By Bruce Einhorn and Chris Kay
Before the pandemic, Taj Pharmaceuticals Ltd. shipped negligible amounts of ivermectin to Russia for veterinary use. But over the past year it’s become a popular product for the Indian generic drug maker: Since July 2020, Taj Pharma has sold $5 million worth of the pills for human use in India and overseas. That’s a bonanza for a small family-owned company with an annual revenue of about $66 million.
Sales of the drug, which is primarily approved to treat diseases caused by parasites in livestock and humans, have surged around the world as anti-vaccine propagandists and others tout it as a Covid-19 cure. They claim it could end the pandemic if only people like Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, would open their eyes to it. “We are working 24/7,” says Shantanu Kumar Singh, Taj Pharma’s 30-year-old executive director. “The demand is huge.”
The company, which has eight production facilities in India, is among a raft of drugmakers – many of them in developing countries – seeking to cash in on ivermectin’s sudden popularity, unfazed by advisories from the World Health Organization and the U.S. Food and Drug Administration saying that clinical studies haven’t shown conclusive evidence of the drug’s effectiveness against coronavirus infections. Undeterred, manufacturers have sharpened their sales pitches and cranked up output.
Ivermectin shot into the limelight last year after some initial studies indicated it held promise as a potential Covid treatment. After world leaders including President Jair Bolsonaro of Brazil and celebrities such as podcaster Joe Rogan seized on ivermectin, doctors worldwide have come under pressure to prescribe it.
Since the patent held by original manufacturer Merck & Co. expired in 1996, small generic drug makers like Taj Pharma have taken up production, accounting for a slice of the global supply. Merck, which still sells ivermectin under the brand name Stromectol, warned in February there was “no meaningful evidence” it was effective against Covid.
Yet all those advisories haven’t discouraged millions of Americans from getting prescriptions from like-minded physicians on telemedicine sites. Outpatient prescriptions have shot up more than 24-fold from pre-pandemic levels, to 88,000 a week in the seven days ended on Aug. 13.
Typically used to treat roundworm infections in humans and livestock, ivermectin won its discoverers, William Campbell and Satoshi Omura, a Nobel Prize in 2015. Some studies have shown the drug can reduce viral load for Covid, according to researchers at Oxford University. But many of the studies on ivermectin’s benefits for Covid patients are small and lack good evidence, according to a recent review by the Cochrane Infectious Diseases Group, which evaluates medical practices.
Health officials have warned that improper dosing of even the human version of the drug could cause nausea, dizziness, seizures, coma, and death in some cases. Local media in Singapore this month detailed accounts of a woman’s Facebook post about how her mother avoided vaccination but took ivermectin instead, influenced by friends attending her church, and fell seriously ill.
Despite safety concerns and a rash of poisonings, the drug’s popularity among those who see the pandemic as a conspiracy is enduring. It’s also become a drug of choice in poorer countries where Covid treatments are hard to come by and regulation is lax. Available over the counter, it was much sought after during India’s delta wave.
Some drugmakers are feeding the interest. Taj Pharma – which says that it doesn’t ship to the U.S. and that ivermectin isn’t a large part of its business – has courted believers and publicized on social media an oft-used line that the vaccine industry is actively conspiring against the drug. The company’s Twitter account was suspended briefly after touting the medicine with tags such as #ivermectinworks.
In Indonesia the government initiated a clinical trial in June to test ivermectin’s effectiveness against Covid. The same month, state-owned PT Indofarma began producing a generic version. It has since distributed more than 334,000 bottles of the pills to pharmacies across the country. “We market ivermectin in line with its main function as an antiparasitic drug,” says the company’s corporate secretary, Warjoko Sumedi, adding that some published reports say the drug is effective against the disease. “Its use as other therapy is the prerogative of the doctors who prescribe it,” he says.
So far, the ivermectin business is small for Indofarma, which had total revenue of 1.7 trillion rupiahs ($120 million) last year. The drug has brought in 36 billion rupiahs in the four months since production started. The company sees more potential, though, and is preparing to introduce its own ivermectin brand, called Ivercov 12, by yearend.
