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The Use of Ivermectin to Treat COVID Has Roots in Our Broken Health Care System

It’s easy to laugh at people eating “horse paste.” But the widespread willingness to take off-label treatments and drugs formulated for animals stems from problems in our privatized health care system, from domestic pharma prices to global vaccine inequality.

Plenty of people have bought into ivermectin as a cure for COVID-19, with many flocking to farm supply stores to buy the livestock version of the drug. (BLM Nevada / Flickr)

By the time Joe Rogan had contracted COVID-19 and announced his decision to treat it with ivermectin, the drug had already become popular with the intellectual dark web and conspiracy-inclined conservatives. The celebrity podcaster may have been making a shrewd brand-management calculation, but plenty of ordinary people have also bought into ivermectin as a cure for COVID, with many flocking to farm supply stores to buy the livestock version of the drug, colloquially termed “horse paste.”

It’s easy to laugh at Rogan and the legions of horse paste customers. But the widespread willingness to use off-label treatments and drugs formulated for animals is evidence not of individual stupidity, but rather of deadly problems with our system of privatized medicine.

The popularity of ivermectin and hydroxychloroquine before it reveal the effects of a pharmaceutical industry built on extracting as much profit as possible from lifesaving medication. In this context, people are more than used to mistrusting the medical establishment and finding their own remedies. Liberals may laugh at them or admonish them, but people’s mass willingness to take unproven COVID treatments, even ones not meant for our species, is based on the inequities created by profit-seeking pharmaceutical companies.

The Wonder Drug

Ivermectin is not exclusively for horses, and it’s far from useless in certain medical situations. It’s an inexpensive and highly effective anti-parasitic medication that can be formulated for humans or animals. Rogan received a dose meant for humans, prescribed by a doctor. In the United States, ivermectin is approved for human prescription in tablet or topical form, but in countries where parasites are more common, it’s available to humans over-the-counter.

In April of last year, researchers in Australia released laboratory evidence that ivermectin could kill SARS-CoV-2 in forty-eight hours when administered in large doses. These findings were obtained through experiments with cell cultures, which were not indicative of conditions within a human body. The researchers made it clear that more clinical testing would be required before ivermectin should be considered an effective treatment against COVID.

As it happened, also in April of last year, a preprint (non–peer reviewed) study was published in Lancet, claiming that ivermectin drastically reduced mortality in COVID patients. The data analyzed in the paper came from a small health care analysis company named Surgisphere and was said to have been gathered from hundreds of hospitals around the world (seemingly in violation of some of those countries’ patient data laws). Surgisphere came under suspicion when they refused to allow independent researchers to verify the hospital data they used for their COVID treatment studies. There were serious problems with the data presented by Surgisphere, and Lancet went on to retract the article as well as a few other COVID studies using Surgisphere data.

The next big piece of evidence for ivermectin came from a study conducted in Egypt. It was the largest study of ivermectin as a treatment for COVID to date, and it didn’t come from compromised Surgisphere data. It was this single study that caused a meta-analysis of ivermectin as a COVID treatment to report that it was indeed effective. Further scrutiny of the Egypt study, however, revealed serious doubts about not only the veracity but the very existence of their data sets.

Like the Surgisphere study, the Egyptian study was retracted and removed from the ivermectin meta-analysis. The conclusion for now seems to be that ivermectin has little-to-no clinical benefit in treating COVID.

Hope for the Developing World

By the time evidence mounted suggesting that the initial claims about ivermectin were built on bad science and possibly fraud, the fallout from those early publications was already in motion.

Several South American and African countries had already approved ivermectin as a treatment for COVID patients. When Peru wanted to conduct a clinical study on ivermectin’s effectiveness, researchers had trouble finding people who weren’t taking it already to enter a control group. Peru eventually retracted its recommendation to treat patients with ivermectin, but several other countries continued distributing it. In South Africa, special interest groups have put intense pressure on the government’s health safety organization to approve ivermectin for COVID treatment. Zimbabwe recently approved the drug for use in clinical trials, backtracking from when it seemed to approve it as a treatment for COVID without restriction.

Ivermectin consumption in poorer countries has created shortages of human-formulated doses.  People have taken to acquiring formulations of the drug meant for livestock, and black markets have arisen in South Africa, India, and all over Latin America where people are buying whatever formulation they can get at inflated prices. Repeated warnings from major health organizations like the Food and Drug Administration (FDA), the World Health Organization (WHO), and the European Medicines Agency (EMA) have failed to stop the train of desperation-induced self-treatment.

