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Ivermectin exploits this communication system: it makes it impossible for the different parts of a worm or other parasite to talk to each other.
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Ivermectin has long been registered for use in animals. What is it and what do veterinarians use it for?
Ivermectin is used against worms, lice, mites and other parasites. The molecule works in a very interesting way. Just like in a sports team, the different cells in a worm’s or louse’s body must communicate with each other so that they can cooperate – without it, each of the louse’s legs would run in its own direction and the poor thing wouldn’t get anywhere! Members of a sports team talk to each other, but within a human’s or animal’s body, communication takes place through specific chemicals that are sent around between cells, almost like emails. Ivermectin exploits this communication system: it makes it impossible for the different parts of a worm or other parasite to talk to each other, by blocking a substance called GABA (gamma-Aminobutyric acid). The parasites can therefore not move in a coordinated way and are effectively paralysed, so they starve to death.
Ivermectin is used in poultry and other farm animals, as well as in dogs and horses, and in some countries also in humans, to counteract parasitic infections. Humans and other vertebrates also use GABA as a means of communication, but the only cells using GABA are in our brain. Fortunately, we have a blood-brain barrier which prevents ivermectin from penetrating the brain at anti-parasitic doses and affecting us.
The regulatory body that registers medicines in South Africa, known as the South African Health Products Regulatory Authority (SAHPRA), said in a statement (dated 6 January) that they have not at that stage approved it for human use, but ivermectin is sometimes used in people in the treatment of tropical diseases that do not occur in South Africa, as well as in cases where mites (scabies), body lice or head lice have made someone very ill. My wife, a medical doctor, confirms this. On 28 January, SAHPRA issued a statement that limited use of the drug will be allowed under Section 21. I will return to Section 21, but first: does that mean it is not toxic?
Precisely because of the blood-brain barrier we have just talked about, most healthy people can resist a dose of ivermectin, which kills parasites. But virtually any medication can be toxic at the wrong dose or with overuse, or if an individual is sensitive to the substance.
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But virtually any medication can be toxic at the wrong dose or with overuse, or if an individual is sensitive to the substance.
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For example, some dogs, such as border collies, have a weaker blood-brain barrier, and even a dose that is safe for other dogs can poison them. Certain medications can also allow the ivermectin molecule to slip through the blood-brain barrier and cause serious, sometimes even fatal, side effects in otherwise healthy people. And a young child’s blood-brain barrier is not strong enough to keep ivermectin out.
You’re talking about parasites now, but COVID is a virus, isn’t it?
You are absolutely right. COVID-19 is caused by a virus. Viruses are even smaller than a single cell, so they do not need to communicate. But here is a fascinating thing: viruses penetrate deep into the cells of humans and animals, and they then effectively hijack the factory inside the cell that makes replacement cell parts to replace those that are damaged over time. The virus then uses the cell’s factory to make copies of itself. In laboratory studies on cell cultures (we call these studies in vitro or test tube studies because they are not done on living humans or animals, but literally on small groups of cells in test tubes), researchers have found that ivermectin, at a relatively high dose, handcuffs or binds the coronavirus that causes COVID-19. A bound virus cannot enter the cell’s factory, so the virus cannot multiply so easily. We also know that people with a higher viral load are usually sicker than people with a lower viral load, and this is why scientists have started investigating the possibility that ivermectin may help to reduce the severity of disease through helping to reduce the rate of multiplication of the virus inside our bodies.
You have just said: “But virtually any medication can be toxic at the wrong dose or with overuse ....” One of the suppliers of ivermectin, a company called Merck and Company, actually warns that the doses that will be needed to possibly counteract COVID-19 are much higher than anything currently considered “safe”. How do we know what is safe?
And there you are hitting the nail on the head. Before a drug can be approved and registered for use in a new species, tests must be done to determine at what dosage the drug becomes toxic. There are short-term effects as well as long-term effects, including kidney failure and liver failure, for which doctors and veterinarians are on the lookout when determining safe dosage.
