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Prices jump for unproven COVID-19 drug ivermectin
Ivermectin, known best as a treatment for ringworm, has doubled in price after some public figures made unverified claims about its effectiveness at treating COVID-19.
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vermectin prices have doubled over the past few days after public officials claimed that the ringworm drug could treat COVID-19, an assertion that has been refuted by medical experts and the World Health Organization (WHO).
At Pasar Pramuka, a market for medical goods in Jakarta, generic ivermectin prices were between Rp 300,000 (US$20.72) and Rp 350,000 per 20-tablet bottle in June, twice the government-set price of Rp 157,700 per bottle, including tax.
On e-marketplaces Tokopedia and Shopee, Ivermax 12, a brand-name version of ivermectin, was selling for up to Rp 600,000 per 10 tablet strip as of June 30, twice the usual price of Rp 265,000 per strip. Ivermax 12 is not subject to government price regulations.
“Since public interest in it is so high, the supply of drugs is running out, so the prices started to rise,” Pasar Pramuka Pharmacies Association chair Yoyon told The Jakarta Post on Monday.
Demand for unproven COVID-19 “cures”, including ginger and herbal drinks, has surged over the past two months as the country grapples with a second COVID-19 wave that has paralyzed healthcare systems across Java.
Ivermectin is used to treat ringworm and has not been proven as a COVID-19 treatment, but public endorsements, coupled with the second virus wave, have caused prices to rise to such an extent that the Health Ministry capped the price of generic ivermectin at Rp 7,500 per tablet.
Yoyon said the association had instructed members to sell ivermectin at reasonable prices and to limit sales to 1 bottle per shopper to prevent speculative hoarding.
Tokopedia and Shopee, the two most popular e-marketplaces in Indonesia, have committed to taking down listings for generic ivermectin that are above regulated prices and banning the vendors responsible.
The Indonesian Pharmacy Association (ASAPIN) said e-commerce platforms and social media sites facilitated most of the above-regulation sales of ivermectin, enabling the jump in price.
“Demand from the public is high, as the self-medication trend has grown uncontrollably, but pharmacists and pharmacies prioritize patient safety. Therefore, we will follow the government’s policy and regulation,” an association spokesperson told the Post.
Popularity boost
Ivermectin began gaining popularity after Presidential Chief of Staff Moeldoko, acting as chair of the Indonesian Farmers’ Association (HKTI), distributed some 2,500 tablets of Ivermax 12 to residents of Kudus, Central Java, in early June, as the regency was enduring a COVID-19 outbreak.
Moeldoko enabled the distribution by pushing the Food and Drug Monitoring Agency (BPOM) to issue an Ivermax 12 distribution permit for the brand-name drug’s sole manufacturer, PT Harsen Laboratories, according to Harsen vice president Sofia Koswara, Tribunnews.com reported.
“Looking at the current data, we are optimistic that ivermectin can be an effective cure for COVID-19 patients,” said Moeldoko at a virtual discussion on June 28 as reported by Kompas.com.
Read also: COVID-19: Antiparasitic drug can kill coronavirus within two days, study finds
On June 21, State-Owned Enterprises (SOEs) Minister Erick Thohir held a press conference on state-owned PT Indofarma’s readiness to mass-produce generic ivermectin as a COVID-19 drug after securing a distribution permit from the BPOM.
“Several medical journals have announced the drug’s effectiveness. Going forward, with a production capacity of 4 million tablets each month, this drug is hoped to be a solution to mitigate the coronavirus in Indonesia,” he said.
Several House of Representatives members and former Maritime Affairs and Fisheries Minister Susi Pudjiastuti have also endorsed ivermectin as a treatment for COVID-19.
University of Indonesia epidemiologist Pandu Riono said the officials’ claims had caused drug shortages for legitimate patients, had spread misinformation to the public and had triggered a bout of profiteering.
“This is crossing the line. There is no evidence, yet their claims have gone so far,” he said in an online press conference on Friday.
Indofarma corporate secretary Warjoko Sumedi told the Post on Wednesday that the company was aware of the criticisms of ivermectin as a potential COVID-19 treatment.
Nevertheless, the company expected the endorsements to expedite ongoing clinical trials on the matter. The trials are being conducted at eight hospitals in the country and are being supervised by the Health Ministry’s research and development center.
‘The best thing for us to do is wait for the completion of clinical trials of ivermectin as a COVID-19 treatment,” he said.
PT Harsen Laboratories did not immediately respond to requests for comment.
An unproven drug
Medical experts from several universities and the BPOM held at a press conference on Friday to debunk claims about ivermectin’s effectiveness as a COVID-19 drug.
Ari Fahri Syam, dean of the University of Indonesia's Medical School, said many countries had conducted clinical trials on ivermectin as a COVID-19 treatment but had found it had little effect on death rates and hospitalization duration.
“The results turned out to be insignificant […]. That means there is no way to firmly say this drug can cure COVID-19,” he said.
Read also: Indonesia expects COVID-19 cases to rise despite stricter curbs
The WHO said in a March 31 statement that the evidence of ivermectin’s effectiveness at treating COVID-19 was “inconclusive” and therefore recommended limiting the use of the drug to clinical trials.
The Indonesian Medical Association (IDI), the United States Food and Drug Administration and the European Medicines Agency concur with the WHO’s stance.
Zullies Ikawati, professor of pharmacology and clinical pharmacy at Gadjah Mada University, warned that using ivermectin on COVID-19 patients could cause serious diarrhea, itching, headaches, dizziness and stomach pain because such patients required higher dosages than ringworm patients.
BPOM hed Penny K. Lukito said the regulatory body only permitted the distribution of ivermectin as a prescription ringworm drug. This meant the drug could neither be sold over the counter or as a COVID-19 treatment.
“Prescription drugs cannot be sold or promoted directly to the public. That's a violation of the rules,” she said.
The BPOM has authorized only Remdesivir and Favipiravir for emergency use as COVID-19 treatments, but even those require a doctor’s prescription.
