least two people in Malaysia have reportedly suffered from acute poisoning due to taking Ivermectin, the MOH said last month.
One was a 35-year-old who had breathing difficulties for five days, and the other was a senior citizen who was found unconscious after consuming 15 pills in one sitting.
The endless search for a cure
Still, Suhazeli, the family medicine specialist, explains that the medical community is more than ready to accept the use of any drug to combat Covid — provided there is evidence.
He points to previous inconclusive studies involving drugs such as chloroquine and lopinavir, and the successful application of corticosteroids such as prednisolone and monoclonal antibody therapy tocilizumab.
“We will take whatever if its validity is based on evidence, through robust research, and has no conflicts with vaccines,” he adds.
Already, there is hype surrounding monoclonal antibody therapy called sotrovimab, after the US FDA in May authorised its emergency use to treat mild-to-moderate Covid cases. However, the agency stressed the treatment is not for patients hospitalised for Covid or who require oxygen.
In public forums such as lowyat.net, sotrovimab has already been lauded as a “cure for Covid” and “rich man’s Ivermectin.”
Some quarters have also urged Putrajaya to start negotiating for it after neighbouring Singapore reportedly signed an advance purchase agreement with GlaxoSmithKline Singapore and Vir Biotechnology for the drug in June. It was scheduled to be available in the republic starting this month.
Sotrovimab aside, Suhazeli claims some in the anti-vaxxer crowd have even started advocating for colchicine — another cheap drug, popular for treating gout — as the next alternative to Ivermectin, should the trials prove not in their favour.
MAECC’s patron Lee, meanwhile, has also kickstarted an online petition urging Putrajaya to pass an emergency plan for traditional Chinese medicine (TCM) for Covid patients.
Citing its alleged effectiveness in China, Lee said the tens of thousands of TCM practitioners here are great resources that can be utilised to support the public and private hospital and healthcare systems. The petition launched in July had garnered a paltry 25 signatures at the time of writing.
No doubt, more suggestions will make their way to social media, messaging apps, the public’s imagination and, as the case with Ivermectin, our Parliament halls, as the Delta variant continues to wreak havoc.
This is especially as Malaysia has yet to achieve herd immunity from vaccinations.
At the time of writing, Malaysia is closing in on 20,000 deaths from the virus. In this region, this figure has been topped only by Indonesia (over 117,000 fatalities) and the Philippines (over 30,000 deaths).
But factoring in our population, Malaysia’s the worst affected country in the region. In the last weeks, there were 104.46 deaths per 1 million people, compared to 78.76 in Indonesia and 20.74 in the Philippines.
The long and short of it is, as long as the death toll continues to climb, no change of government may satisfy the desperation and fear of the public.
Ivermectin, and likely any future untested “miracle” drug, will continue to entice and put lives at risk.
In Part 2, #BeritaBaruNakUp will dissect the support of Ivermectin by Members of Parliament in Dewan Rakyat, and how that affected sentiment on social media and among its advocates. Part 2 drops next week!