Ivermectin is effective against parasites such as lice and worms at a relatively low dose, because they are very sensitive to the drug. Unfortunately, the amount that people have to take to reduce the reproduction of the coronavirus significantly, seems to be much higher, and this means that there is a chance that the drug could cause lasting damage to humans at the effective dosage. A clinical study is the only way to be sure that a drug is safe at a certain dosage.
I just want to understand: ivermectin is administered to animals (and, in severe cases, humans) after the patient has already been infected with parasites – or can it also be used preventively to stop parasites?
Ivermectin is not a repellent. Lice and worms still need to bite a human or animal to be affected by the ivermectin. So, yes, ivermectin is a treatment for infection. But sometimes the level of infection is so low that the animal shows no symptoms. In this case, ivermectin can prevent the parasite from reproducing, so we are talking about the drug being able to prevent infestation. But that is not really true. Ivermectin only prevents a situation where the parasite load becomes so heavy that the person or animal starts to feel sick. You see, infection is having any amount of something in your body. Infestation is being completely overrun by it! Because ivermectin is not a repellent, but works to slow multiplication, it will not prevent infection, but it may help reduce the risk of severe infestation.
Well, if it’s not a repellent, then let’s talk about vaccines, or vaccinations: dogs, cats and many other animals are vaccinated by veterinarians, right?
Virtually all domesticated animals are vaccinated against the animal equivalent of childhood diseases, as well as against rabies. Viruses cannot be killed easily, so the very best way to keep our animals safe from viruses is to vaccinate them against those viruses. Because, unlike ivermectin, which only prevents severe infestation, vaccines actually help to prevent infection!
Our agricultural industry is dependent on certain vaccinations, not so?
Absolutely. Every chicken we eat, and each one that lays the eggs for our breakfast, is vaccinated. The same goes for animals producing mutton, beef and milk.
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Every chicken we eat, and each one that lays the eggs for our breakfast, is vaccinated.
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You would also, for example, not be able to drop off a dog or cat at an animal shelter if their vaccination programme were out of date. Why not?
I’m sure our readers have already read that the COVID-19 vaccine is not 100% effective, but somewhere between 70% and 99%. All vaccines work that way. In fact, all drugs work that way, because our bodies do not all react exactly the same to vaccines or drugs. For example, my husband takes Panado for headaches, but it does not help me at all. I prefer Nurofen. So, let’s say your dog has been vaccinated against parvovirus. He has only a 10% chance of becoming infected if another dog transmits the virus to him. But an unvaccinated dog has a 100% chance of becoming infected, and then transmitting the infection to 10% of the vaccinated dogs he comes into contact with. We ask pet owners to vaccinate their dogs before they come to stay in an animal shelter, not only to protect their dogs themselves, but also for the sake of the other four-legged guests.
So, puppies and kittens get vaccinated, just like little human babies are vaccinated against dangerous diseases like polio – am I right?
Exactly. We have just talked about the fact that a dog vaccinated against parvo has only a 10% chance of being infected by the virus, but even the unfortunate 10% can usually fight the virus much more easily, which means they become much less ill. Remember the infection versus infestation thing we have just spoken about? Even if an animal’s body did not respond 100% to the vaccination, the partial response is very effective in helping the animal fight the virus before it becomes serious. So, a vaccinated animal may become infected in a very small number of cases, but chances are that even the unlucky few will have a much lower viral load and be much less ill, and much less contagious.
We recently took a young pit bull terrier for a six-month vaccination, and a few days later a small lump appeared on the spot where it had been injected. Can you explain this as a vet?
Oh, I love pitties! Partly because they are actually very sensitive dogs. And it is precisely the sensitivity that causes the lump. You see, a vaccine works like a self-defence class. Inside the vaccine is a very, very small amount of the virus, and the virus has already been handcuffed or otherwise weakened so that it will not be able to make you nearly as ill as the regular virus would. But your body gets to know the virus, and it learns which karate kicks can whack the virus hard. If you are later exposed to the dangerous, “wild” version of the virus, your body will say, “Aha! I know your kind!” It will then kick out the virus before it can cause disease.
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Inside the vaccine is a very, very small amount of the virus, and the virus has already been handcuffed or otherwise weakened so that it will not be able to make you nearly as ill as the regular virus would. But your body gets to know the virus, and it learns which karate kicks can whack the virus hard.