It’s not hard to understand why there is such high demand for ivermectin in developing nations. Treatments that have some clinical evidence behind them such as dexamethasone, remdesivir, and monoclonal antibodies are not nearly as widely available or affordable as ivermectin. And despite vaccines being available since last December, access to the vaccines continues to be limited in poorer nations.

As soon as the first COVID vaccines were approved, it became clear that poorer countries would have to rely on the generosity of richer nations to obtain them. But those richer nations were less focused on finding solutions in light of global interdependence than they were on getting their citizens back to work. The wealthy nations bull rushed the market, signing bilateral deals to secure numbers of doses several times the size of their populations. Even with the market power of richer nations to secure vaccine doses, distribution still lagged in places like Canada and the European Union due to dilapidated state capacity caused by neoliberal hegemony. Poorer nations were left to fend for themselves or rely on the WHO’s COVAX program.

COVAX itself had issues competing with wealthy nations for doses, and due to our global hierarchy, they kept providing doses to rich countries that had already procured plenty. Canada, for example, has secured more doses per capita than any other country, and yet continues to benefit from the COVAX program. The paradoxical fact that poor nations tend to pay more for drugs than rich nations hasn’t changed in light of COVID. In pursuing their own bilateral deal with AstraZeneca, Uganda ended up paying $7 per vaccine dose while the EU paid only $3.50.

The obvious solution of giving countries the ability to produce their own vaccines by waiving patent protections is still being blocked by the UK and the EU, with encouragement from their sponsors in the pharmaceutical industry. The United States was on the side of upholding copyrights until very recently, and even with stated US support for loosening restrictions no real movement has been made. Cases are spiking in poorer nations. The greed of Big Pharma companies and rich countries has created a context in which people are desperate for anything to keep their loved ones alive.

Homegrown Parasites

Ivermectin’s widespread use in poor and developing nations has served as foundational evidence for the American right wing in their specious conspiracy theories about COVID.

For professional pontificators like Laura Ingraham, Joe Rogan, and Jordan Peterson, ivermectin is the “wonder drug” that powerful people don’t want you to know about. The idea that nefarious government actors are colluding to keep the miracle cure out of your hands so you’ll take their vaccine is very appealing to those inclined to distrust our political establishment. The fact that, unlike in the developing world, vaccines are readily available in most places in the United States only serves as proof that they are not to be trusted. We’ve long been taught that nothing good is truly free.

The FDA has noted that the number of prescriptions for ivermectin has increased over the course of the pandemic. Of course, not everyone is waiting for a doctor to prescribe them the miracle anti-parasitic; some just take a trip to their local farm supply store to buy horse paste, relying on questionable websites to measure out acceptable human doses of ivermectin from  livestock formulations. This led the FDA to release the following tweet:

It’s important that the FDA communicate that ivermectin is very likely useless against COVID, and that people shouldn’t be taking it without instructions from a doctor. But the agency’s condescension betrays ignorance about the systemic roots of the phenomenon.

In a country where millions of people are uninsured and underinsured, poor people have a hard time affording medicine. Rising prescription drug prices have led some to take over-the-counter animal medications to save money. This is neither a new phenomenon nor simply a product of the pandemic. Antibiotics are generally inexpensive, but when it’s difficult or expensive to see a doctor and get them prescribed, people often seek out their veterinary equivalents. Abuse of antibiotics for cold-like symptoms has contributed to the frightening rise of antibiotic-resistant disease-causing bacteria.

Poison control centers in Texas, Florida, Georgia, and Mississippi have all reported large upticks in calls about ivermectin poisoning, with Mississippi reporting that 70 percent of these calls have come from people taking livestock dewormer. Those states share the unfortunate distinction of having some of the highest rates uninsured people in the United States. Yes, the vaccine is free — but a culture of alternative medical self-treatment has already developed in places where most medicine costs a fortune. These are problems that would be prevented by a program of universal tax-funded health care.

Horse paste jokes can be tempting, but they don’t do anything to solve the problem. Instead of making fun of people for believing in conspiracy theories, it would better serve us to put pressure on the companies and countries holding up global vaccine patent waivers. In the United States, we should be pushing aggressively for at least temporary universal Medicare expansion so that people can ask an actual doctor for medical advice rather than consulting their favorite podcast host.

There will always be conmen and people who are easily beguiled. We can mitigate these social factors by addressing the material inequities that feed them.