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Ivermectin advocating Professor Colleen Aldous recently attended the College of Primary Health Care Physicians of Zimbabwe and was stunned by yet another unfathomable decision by authorities on the treatment of Covid-19. Highly regarded doctors related their use of Ivermectin to treat Covid-19 successfully. But at the conference, the National Medicine and Therapeutics Policy Advisory Committee announced that Vitamin C, Vitamin D and zinc were lumped with Ivermectin as medications not recommended for use in treating Covid-19. As Prof Aldous points out below, “the regimen many doctors had successfully used during the pandemic was squashed.” – Nadya Swart
Zimbabwe’s Advisory Committee bans the use of vitamins for Covid-19 treatment
By Prof Colleen Aldous*
I am always astounded that authorities manage to descend even further after they reach what we think is their lowest point!
Last week, I attended the 2022 Annual Joint Congress of the CPCPZ/PSZ* at Victoria Falls. I was invited to speak on evidence-based medicine (EBM) in the context of the theme of the conference, “Active Adaptation to Emerging Challenges in Health Care Delivery: Lessons learnt from the COVID-19 Pandemic.” At the congress, Dr Sabine Hazan presented the Covid-19 treatment regimen that she implemented in Malibu, California, which included Ivermectin. Dr Jackie Stone from Zimbabwe presented the results of her treatment regimen, which also included the drug. Dr Hazan treated over 3,000 patients with a zero mortality rate. Dr Stone lost only six patients out of several hundred, who died when they were hospitalised and their regimens were changed. Both doctors kept their patients out of hospitals, treating them in their homes – until Dr Stone was stopped from using her regimen.
My jaw dropped when Dr Edward Chagonda, the Zimbabwe football team’s doctor and specialist family physician who lectures at the University of Zimbabwe family medicine programme presented the Advisory Committee’s Draft Covid-19 Treatment Guidelines. This committee had previously asked the CPCPZ for their Covid-19 treatment guidelines. They were enthusiastically handed over in the hope that they would make a positive contribution to the national guidelines.
Imagine the shock of the audience, all CPCPZ and PSZ members, when they saw the guidelines were taken directly from the WHO guidelines, which includes molnupiravir as an antiviral, a drug with 50% efficacy for progression to severe disease compared with the 66% of Ivermectin. The WHO recommended drugs’ list for Covid-19 is unaffordable for the average Zimbabwean citizen. Every drug from the CPCPZ protocol was listed under medications not recommended for use in Covid-19 treatment. Predictably, they tossed Ivermectin onto the list, but Vitamins C, D and zinc? It was clear that the CPCPZ protocol was requested in order to list all the drugs in their regimen as specifically not to be used –the regimen many doctors had successfully used during the pandemic was squashed. I don’t believe the list was thought through at all. It appears it was merely copied and pasted from the CPCPZ regimen. It is unheard of that a doctor should not prescribe at least vitamins and zinc for a Covid-19 patient: medications that are available over the counter.
There are two groups of healthcare professionals involved in the treatment of Covid-19.
Firstly, there are primary healthcare physicians or GPs who requested permission to use Ivermectin from the Zimbabwe Ministry of Health. The authority was granted with a clause to provide treatment data to the Ministry as an ongoing research project. It is this data that should be provided to the ministry. I worked with Dr Jackie Stone on a journal article which has been accepted for publication that shows the immediate improvement of oxygen saturation after initiating her Ivermectin regimen. Data from other doctors in Zimbabwe who used Ivermectin will be seen as anecdotal evidence as it is not in the form of a randomised control trial. But after the arrest of Dr Stone and her subsequent legal tribulations because of her regimen, many doctors have gone quiet about their use of Ivermectin.
Secondly, there is a specialist physicians’ group which has a very different approach to treatment. They have been vocal in their rejection of the primary care physicians’ protocol. According to one of the delegates at the conference, “Unfortunately for Zimbabwe, specialist physicians are regarded as mini gods but to me their recommendations would mean no one will get treatment for Covid-19 simply because patients will not afford (sic). Their treatment guidelines and recommendations are regurgitated from WHO.”
Then there are the patients. They are not all as gullible as some may think. They will take treatments they believe in, whether the authorities like it or not. The majority of Zimbabweans will not be able to afford the suggested regimen, and will not wait for disease progression without taking any treatment. They would rather self-treat, including with Ivermectin.
Dr Chagonda served on the advisory Committee that drew up these guidelines and told the audience that these guidelines would be enforced like nakedness would be jailed. I kid you not; that was his metaphor. Whilst there was an effort to push these guidelines through quickly, the draft document has been referred back to the Covid-19 treatment guidelines committee for input by all stakeholders, especially family physicians and pharmacists, who happen to be the frontline workers in the fight against Covid-19. The Ministry of Health has been rational in waiting for inputs from doctors who have successfully treated Covid-19. They have deferred signing off on the guidelines until this has been achieved.
My presentation on EBM, which immediately preceded Dr Chagonda’s talk, I hope made an impression. I presented the EBM pyramid and intersection diagrams and spelt out what research on repurposing drugs such as Ivermectin is appropriate in a pandemic. I showed what research for and against Ivermectin use in Covid-19 is currently published and what was available when the WHO declared Covid-19 a pandemic. I stressed the consideration of the totality of evidence, not only the narrow focus on randomised control trials. However, there is still this indoctrination in some whom I believe to be set thinkers, not growth thinkers, who say only a large randomised controlled trial can persuade them before they will admit a drug works. Until then, there is apparently insufficient evidence for them. I also made the point that Africans understand their own problems better than any supra-power and that we should use our own brains to solve our own problems in ways we know would work in our contexts.
I had been in Victoria Falls for five days, and I have not seen an elephant. Dr Hazan told me she saw one in the road outside a restaurant she was at. Dr Stone says she has never been to the falls for longer than 24 hours without seeing one. There was old and fresh elephant droppings everywhere in the town. I saw the spoor of a baby as well as a lone bull elephant. I saw baobab trees wrapped in diamond mesh fencing to protect them from the damage done by elephants. All anecdotal evidence! I had not seen an elephant in Victoria Falls yet. Seeing is believing. Therefore, I disclose with the confidence of the Advisory Committee that there is insufficient evidence of elephants in Victoria Falls for me to recommend that you go there to see them.
*CPCPZ/PSZ – College of Primary Health Care Physicians of Zimbabwe / Pharmaceutical Society of Zimbabwe.
- Professor Colleen Aldous is a healthcare scientist at UKZN’s College of Health Sciences where she runs the Doctoral Academy. She is a member of the Academy of Science of South Africa. She has a PHD and has published over 140 peer-reviewed articles in rated journals.
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