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But even if the version of the virus inside a vaccine cannot cause serious illness, there is still a bit of a scuffle between the virus and your body’s immune system as it learns exactly which karate chop will floor the virus. It may cause a small local reaction such as a lump, or the patient may feel somewhat tired or as if they have a mild cold. As a veterinarian, I am not at all worried about it. In fact, we find that animals which show a small local reaction, such as a lump, often build up very strong resistance to the disease for which they have been vaccinated.
A vaccination, for humans or animals, is therefore something that may make the person or animal very slightly ill, in order to make sure that they do not become very ill. Do I understand this correctly?
Exactly. But even more than that. A vaccine also makes a person or animal less likely to transmit the disease to others. So, it protects you and the people or animals you come into contact with from serious or deadly disease. It’s worth a small lump or feeling tired for a day or two!
I was one of the guinea pigs for the AstraZeneca vaccine. Shortly after my first vaccination, I felt ill, but only for a day. After my second vaccination, when a larger viral load was injected into me, there were no symptoms. Can you, as a veterinarian, explain this?
I’m not a human virologist, but I can tell you why it does not surprise me. With the first dose, your body had to learn how to counteract the virus. The first few attempts – the first few karate kicks – were probably ineffective. This is a nasty virus: it has its own kung fu moves! With each failed attempt, your body uses up cells that it has to replace, and that costs energy and can make you feel unwell. After a day or two, your body has learned the right kick. The second vaccination may have had a greater viral load, but your body’s fighters were already trained. This time, it was not necessary for them to learn any new defences – they could deliver the knockout immediately without losing any of their troops.
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After a day or two, your body has learned the right kick. The second vaccination may have had a greater viral load, but your body’s fighters were already trained. This time, it was not necessary for them to learn any new defences – they could deliver the knockout immediately without losing any of their troops.
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I want to ask something about viruses in general. Why do I not get the same viruses that dogs and cats do?
That’s a super-interesting question, Izak. Do you remember how we talked earlier about the viruses invading and hijacking our cells’ factories so that they can reproduce? Well, our cells are not stupid! They do not leave the door to their factories open! To enter a cell’s factory, a virus must be able to unlock it. You have probably seen pictures of the coronavirus that causes COVID-19. It has many projections on its surface. Now, one of these projections happens to be similar enough to the shape of the key that unlocks a human cell’s factory. Each species’s factories’ locks have different shapes. It is therefore very rare to get a virus that can unlock the door of more than one species’s cell factory.
So, is it true that my dog and my cat cannot give me COVID-19?
Exactly. Dogs and cats both have their own versions of the coronavirus, but even if one of our viruses enters their body, or one of theirs ours, they cannot simply enter the cells’ factories. This means that our pets’ viruses can never replicate enough to make us sick. Worldwide, one or two cats and dogs have tested positive for the version of coronavirus that gives humans COVID-19, but, for this very reason, they have never been as sick as we get. Their viruses do not fit the locks of our cell factories, and vice versa.
It has happened twice before that coronaviruses have jumped from animals to humans. In 2002, SARS (severe acute respiratory syndrome) took the world by storm, and in 2012 it was MERS (Middle East respiratory syndrome). Now, COVID-19 has apparently jumped from bats to humans. How would you explain that as a veterinarian?
We have already mentioned the hijacking of the cell factory. Inside the factory, the virus uses the machinery we use to repair our own cells to make copies of itself. But it has to work fast because it’s working on stolen machines! Viruses therefore reproduce as quickly as possible, and if anyone works so hastily, small flaws creep into the copies. Try it for yourself. Write the word vaccine 100 times as fast as you can. When you look at what you have written, you will see that no two of the 100 are exactly alike. The faster you write, the sloppier the copies become. Viruses work just like that. For every billion copies made inside a bat, one may simply accidentally get a button on its surface that is not the right shape to unlock a bat’s cell factory, but instead it could enter a human’s. If one unfortunate person then comes into contact with this rare mutation of the virus, the person can become infected; that person can then pass it on to others.