Last year, Brazilian maker Vitamedic Industria Farmaceutica sold 470 million reais ($85 million) worth of ivermectin, up from 15.7 million reais in 2019. It spent 717,000 reais on ads touting ivermectin as an early treatment against Covid, Vitamedic director Jailton Batista said on Aug. 11 during testimony to Brazilian lawmakers investigating the government’s handling of the pandemic. The company didn’t respond to requests for comment.
In countries where there’s either a shortage of ivermectin meant for humans or people are unable to get prescriptions, some are seeking out the veterinary variant, which can pose the risk of severe side effects. Afrivet Business Management, a major South African maker of animal medicines, has seen prices of its ivermectin product at retail outlets in the country jump tenfold, to almost 1,000 rand ($66) per 10 milliliters. “It may or may not be effective,” says Chief Executive Officer Peter Oberem. “People are desperate.” The company, which imports the active pharmaceutical ingredient for the drug from China, has at times been out of stock.
In September the Indian Council of Medical Research dropped the drug from its clinical guidance for management of Covid in adults. Even so, a number of Indian companies—which produce about a quarter of the world’s low-cost generics—market ivermectin as a Covid drug, including one of the biggest, Sun Pharmaceutical Industries, and Emcure Pharmaceuticals, a Pune-based drugmaker backed by Bain Capital. Bajaj Healthcare Ltd. said in a May 6 filing that it would introduce a new ivermectin brand, Ivejaj, which Anil Jain, the company’s joint managing director, said would help to improve the health of Covid patients and offer them a “much-needed and timely therapy option.” Spokespeople for Sun Pharma and Emcure declined to comment, while Bajaj Healthcare and Bain Capital didn’t immediately respond to requests for comment.
Sales of ivermectin products in India in the year through August tripled, to 3.87 billion rupees ($51 million), from the previous 12-month period, according to Sheetal Sapale, president of marketing at Indian researcher Pharmasofttech AWACS Pvt. “Many companies have entered the market to seize this opportunity and have made the most of it,” she says. “As incidences of Covid come down significantly, this may not be seen as a long-term trend.”
While some companies are actively promoting the drug’s misuse, many have stayed silent, says Carlos Chaccour, an assistant research professor at the Barcelona Institute for Global Health who’s studied ivermectin’s effectiveness against malaria. “There are people that have fished in a wild river, taken advantage of the situation to get some profit,” he says.
Bulgarian drugmaker Huvepharma, which also has factories in France, Italy, and the U.S., didn’t sell ivermectin for human consumption at home until Jan. 15, when it won government approval to register the drug, not to treat Covid but strongyloidiasis, a rare infection caused by roundworm. There have been no recent cases of strongyloidiasis in Bulgaria. Still, the approval helped the Sofia-based company get ivermectin to pharmacies, where people could buy it as an unauthorized Covid treatment with a doctor’s prescription. Huvepharma didn’t respond to requests for comment.
Even when governments discourage the use of ivermectin, drugmakers need to acknowledge that some doctors will repurpose their products in unauthorized ways, says Maria Helen Grace Perez-Florentino, medical marketing and medical consultant for Dr. Zen’s Research, the marketing arm of metropolitan Manila-based Lloyd Group of Cos., which began distributing locally made ivermectin in May.
Dr. Zen’s has held two online conferences about the drug for Philippine doctors featuring speakers from abroad, providing information about dosage and side effects. That’s just practical, says Perez-Florentino. “We talk to doctors who are open to using ivermectin,” she says. “We do product knowledge, its side effects, proper dosage. We inform them.”
Like Merck, some makers of the drug have been vocal in their warnings against ivermectin’s misuse. That includes Ireland’s Bimeda Holdings, Missouri-based Durvet, and Germany’s Boehringer Ingelheim. But others, such as Taj Pharma, are less hesitant about making the link between ivermectin and Covid, which has posted articles on its website touting the drug. Taj Pharma’s Singh says the company is being responsible. “We do not claim the drug has any effect on Covid,” Singh says. “We really don’t know what is going to work.”
That uncertainty hasn’t stopped the company from again hawking the drug on Twitter, where its account has been restored. An Oct. 9 tweet promoted its TajSafe Kit, ivermectin pills packaged with zinc acetate and doxycycline, with the hashtag #Covidmeds.
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