THE hesitancy to use Ivermectin, the anti-parasitic drug to repurpose for Covid-19, is not about science. The science is clear and conclusive with regard to its prophylactic, therapeutic and safety issues. 

When there is a second or third-wave surge in many parts of the world with fast rising infective and death rates, the World Health Organisation (WHO) opines that Ivermectin only be used to treat Covid-19 within clinical trials is unjustifiable. Officials from WHO should know that in science opinions do not count. Only published papers do. 

It is not that Ivermectin has caused untold number of deaths and serious harm to those prescribed the drug. On the contrary, some 3.7 billion doses have been prescribed in the last 40 years and reports of side effects have been negligible. In fact, it is one of the safest drugs, if not the safest, in the entire pharmacopoeia.   

According to VigiAccess.org (last accessed on May 21, 2020), the Covid-19 vaccines adverse reaction accumulated since the end 2020 recorded 799,649 cases. Whereas Ivermectin has recorded 5,410 cases of mild adverse reactions since 1992. 

The flurry of scientific information for Ivermectin that surfaced over the last year should not have escaped the attention of any serious researcher, health organisations such as the WHO, and the health ministries the world over. 

Ivmmeta.com, which reports on real-time meta-analysis of all clinical studies of Covid-19 (updated as of May 18, 2021), has the most up-to-date compilation of all studies. For Ivermectin alone there are a total of 56 studies that involved 18,447 patients, to the following more detailed breakdown:

1. Fourteen prophylaxis trials showing 85% improvement. RR 0.15 (0.09 – 0.25).
2. Twenty-three early treatment trials showing 78% improvement. RR 0.22 (0.12 – 0.39).
3. Nineteen late treatment trials showing 46% improvement. RR 0.54 (0.40 – 0.72).
4. Twenty mortality results showing 74% improvement. RR 0.26 (0.15 – 0.44).
5. Twenty-eight randomised, controlled trials (RCTs) showing 66% improvement. RR 0.34 (0.24 – 0.50).

All the above-mentioned trials have high percentage of improvement, hence also attained statistical significance. The relative risks (RR, also known as odds ratio) are all significantly below 1, meaning the likelihood for the ivermectin group having a result like the control group is very minimal. 

The RCTs are considered the gold standard and are of high value in evidence-based medicine (EBM). Together with systematic review and meta-analysis, they occupy the top hierarchy of evidence in EBM. 

There are 28 RCTs listed in ivmmeta.com showing Ivermectin a remedy of great efficacy in prophylaxis, therapeutic and mortality. Only one well-designed, well-conducted, high-powered, double blind RCT showing positive results is good enough for the conclusion that the result is conclusive. 

Scientific reports showing the efficacy of Ivermectin is compelling. Those who argued that the results for Ivermectin is inconclusive often cited two studies – Chaccour et al (2021), a pilot study of 24 subjects, and another medium-sized trial, Lopez-Medina et al (2021), involving 476 subjects. 

Despite both studies not achieving statistically significant results, the clinical parameters showed lots of improvement for the ivermectin arms, such as faster rate of recovery, reduction in loss of sense of smell, and lower IgG titers (Chaccour study); two days faster resolution of symptoms and lesser adverse events (Lopez-Medina study). The small difference in values between the two arms in both studies, although did not show statistical significance, to the physicians they are clinically very significant. 

We are currently in a Covid health emergency, at war with a seemingly elusive coronavirus. As such, there is provision for emergency use authorisation for vaccines and medications. All available resources must be used to bring the war to a swift end, including adapting to pragmatic solutions.  

In April 2021, the world heard of India’s plight regarding the deadly second surge of Covid. Tens of thousands died. The highest daily infection record in the world – 360,960 cases in a day, and a toll of more than 200,000 deaths. 

Ivermectin was quickly disseminated under emergency use in several cities and states. In Delhi, at the peak of the infection on April 20, there were 28,395 cases. Three weeks after the Ivermectin rollout, cases dropped to 6,430 a day. 

In the state of Goa, as a pre-emptive measure, Ivermectin was disseminated on May 10. Within five days cases dropped from 3,124 to 1,314 a day. In the Uttar Pradesh state, daily cases dropped from 37,944 to 10,505 in four days. There were other examples. These news were only reported by fringe media and shamefully not covered in the mainstream. 

India, a mockery in the world’s eyes a month earlier has suddenly become a shining beacon within a month. WHO has much to learn from India.

Closer to home, the Philippines and Indonesia have allowed emergency use authorisation for Ivermectin. There is no justification to hesitate. – May 27, 2021.

* Captain Dr Wong Ang Peng is a researcher with an interest in economics, politics, and health issues. He has a burning desire to do anything within his means to promote national harmony. Captain Wong is also a member of the National Patriots Association.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.