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Viruses therefore reproduce as quickly as possible, and if anyone works so hastily, small flaws creep into the copies. Try it for yourself. Write the word vaccine 100 times as fast as you can. When you look at what you have written, you will see that no two of the 100 are exactly alike.
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Back to ivermectin. Is ivermectin a registered vaccine for animals?
Not a vaccine, but a registered drug. A vaccine is a harmless version of a germ (virus or bacterium) that teaches the body’s own immune system how to fight the wild, dangerous version. Ivermectin does not do this at all. It works directly against the parasites. Animals’ immune systems do not become stronger or smarter due to the use of ivermectin.
In January the Mediclinic group of companies has warned people about the indiscriminate use ivermectin. They said there was not enough data available. Is this a nice way to keep more people on ventilators?
Let’s start with the science: we know that someone with a higher viral load is sicker. We also know that ivermectin in those test tube studies we have talked about helps slow down the virus’s multiplication. Logically speaking, the remedy is needed before someone is sick enough to need a ventilator for survival.
No, the reason why the doctors who draw up clinical protocol for hospital groups like Mediclinic do not want us to use ivermectin has to do with the oath that every doctor takes not to harm their patients. Because ivermectin has not been tested long-term in humans at the dosages needed to reduce virus replication significantly, we simply do not know enough to guarantee that people treated with it will not have any long-term problems. Until we find out, it is a reasonable decision not to expose patients to unknown dangers unless there are no other options.
Doctors, including those at Mediclinic, make difficult decisions every day about a virus we’re still learning to understand. Their decisions are based on people’s safety.
You’re a scientist – let us talk data, then. I would like to return to SAHPRA’s original statement on ivermectin, which they have since pulled from their website. They do not shoot down its use. They even admit that in some cases it has apparently yielded positive results in people who were already ill, but they say that the correct methods were not followed to obtain clean enough data from those studies. Can you explain their big words in simple English?
Do not worry, vets also at times struggle to decipher such statements!
The easiest way to understand this is to look at one person’s example. Former US president Donald Trump has probably been one of the highest-profile people recently treated for COVID-19. Readers who followed his story will remember that he was treated with oxygen, antibodies, malaria medication and at least three other drugs. I think I counted seven different things with which he was treated at the same time. And he got better. But which one of the seven remedies was the one that helped the most? Would it have happened faster or slower had they only used six of the seven? Or just five?
When we talk about the correct methods of obtaining clean data, we mean that preferably only one thing should be used at a time. Also, it should be used on enough people to see repeatedly whether the group performs better than another group, with or without that one, single drug.
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When we talk about the correct methods of obtaining clean data, we mean that preferably only one thing should be used at a time. Also, it should be used on enough people to see repeatedly whether the group performs better than another group, with or without that one, single drug.
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In COVID patients worldwide, doctors use different mixtures of drugs, depending on what is approved in their country and what symptoms the patients show. This means that some studies of ivermectin use do show that the patients who have received ivermectin do better. But other studies do not necessarily show the same difference, and we do not know whether the erratic results have to do with the ivermectin, or with the patient, or with any of the other drugs used.
Plus, we cannot just inject everything Donald Trump has received into everyone. Not only would it be hugely expensive, but it could also be dangerous to mix multiple medications. There are two reasons: firstly, the liver or kidneys have to break down and excrete every drug we take. Too many drugs having to be excreted by one of the organs at the same time can overwhelm and poison the organ, which can sometimes be deadlier than the virus itself. Secondly: do you remember the blood-brain barrier? Different medications can weaken the barrier, which in turn gives the ivermectin access to the brain, with horrendous effects.
So, what does SAHPRA want? Enough people with mild COVID-19 infections, who are treated with ivermectin and who agree to have all their symptoms and other things, like their blood, inspected throughout the course of their illness, so that research doctors can see whether they really always do better than people without ivermectin, and also see what other effects ivermectin has on the body of someone with COVID. It would have to be a large number of people, because if something went wrong, a patient would have to retire from the study so that they could get more intensive therapy with other drugs.
What is Section 21 of Law 101? There is a lot of talk about that now.
