Reviews | Mexico City’s decision to distribute ivermectin marked a new low for the mishandling of the pandemic



For anyone paying a little attention, it’s clear that Mexico has done a poor job dealing with the pandemic. In June 2020, Hugo López-Gatell, President Andrés Manuel López Obrador’s coronavirus czar, said a potential death toll of 60,000 would be a “very dire scenario”. More than 300,000 Mexicans have died so far, and some estimates paint a much more dire picture. image.

But recent reports that the Mexico City government conducted an ethically dubious public health “quasi-experimental study” involving ivermectin have exposed the ruling party’s negligence and recklessness.

In December 2020, the city’s health ministry began distributing thousands of medical kits containing aspirin, the antibiotic azithromycin, and ivermectin to people who tested positive for the coronavirus. At the time, access to vaccines was still very limited and the use of ivermectin was not unprecedented. But the evidence was sufficient to strongly discourage its use as a public health strategy, especially to prevent hospitalization.

But Mexico City Mayor Claudia Sheinbaum and her team chose to continue. His administration spent nearly $1.5 million on medical kits.

“At the end of January 2021, an unapproved drug without proof of therapeutic efficacy had been supplied to more than 50,000 inhabitants of the capital without any control or rigorous follow-up,” said Juan Pablo Pardo-Guerra, sociologist at the University of California. in San Diego, wrote recently.

As the questions grew, officials in Mexico City pressed on. “It’s an extremely safe pest control; it is used massively and there are no side effects that put the population at risk,” said the city’s health secretary, Oliva López Arellano.

Despite reports contradicting López Arellano’s assurances, the distribution of ivermectin continued for months. The recipients were not informed of the debate surrounding the drug.

“The lack of informed consent and the use of an unapproved drug for this condition is of great concern,” Mexican epidemiologist Jaime Sepúlveda, who directs the Institute for Global Health Sciences at the Institute, told me. University of California at San Francisco. “Even the pharmaceutical company that produces ivermectin (Merck) has recommended against using it as a treatment for covid-19.”

For Pardo-Guerra, the lack of transparency has more worrying implications. “Citizens were exposed to an experiment that did not have their approval or consent, and which did not in the least meet ethical standards for experimentation on humans,” he wrote. “In this sense, the city government’s ‘quasi-experiment’ is reminiscent of the infamous clinical trials for syphilis treatments that the US government conducted with marginalized populations in Tuskegee, Alabama.”

In the absence of extensive independent evidence to support their claims that ivermectin is an effective means of preventing covid hospitalization, Sheinbaum’s team wrote their own. In May, she announced dazzling results: “a reduction in the probability of being hospitalized between 52 and 76%”, according to José Merino, head of the Digital Agency for Public Innovation in the city.

Merino has sprung results on Twitter. “It validates public policy,” he said. said. Along with others, Merino submitted an article with the results for publication on SocArXiv, an open forum for working papers. Over the next six months, it was downloaded 10,000 times, adding to misinformation about ivermectin.

But politics and the newspaper soon ran into trouble. In August, PolitiFact debunked its central claims. Skeptical voices in Mexico interrogates study findings on the effect of ivermectin on hospitalization rates and debated the obvious ethical implications of keeping participants in the dark.

Then, last week, Pardo-Guerra published a damning article thread against Merino and his co-authors, asking SocArXiv to remove the ivermectin article from the website. It would be “an important step in ensuring preprints don’t become a source of dangerous misinformation,” he said. wrote. Barely three days later, the site took of the work and lambasted its authors for “spreading misinformation”, “unethically” distributing “unproven drugs” and failing to “properly disclose their conflict of interest”. Merino reacted furiously, accusing Philip Cohen, the site’s founding director, of acting out of political motivation and being “unethical” and “colonialist”. (Cohen’s cutting response can be read here and here.)

Yet academic opprobrium and online mockery should be the least of the Sheinbaum administration’s worries. He could face prosecution. “It was bad policy,” Cohen wrote. “And unethical (particularly because they didn’t tell people there was no research basis for the recommendation to take ivermectin.)”

Pardo-Guerra says it is “the story of an unjustifiable action that was justified by a false and arbitrary analysis disguised as science”.

It may all come down to Sheinbaum, a trained scientist who poses as an “obsessive administrator.” She is also considered the political heiress of the president.

On Tuesday, she called herself the victim of an obscure “conservative” plot. But questions persist: what did she know and what did she sign? His political future could depend on the answer.


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