View: Don’t run after this untested hydroxychloroquine ‘cure’

By Pooja Tripathi

Much before the World Health Organisation declared the Covid-19 outbreak to be a pandemic on March 11, much lives and livelihoods were lost. This led to most countries implementing lockdown, on an international, national or regional scale, bringing human mobility to a stop to an unprecedented scale, disrupting trade, and destroying commerce and livelihoods.

The virus has also revealed the vulnerability of our public health systems. For now, the priority has shifted to enabling people to return to work and earn a living for their needs – for many, on daily wages. But the real object of the war against Covid-19 remains centred around treatment, bringing down mortality levels, and scrambling to find a cure to the virus.

One drug that has attracted attention as a potential antiviral agent against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that causes Covid-19, currently used as treatment for malaria and auto-immune disorders such as lupus and rheumatoid arthritis, is hydroxychloroquine (HCQ). While there is no comprehensive or conclusive data on HCQ’s Covid-19-busting efficacy, there have been some early studies that have offered a glimmer of hope.


Studies from China found that HCQ could inhibit SARS-CoV-2 in vitro, that is in a laboratory test-tube or a petri dish. An early French study, which prompted much interest in HCQ in the first place, had a sample size of 20 patients, a very small subset and had no controls. Only a very small subset in the study had a combination of azithromycin, an antibiotic, and HCQ, with some synergy appearing between the two drugs in a very small number of patients who received both drugs.

These findings, and the subsequent buzz around HCQ, prompted many, including US President Donald Trump, to tout HCQ as a ‘game-changer’ in the fight against Covid-19. The US Food and Drug Administration (FDA) designated HCQ for off-label, compassionate use for treating those tested coronavirus-positive. WHO added the drug to its large global ‘solidarity trial’ to test a variety of potential treatments. But virologists and infectious disease experts caution that this hope and excitement over HCQ is premature – and dangerous, considering it can trigger hoarding, resulting in a shortage of stocks for those who actually benefit medically from HCQ.

A few days after adding HCQ to the list of pharma products that could not be exported, India lifted the ban, allowing monitored export. With Trump earlier announcing that the US could ‘retaliate’ if India didn’t release its stocks of the drug – India is the world’s leading producer of HCQ, many quarters reacted as India buckling to US threats. Some local shortages, which had nothing to do with the lifting of the ban on HCQ, didn’t help matters.

Medical experts are also concerned that this aggressive push of HCQ could prompt dangerous trends of self-medication. Despite the absence of strong evidence, some people are already attempting this with disastrous consequences. HCQ can have dangerous side-effects if the dose is not carefully controlled. Cases of HCQ poisoning have already been reported in Nigeria, the US and in Assam.

The medical community wants a safe and effective remedy of Covid-19, not a trial-and-error scramble. We still don’t know if HCQ fits the bill as the possible annihilator of Covid-19. The world delayed in tracking and containing a life-threatening virus. The policy responses of governments around the world were lax before turning into urgent.

As we move from lockdown to the incremental and gradual lifting of it in a rational manner while maintaining on necessary safety protocols, we should step back and look at the lesson staring at our faces that needs to be finally and quickly learnt: investment in public health can no longer wait. And certainly not on the back of a rumoured ‘wonder drug’.

(The writer is a public health specialist)

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