Section 21 of Act 101 of 1965 is a part of the Act that allows veterinarians and doctors to apply to the government to import and/or use a locally unregistered (ie untested or unapproved) drug or vaccine in emergencies in a specific patient, for a pre-agreed purpose.
SAHPRA must look at each application to determine whether or not the potential benefit of the product exceeds the potential adverse effects for the patient, for the physicians, veterinarians and nurses who are to administer the drug, and for the environment.
As veterinarians, we use Article 21 applications when we want to import vaccines for diseases that do not occur frequently, or for the treatment of rare cancers for which the drugs exist in Europe or America but not in South Africa, for example.
Section 21 exists to protect the doctor, veterinarian and community should something go wrong with the patient it is being used on. We have talked about the registration process, which takes into account things like long-term side effects as well as other aspects of the drug’s safety. Medications used under Section 21 have not had the benefit of all these tests. If something goes wrong, then there are two important things: firstly, SAHPRA can use the other registered permissions for the same medication to trace and warn other doctors or veterinarians before their patients also get into trouble. Secondly, the permit gives the doctor or veterinarian some protection, because if we use a drug in an unorthodox way completely without permission and our patient dies or becomes sicker as a result, we can be charged with malpractice.
The newspapers are full of small groups of doctors and pharmacists who say they are ready to start using ivermectin (see IOL and Netwerk24). And on 27 January, SAHPRA itself said that it would now make ivermectin available for compassionate use through Section 21. So, are they changing their minds, then?
Nope. SAHPRA and their regulatory counterparts in Europe, the USA and the UK all still maintain that more large-scale clinical trials are needed before they know whether ivermectin use is justified in COVID patients, and, if so, then at what dosage and at which stage of the disease.
Compassionate use authorisations are granted to doctors when they have a patient who is seriously ill and not responding to other treatments for the disease they are fighting. It is called that because it is generally reserved for cases where the doctor is convinced that nothing else will save the patient’s life, because everything else has been tried.
Individual, exceptional authorisation for compassionate use does not mean that SAHPRA regards ivermectin as safer now than before, nor does it make it any less illegal for doctors or vets to use ivermectin in humans, or to sell it for human use, without SAHPRA’s direct written consent.
As a vet, I have had friends ask me to sell them ivermectin for themselves or their families. It is genuinely illegal for a vet to do so. Please don’t hold it against us. We’re also doing the best we can not to put human lives at risk.
For those readers who would enjoy the background, SAHPRA’s full reasoning is available on their website.
Can ivermectin alter your DNA?
No. Ordinary drugs cannot change your DNA. However, ivermectin can damage your organs, including your brain, and the side effects can be fatal. It is not a medication to use unless your doctor approves it and monitors you during use.
Can any of the vaccines worldwide alter human or animal DNA?
If that were the case, I would have used the vaccine that would make me as beautiful as Michelle Obama years ago! But seriously: our DNA determines what we look like, how tall we are, whether we have blue or brown eyes. It is the blueprint of our bodies, stored in every cell, and it does not change through our lives.
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Someone who hijacks your Toyota may drive it till it is quite battered, but he will not turn it into a Porsche!
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Vaccines – all vaccines – work by teaching your body’s white blood cells how to recognise and fight a germ. The vaccine is simply a small amount of a non-dangerous version of the wild germ. The virus itself is much more dangerous. Yet, even a virus that invades a cell’s factory and takes over the protein replication mechanism does not change the DNA. Someone who hijacks your Toyota may drive it till it is quite battered, but he will not turn it into a Porsche! Viruses make us sick, but do not change our DNA. Vaccines even less so, because they are just weaker versions of the viruses.
Will you take a vaccine against COVID-19 when it is supplied to South Africans?
I will be at the front of the queue. Not just for my own sake, but also for the people I love. I want to do everything in my power to keep the doctors and nurses in our hospitals safe. After being vaccinated, my chances of getting seriously ill from COVID-19 will decrease drastically, and with it the chances of infecting other people without my knowledge. Each of us who are vaccinated is like a controlled burn that can slow down the spread of the virus.
The Dalai Lama said, “Be the change you want to see in the world.” I want to see a world where I can hug my friends again. By getting vaccinated, I can bring that day closer.
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