Two years after the outbreak of the Covid-19 pandemic, vaccination coverage in the region does not exceed fifty percent of the adult population, so it is practically impossible to predict the end of the fight against the virus.
A big obstacle to such a scenario are anti-vaxxers who spread disinformation and promote quackery. One of the theories that has particularly “hit” the region in recent months is the belief that ivermectin, a veterinary pharmaceutical product, helps prevent and treat Covid-19.
Ivermectin is a drug discovered in the 1970s that has since been used successfully to treat parasitic infections in animals and humans. However, in the countries of the region, it is given exclusively to animals and for infections with parasites in the intestines, stomach and lungs, as well as in cases of infection with lice, scabies, and similar. It can be given as an injection or as a powder mixed into animal feed.
The belief that ivermectin cures Covid-19, although several scientific studies have denied it, has spread in recent months among the more gullible citizens in our region. Viber groups were opened in which even some doctors recommended the medicine and advised where it could be obtained “on the black market”. The journalists of the websites Raskrinkavanje (.ba), Raskrikavanje (.rs) and Raskrinkavanje (.me) have found that although ivermectin is not approved for human use in Bosnia and Herzegovina, Montenegro and Serbia, the demand for this drug in pharmacies is not waning.
The result of increased demand is the disinformation about this drug circulating in the online space and media for several months. Raskrinkavanje (.ba) wrote about ivermectin-related disinformation on two occasions, in late October and mid-November 2021. Both texts discussed why the claims about the effectiveness of this drug in the treatment of Covid-19 infection are incorrect. After the same claims appeared in Serbia, Raskrikavanje (.rs) has dealt with this topic on several occasions as well. In Montenegro, Raskrinkavanje (.me) also analyzed this topic and false allegations, such as that “the drug ivermectin can destroy a new coronavirus within 48 hours”.
In February last year, Merck, a manufacturer of ivermectin, issued a statement emphasizing that there is still no scientific evidence to confirm that this drug effectively treats Covid-19. However, many citizens are looking for ivermectin in pharmacies across the region.
In Bosnia and Herzegovina, ivermectin is sought after in both human and agricultural pharmacies
Ivermectin is not on the list of approved drugs in BiH, but several pharmacies in Bosnia and Herzegovina say the number of inquiries for this drug in the pandemic has increased.
“The number of inquiries for the drug ivermectin has increased, however, since it is not registered with the Agency for Medicines and Medical Devices of Bosnia and Herzegovina, the Public Institution Pharmacies Sarajevo has never had it in its range of drugs”, they told Raskrinkavanje (.ba).
A similar response came from PZU pharmacy Al-Hana Sarajevo, where they further pointed out that they had not met with any recommendation of doctors for this drug.
The journalists from Raskrinkavanje also visited several pharmacies in Sarajevo and East Sarajevo, where they talked directly with pharmacists who work there. In this case, too, experiences are different: some say that there was no increase in demand, while others point out that demand has multiplied. The Pharmaceutical Chamber of the Federation of Bosnia and Herzegovina and the pharmacy Europharm also told us in a telephone conversation that there wasn’t an increase in the number of inquiries for products containing ivermectin.
When it comes to using this drug in animals, the list of veterinary medicinal products for which a marketing authorization has been issued on the territory of BiH, maintained by the Veterinary Office of Bosnia and Herzegovina, includes a total of 19 products containing active substance ivermectin. Among these 19 products, 13 are in the form of a solution for injection, three are in the form of a premix for medicated food, two are pastes for oral administration, while one of the products is available in the form of tablets.
Journalists from Raskrinkavanje also talked to veterinarian Ervin Hajdarevic from the veterinary pharmacy “Sapice”. As he told us, many clients came to the pharmacy to ask for ivermectin, and most of them asked for the medicine in the form of tablets.
“There were questions about ivermectin, whether it can be supplied: ten, fifteen people in the range of the last two or three months. They are interested in whether it can be supplied in the form of tablets, probably because it is easier to administer a dose that way”, says Hajdarevic.
“I was basically turning them away, I didn’t have it and I don’t have it for sale. I wouldn’t even sell it, even if it could be bought, because I’m not a supporter of that”, he adds.
On the other hand, the veterinary pharmacy Linea Alba told us that their experience was different and that there was no increased number of inquiries for products containing ivermectin.
When it comes to the procurement of products containing ivermectin, one of the interlocutors involved in the sale and distribution of veterinary medicines told us that during the Covid-19 pandemic, they recorded several inquiries from human pharmacies, i.e., pharmacies that sell medicines intended for humans.
High demand for ivermectin in veterinary clinics and agricultural pharmacies in Montenegro
Ivermectin is not registered for human use in Montenegro either. Despite that, since the beginning of the Covid-19 pandemic, Montenegrins have been looking for it in veterinary and regular pharmacies, in order to be treated for Covid-19 infection.
Veterinarian Milan Mitic says he does not understand why this is the case.
“In Montenegro, we all know each other and then everyone calls you on the phone: ‘please give me 2 ml of ivermectin, please give me 3, 4 or 5 ml.’ We know they need it for coronavirus infection treatment. Of course, no one has ever received it in this clinic, because it is a legal violation”, says Mitic and adds that in Montenegro, it is only possible to get ivermectin through veterinarians and registered distributors:
“We cannot use and give veterinary medicines, which are registered for animals, to people”, he said.
He believes that there was a permutation between two drugs, ivermectin and levamisole, which come from the same family of drugs.
“Levamisole is used to correct the immune system, that is, to raise immune cells. It can be used in the fight against viral and bacterial infections, however, not in humans, but in animals”, he said, warning of side effects that could be very serious and lead to hospitalization.
