Quality of clinical evidence and political justifications of ivermectin mass distribution of COVID-19 kits in eight Latin American countries

• Published in: BMJ global health Vol. 8; no. 5; p. e010962
• Main Authors: Requejo Domínguez, José Antonio, Mino-León, Dolores, Wirtz, Veronika J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.05.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Bias; Coronaviruses; COVID-19; Decision making; Government; Health policy; health systems; Hospitalization; Humans; Ivermectin - therapeutic use; Latin America; Meta-analysis; Mortality; Original Research; Pandemics; Prevention; Public health; Public officials; Severe acute respiratory syndrome coronavirus 2; Latin America; El Salvador; Panama; Guatemala; Brazil; Mexico; Honduras; Bolivia; Peru; COVID-19; health systems; public health
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2022-010962

BackgroundSeveral countries in Latin America conducted mass distribution of COVID-19 kits intended to treat mild COVID-19, thereby preventing excess hospitalisations. Many of the kits contained ivermectin, an antiparasitic medicine that was not approved at the time for the treatment of COVID-19. The study objective was to compare the timing of the publication of scientific evidence about the efficacy of ivermectin for COVID-19 with the timeline of distribution of COVID-19 kits in eight Latin American countries and to analyse whether evidence was used to justify ivermectin distribution.MethodsWe conducted a systematic review of randomised controlled trials (RCTs) published on the efficacy of ivermectin or ivermectin as adjuvant therapy on mortality from, or as prevention for, COVID-19. Each RCT was assessed using the Cochrane Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Information on the timing and justification of government decisions was collected through a systematic search of leading newspapers and government press releases.ResultsAfter removing the duplicates and abstracts without full text, 33 RCTs met our inclusion criteria. According to GRADE, the majority had a substantial risk of bias. Many government officials made claims that ivermectin was effective and safe in the prevention or treatment of COVID-19, despite the lack of published evidence.ConclusionAll eight governments distributed COVID-19 kits to their populations despite the absence of high-quality evidence on the efficacy of ivermectin for prevention, hospitalisation and mortality in COVID-19 patients. Lessons learnt from this situation could be used to strengthen government institutions’ capacities to implement evidence-informed public health policies.