A supporter of President of Brazil Jair Bolsonaro waves a box of ivermectin at a pro-government demonstration in Brasilia in May 2021. Andressa Anholete/Getty Images
The popularity of unproven anti-parasitic drug ivermectin as a COVID-19 treatment is surging.
Its use has roots in South America, where it was hyped by populist leaders citing debunked research.
"Nobody paid attention... now we see the same" in the US, a Peruvian official told Insider.
In May 2020, when the coronavirus was sweeping the South American nation of Peru, Dr. Patricia Garcia of the country's health ministry began receiving disturbing reports from the country's hospitals.
They detailed injuries not caused by COVID-19, but a drug people thought would help them: the anti-parasitic substance ivermectin.
"The kind of things they were telling was people that were coming with severe gastritis [stomach inflammation], and also pancreatitis, because they were taking the ivermectin in desperation," Garcia told Insider.
As the coronavirus continued to spread, people's faith in ivermectin as a way out of the crisis grew more fervent, said Garcia.
It would be almost a year before ivermectin would become widely discussed in the US, as a subset of Americans began to insist on receiving it.
The US demand for ivermectin surged as vaccination - the most effective COVID countermeasure - became increasingly politicized. Doctors strongly advise against taking it but, as of October 16, more than two-dozen lawsuits had been filed around the US from people demanding access to it.
"History is repeating," said Garcia. "Nobody paid attention about what was happening in Latin America and now we see the same situation."
A municipal worker sprays disinfectant past a street vendor at a market in Puno, Peru, near the border with Bolivia, on June 10, 2020. CARLOS MAMANI/AFP via Getty Images
In the Peru of May 2020, there were no vaccines, and ivermectin's rise was being driven by hope and desperation.
Pharmacies fast ran out of pills as thousands sought to obtain it, and a lucrative ivermectin black market emerged, as local media reported at the time.
Adherents recommended both that healthy people take ivermectin as a preventative, and that it be used to treat COVID-19 after infection.
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Many resorted to a stronger version of the drug, normally used to deworm horses. That form is taken by injection, and people who took it were left with serious skin lesions, said Garcia.
As the fervor spread, evangelical groups based in southern Peru injected 5,000 people from indigenous communities with the drug.
In some cities, including the capital, Lima, public health officials distributed the stronger, dangerous form of the drug to whole neighborhoods.
The belief that ivermectin could work against COVID-19 is almost as old as the pandemic, predating vaccines and even proper testing.
Almost two years later, there is still no conclusive evidence that ivermectin is effective against COVID-19, and it has been repeatedly debunked, including by the FDA in September.
It said that taking large doses of any kind of ivermectin is dangerous, and that humans should never take drugs intended for treating animals.
Carlos Chaccour, a researcher at the Barcelona Institute for Global Health, pointed to an obscure research paper in early 2020 which appeared to answer the desperate desire for a workable treatment.
The paper drew on data from Surgisphere Corporation, a small research group in Chicago, which published it in April 2020 seeing to establish a link between taking ivermectin and surviving COVID-19.
A pharmacist in Santa Cruz, Bolivia, with doses of ivermectin. Rodrigo Urzagasti/picture alliance via Getty Images
The researchers, who also touted hydroxychloroquine, said the paper's basis was data from thousands of hospitals around the world. Their research was published by top-tier medical journals including The Lancet and The New England Medical Journal.
But doubts soon emerged the authenticity of Surgisphere's data, the credentials of its team, and the methodology they used.
The Lancet and The New England Medical Journal retracted the study after a backlash from the scientific community and an investigation by The Guardian. But by then, said Chaccour, the damage was done.
In summer 2020, government officials in Peru, Bolivia, and Guatemala made ivermectin part of their COVID-19 strategies, often citing the retracted study as evidence.
Chaccour told Insider that the drug was embraced so readily because it seemed to present a simple solution, was relatively cheap, and was already widely used in the region.
He noted that a danger of the drug - perhaps worse than its adverse effects - was that people who believed it to be effective against COVID-19 were more likely to ignore actions that actually work.
"One of the risks of ivermectin is not just the safety, but the hazard of people not using masks or not getting vaccines or not doing social distancing because they think they are protected," he said.