“Imagine that you have a Covid virus infection, that you already have a strong clinical picture, you take ivermectin for all that and there are side effects, so your respiratory problems are followed by gastrointestinal and you are in a very serious problem”, he warns.
A pharmacist from a pharmacy in Podgorica, Tanja Vuceljic, warns of the same issue, saying that there were several sporadic cases of demand.
“It is a medicine that is registered only for veterinary use and is sold in agricultural pharmacies. It is a dose-adjusted medicine for large cattle, which is present in high concentrations and which, if taken as such, can cause very severe, side effects, abdominal pain, severe diarrhea, fever, fainting, so the risk of toxic effects is high”, she said.
In the form of a paste, which is primarily intended for horses, Ivermectin was purchased by one of the largest importers of veterinary medicines in our country in early 2020, before the pandemic. Stocks are running low because, as the director of the wholesale and doctor of veterinary medicine Ivan Djurovic said, the demand has increased, especially in the south.
“It’s quite risky to use it. Animal products, especially milk, when ivermectin is given, must not be used, and veterinarians must respect that in the field”, said Djurovic, who knows many people who have used it.
“This injectable product, which is intended for use under the skin, is not intended to be taken orally, so people found other ways. They put a small amount of it on the sugar cube, and it is dosed per kilogram. So, one milliliter goes to 50 kilograms of body weight, and then people use it accordingly”, said Djurovic and added that individuals mostly used it when they became infected, on the first and fifth day or the first and third, and those are some ‘special recipes’.
He, like Dr. Mitic, warns citizens that the only cure for coronavirus is vaccination!
“We have a serious problem, this is a global problem, and I hope we are all aware of that. The whole planet, the whole society is sick and we have no room here to play with ivermectins, neomectins and other related products. So, what is recommended is vaccination and not ivermectin”, concluded Dr. Mitic.
In Serbia, “they come every 2-3 days to ask about the drug”
In Serbia, the demand for ivermectin in some pharmacies has also been increasing in recent months, although it is also not registered for human use.
The Viber group “Ivermectin – recommendations”, which appeared in the public spotlight at the beginning of November 2021, probably contributed to this. The group had as many as 11,000 members and some Serbian doctors advised people to drink this antiparasitic drug to prevent and treat coronavirus.
In several Belgrade pharmacies, which the journalist of Raskrikavanja visited and talked with the staff, experiences related to the demand for this medicine are different. While some say that there were no interested parties, others say that the interest has been more frequent in the last six months.
“Now, every few days, 2-3 patients come to ask whether and where they can get it, while in the previous six months, that question was asked on a daily basis, by at least 5-10 patients”, Galen Pharm Pharmacy told Raskrikavanje.
When it comes to treating people, in Serbia, this drug is on the D list of the Republic Health Insurance Fund (RHIF) – these are unregistered drugs prescribed only in exceptional cases, when no other therapy helps. In Serbia, ivermectin tablets are prescribed to people exclusively for the treatment of severe scabies. In that case, it is given only with a prescription, at the expense of the RHIF.
Pharmacies Belgrade confirmed this to Raskrikavanje.
“We work according to the doctor’s exact prescriptions, for a specific, targeted patient. This has been done here for years, for dermatological use, rosacea therapy mainly in humans, and in veterinary use, more for parasitic problems”, said the Belgrade Pharmacy.
The situation is similar with veterinary pharmacies in Serbia. They mostly deny that they enabled the sale of ivermectin.
“There was interest, but we are not authorized to sell it to people because we are a veterinary pharmacy. We use only injectable (ivermectin), which we can apply, we don’t even sell it to pet owners, let alone give it to someone. What we use is an injection that can only be given by veterinarians, and to animals, not to anyone else”, they point out.
We received similar answers from other pharmacies for animals, where they say that many citizens inquire about ivermectin over the phone.
“The number of citizens has increased, they came, they asked, but we don’t have it, so we couldn’t meet their demands”, they say in one veterinary pharmacy, while in another they note that citizens are constantly inquiring, but that they have no right to sell it”.
The veterinary pharmacy “Ljubimci” says that “a million people inquired”, but that they do not sell ivermectin and would not sell it to people in any case.
“It is a medicine that is not registered for human use, it is only in one form, for scabies”, the pharmacy “Ljubimci” notes.
Is there a responsibility?
In Serbia, back in November 2021, the Ministry of Health announced the consequences for those doctors who publicly, without sufficient scientific arguments, recommended ivermectin in the prevention and treatment of Covid-19. Even the Medical Chamber of Serbia (LKS) reacted, initiating proceedings against 18 doctors, promoters of ivermectin. However, even two months later, the procedure’s outcome is unknown. According to the statute of the LKS, doctors can receive a public reprimand, a fine or the suspension of their license.
According to Deutsche Welle’s article, from November 2021, “the head of the cardiology department at the Pediatric Clinic in Nis was fired for promoting ivermectin in a group on the Viber platform”, but it is not known whether he and the other physicians who have done the same will still be able to treat patients.
The Institute of Medicines and Medical Devices of Montenegro (CinMED) confirmed for the website Vijesti that “they are not aware of the possible misuse of this medicine for the treatment of patients with coronavirus”. According to an article from January 8, 2022, the Medical Chamber of this country did not provide them with an answer to the question whether proceedings have been initiated against doctors who inadequately treated and advised patients or whether there “were cases of suspension or revocation of the license”.
The reactions of the competent institutions were also absent in Bosnia and Herzegovina, and the public is not aware of any case of sanctioning individuals who promoted or used ivermectin in the treatment of patients.
Thus, calls for accountability from physicians promoting ivermectin as a method of treating Covid-19, despite the fact that the efficacy of this drug has not been proven, generally do not exist, or their resolution is slow. The absence of consequences leaves room for further spread of this and other unproven treatment methods, thus undermining confidence in official, scientifically tested methods.