In last week’s column, we wrote about the amazing outcome many states in India like Uttar Pradesh and Delhi have attained with an ivermectin-based multidrug prevention and early treatment kits.

With a population of 241 million, more than twice that of the Philippines, Uttar Pradesh has been averaging less than 100 new COVID cases daily in the last three months, and less than 20 a day in the last three weeks. The deaths average one a day in the last six weeks. More than half of its districts or provinces have been declared COVID-free with zero active cases.

One can’t possibly attribute it to its anti-COVID vaccination, because it’s one of the slowest among the Indian states in its vaccination rollout, with less than 5 percent of its population fully vaccinated.

Treatment protocol

Some Indian colleagues we exchanged ideas and clinical experiences with tell us that it’s the firm resolve of the health officials and medical community in Uttar Pradesh that became a game changer. They defied the stern warning of the World Health Organization (WHO) against the use of ivermectin for the prevention and treatment of COVID-19 cases.A few months after the outbreak last year, a medical team at the state’s capital in Agra, led by Dr. Anshul Pareek, gave ivermectin to all members of its rapid response team, which was tasked with the prompt identification and isolation of diagnosed or suspected COVID-19 patients.

It was a crude experiment, but after several months, they observed that none of them got infected with COVID-19 despite their high-risk of exposure, with daily contact with their countrymen who tested positive for COVID-19.

The state’s surveillance officer, Vikssendu Agrawal, filed this report, and their health officials included ivermectin in their treatment protocol, making Uttar Pradesh the first state in the country to administer prophylactic and therapeutic ivermectin to its citizens. However, because of the WHO’s advisory, and a still strong national sentiment to toe the line, the recommendation on ivermectin was downplayed and implemented in a low-key manner.

The tipping point came when India had the big surge in late March and April. With the Indian health-care system literally clutching at straws as it tried to keep its head above water, and with patients dying by the thousands daily, the All India Institute of Medical Science and Indian Medical Research Council made its now-or-never recommendation to include ivermectin for early treatment of cases and prevention of those who were exposed to an infected person.

The WHO maintained its stand against ivermectin, but most doctors in states like Uttar Pradesh couldn’t care less what the WHO was telling them. They believed it worked for COVID-19. The “ivermectin-has-insufficient-evidence” admonition by the WHO and WHO-obedient expert societies in India lost credence, as far as the ordinary Indian practitioner was concerned.

In two weeks’ time, the cases in the ivermectin-using states started to drop by half, and in six weeks, they achieved 85- to 90-percent reduction in cases. In three months, the cases further decreased by 95 percent to 99.9 percent compared to peak levels. For several months now, many states are enjoying near-normal, pre-COVID activities.

Scientific evidence

We believe that India’s experience is a best practice success story that needs to be shared with the rest of the world. Practicing physicians and researchers should study this as real-world scientific evidence, which should carry just as much weight to corroborate the results of randomized controlled clinical trials. There should be an open discussion and debate on its applicability in other developing countries like the Philippines. Our demographic profile is very much similar to this Indian state. What’s good for the goose is good for the gander as well.

When we had a virtual meeting with Health Secretary Francisco Duque III more than two months ago, we suggested to him that he confer with his counterpart in India, and see how we could reap the same benefits they were already enjoying then with the use of their ivermectin-based treatment kits. He agreed to do that, but there seems to be no indication that he did that, or if he did, that he was convinced to duplicate what they did in some Indian states like Uttar Pradesh.

Ivermectin controversy

When the ivermectin controversy broke out into a national issue with a series of commentaries we wrote in March and April, Secretary Duque explained in a phone conversation that we needed to understand his position because he was caught in the center, with some doctors pushing for it, while the majority, including the expert societies, against its use.

I gave an unsolicited piece of advice that that was the burden of leadership—to study all data and evidence thoroughly and decide, based on one’s own judgment, what was best for the people, and not what was recommended by the experts. After all, I said that no one could truly claim to be an expert in a rapidly evolving field of science as COVID-19.

We believe it’s never too late for Secretary Duque to show that spark of leadership brilliance, which we believe he inherently has, and decide on what is best for the country.

We can afford to import very expensive antiviral drugs costing our patients an arm and a leg, but it’s quite difficult to understand the strong hesitancy in trying to include ivermectin and similar repurposed and affordable drugs in our treatment armamentarium for COVID-19.

It’s equally strange that the success story with ivermectin in India seems to be downplayed by major media outlets not only in India, but even in the United States and Europe. There seems to be an unseen pair of hands orchestrating the suppression of good news on ivermectin.

But you can never put a good treatment down. In fact, despite the renewed vigor of the Department of Health to discourage doctors and patients from taking ivermectin for prevention and treatment, several provincial health officers and local government officials have decided to use it for their constituents. They’re invoking the guidance from President Duterte, who said in one of his weekly broadcasts that, for so long as the doctor and the patient mutually agree to try using it for COVID-19, then that should be respected. INQ

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