As a second wave of the coronavirus hit South America in the latter half of 2020, ivermectin became more popular still. The city of Cali in Colombia handed it out to all of its COVID patients in late July. Weeks later the state of Chiapas in Mexico followed suit.
In Brazil, South America's most-populous country, the drug was endorsed by the country's populist president, Jair Bolsonaro, and by his allies at a regional and national level.
But it wasn't just politicians. They were riding a wave of social-media misinformation that was still spreading. In groups on Facebook and WhatsApp, misinformation about ivermectin was being shared by millions, experts told Insider.
Among its influential promoters was COMUSAV, a group of renegade medics based in Bolivia, whose core product was a kind of industrial bleach promoted as a miracle cure for a vast array of ailments that included COVID-19.
They pushed ivermectin to their followers across the continent on their Facebook pages, which had tens of thousands of followers.
(Many of the group's pages were removed following an investigation by Insider in March 2021.)
A data analyst, Juan Chamie, was among those who helped to bring the enthusiasm for ivermectin from the populists of South America to their equivalents in the US, experts told Insider.
Chamie claimed to have data showing lower COVID-19 mortality in parts of South America where public health authorities approved ivermectin.
But Chaccour and data scientist Joe Brew have said his analyses are misleading, and ignore other factors that could explain the differences.
"Just because things are associated does not necessarily mean that one thing causes the other," they said.
That hasn't stopped Chamie's analyses being shared widely, until his account was suspended by Twitter.
Among those taking note was Laura Ingraham, primetime host of Fox News' show "The Ingraham Angle."
In December 2020 Ingraham posted a graph of data attributed to Chamie to her 3.8 million followers.
It purported to show a reduction in COVID-19 cases, comparing areas of Chiapas, Mexico, where officials did and did not distribute ivermectin.
Chaccour said that, as with Chamie's other claims, the decrease could be coincidental or due to other factors.
Ingraham already had a history of promoting ivermectin. As far back as March 2020, Ingraham had tweeted about the Surgisphere research that was later debunked.
Chaccour believes that Ingraham's advocacy was a tipping point for ivermectin in the US.
Progressive campaign group Media Matters noted that Ingraham's enthusiasm extended to her widely-viewed Fox News show.
In two episodes in December 2020, Ingraham claimed that medical authorities were conspiring to suppress the substance and ignoring evidence of its effectiveness. Andrew Lawrence, a Media Matters staffer, told Insider that Ingraham was "definitely the leader" among network hosts promoting the substance.
A Fox News spokesperson said in Ingraham's defense that she never explicitly told viewers to take the drug.
In comments to The Washington Post, Ingraham criticized attempts to "silence" scientists with unorthodox messages. "Just like the scientific consensus, the medical consensus is evolving. It changes," she sad.
Chamie also formed contacts with the Front Line Critical Care Alliance (FLCCA), a group of US medics who were influential in pushing ivermectin in the US, as detailed in a September investigation by Insider's Hilary Brueck.
Chamie describes himself as a senior data analyst for FLCCA on his LinkedIn page, and the group cites his research on its website.
The group has been instrumental in brokering ties between the pro-ivermectin movement and Republican lawmakers who promoted the drug.
Last December, Dr Pierre Kory, a member of the group, testified before the US Senate about ivermectin in what one critic, Brown University dean Dr. Ashish Jha, described in The New York Times as a "misinformation super-spreader event."
In a statement to Insider, the FLCCC defended its position on ivermectin, forwarding Insider a list of studies based on anecdotal evidence suggesting that ivermectin may be effective in reducing COVID-19 deaths. These studies are not considered conclusive by experts.
The group did not respond to questions regarding Chamie's research, and Chamie himself did not respond to requests for comment from Insider.
As proponents in the US clamored for wider use of ivermectin, in South America disillusioned officials were reversing their position.
In February Peru removed ivermectin from its COVID treatment protocol altogether because of the absence of evidence that it worked.
"It's incredible for me that we, a whole region, already went through this terrible situation in which lots of people have died," Garcia, the Peruvian official, told Insider.
"They were taking ivermectin because it was known to us, so it was easy for us. And it didn't work."
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The roots of ivermectin mania: How South America incubated a fake-medicine craze that took the US by storm - Yahoo News