The ivermectin story has an odd irony. One of the most divisive medications in contemporary medicine is a medication that helped hundreds of millions of people in tropical regions live free from crippling parasitic infections and won its creators a Nobel Prize in 2015. It’s not because of what it does, but rather because of what people thought it could accomplish.
Let’s begin by discussing the true purpose of ivermectin, also referred to as ivermectina in many Spanish-speaking nations. The medication, which was approved for use in humans in 1987, essentially paralyzes the nerve and muscle function of parasites until they die by binding to their glutamate-gated chloride channels. Importantly, the drug can eliminate a parasite without doing the same to its human host because these channels aren’t accessible in the mammalian central nervous system in the same manner. That’s a big difference. It’s the main reason the medication is safe when taken as prescribed.
The list of ailments it treats is one that most people in more affluent nations have never experienced. In parts of Latin America and sub-Saharan Africa, blackfly bites near swift-moving rivers can transmit the parasitic disease known as onchocerciasis, or river blindness. As the name implies, it can result in blindness as well as serious skin conditions. A threadworm is the cause of strongyloidiasis, which silently lingers in people’s intestines for years or even decades. When taken as a single dose or for a brief period of time, ivermectin eliminates these infections with an almost remarkable degree of reliability in terms of global health. Its approved uses also include head lice and scabies, which are more common issues in affluent environments; topical versions of the medication are available for both.
The dosage is determined by body weight. The standard for river blindness is about 150 micrograms per kilogram. It is more like 200 micrograms per kilogram for threadworms. Usually, it is taken on an empty stomach. The computation is done by a physician. All of this is not particularly difficult, and the medication has been widely disseminated through public health initiatives for many years to the most vulnerable populations.
When COVID-19 arrived, the narrative became much more complicated.
Repurposing existing medications was popular in the early months of the pandemic, when there were few effective treatments available and a sense of desperation pervaded both the general public and some members of the medical community. Ivermectin garnered a lot of attention, in part due to early, small-scale studies that suggested potential antiviral activity and in part due to a broader cultural moment where confidence in reputable medical institutions was already eroding. Social media, YouTube channels, WhatsApp chains, and pharmacy counters that no longer required prescriptions were some of the ways it spread.
The issue is that the early promise was not maintained by the clinical evidence as it accumulated in larger and more rigorous trials. Ivermectin did not lower hospitalization or serious illness among COVID-19 outpatients, according to the well-designed TOGETHER trial. Through their own review procedures, the FDA, WHO, and CDC came to the same conclusion: there is just not enough evidence to support its use against the virus.
The confusion had actual repercussions. People made themselves ill by purchasing veterinary formulations, which are concentrated products intended for horses and cattle. Calls increased, according to poison control centers. Misinformation was happy to fill the gap between the drug’s true value in one situation and its unproven use in another.
Sitting with the strangeness of that is worthwhile. Ivermectin is not a harmful medication. It continues to be a silent, indispensable tool in the populations it was intended to assist; it is affordable, efficient, and is still given to millions of people annually as part of international efforts to eradicate disease. The Nobel committee was correct. Its authorized uses are supported by sound science.
More than anything else, the past few years have shown how easily a valid medical narrative can be twisted in ways that science never intended. The medication, ivermectina, is effective. It is now surrounded by much more complicated things.
