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HYDROXYCHLOROQUINE WARS

Brazilian scientists caught in crosshairs as virus crisis takes political turn

Indigenous leader Kretan Kaingang marches in protest against President Jair Bolsonaro as Brazil's Covid-19 death toll reaches new heights.
Indigenous leader Kretan Kaingang marches in protest against President Jair Bolsonaro as Brazil's Covid-19 death toll reaches new heights. AFP

The question of using hydroxychloroquine to treat Covid-19 has erupted into a hot political crisis in Brazil, where the drug is being promoted and administered despite warnings from scientists that it could be very dangerous.

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A global hotspot for infection second only to the United States, Brazil has been overwhelmed by the coronavirus, ratcheting up 555,000 cases and counting. 

Far-right President Jair Bolsonaro is forging ahead with the production and distribution of hydroxychloroquine, which is made from the anti-malaria drug chloroquine, and has ordered it to be manufactured in military laboratories.

US President Donald Trump, who himself took the treatment prophylactically, on Sunday announced the shipment of two million doses to Brazil.

There is little scientific evidence to show hydroxychloroquine is effective in either preventing or treating Covid-19. While tests in China and France showed chloroquine inhibits the proliferation of the virus in cell cultures, several trials have found the drug causes serious heart rhythm problems, casting doubt on its safety as a Covid-19 treatment.

France has banned hydroxychloroquine from being prescribed to Covid-19 patients outside of clinical trials, while the US Food and Drug Administration has warned that it can cause heart arrhythmia.

French drugmaker Sanofi on Friday paused the recruitment of new patients for its clinical trials and stopped supplying hydroxychloroquine for use in Covid-19 patients until it is considered safe to do so by the World Health Organisation.

In Brazil, where a thousand people are dying each day from Covid-19, the use of hydroxychloroquine and chloroquine has carved a political divide between those on the left, who say the therapy needs further scientific study, and right-wing supporters of Bolsonaro, who believe it may hold the answer to the virus crisis.

Angry at resistance to the drug, dubbed a “game-changer” by Trump, Bolsanaro said “right-wingers take 'cloroquina' (chloroquine), left-wingers take Tubaina” – a cheap Brazilian soda.

Gravediggers work during a mass burial of people who died of Covid-19 at the Parque Taruma cemetery in Manaus, Brazil May 13, 2020.
Gravediggers work during a mass burial of people who died of Covid-19 at the Parque Taruma cemetery in Manaus, Brazil May 13, 2020. REUTERS - Bruno Kelly

Research team under threat

Heightened frenzy surrounding hydroxychloroquine has seen Brazilian researchers in the Amazon capital Manaus, who questioned its efficacy, suffer death threats from Bolsonaro supporters.

“People were saying that they were going to kill me, that they were going to kill my family so I would know what it was like to lose someone,” Marcus Lacerda, lead investigator of the first randomised controlled clinical trial to test chloroquine, told the Financial Times

His team’s phase 2 study – which was financed by the Brazilian government and involved involved 21 research institutions in Brazil, Spain, and Mozambique – sought to analyse the lethality and toxicity of high and low doses of chloroquine in coronavirus patients.

The harassment intensified when Eduardo Bolsonaro, the president’s son, suggested in a tweet that the study – which was suspended after 11 patients died – had administered chloroquine doses “well above the standard”.

Brazilian President Jair Bolsonaro participates in a rally of his supporters in the capital Brasilia.
Brazilian President Jair Bolsonaro participates in a rally of his supporters in the capital Brasilia. REUTERS/Ueslei Marcelino

According to an article published in The Lancet, however, the same high doses of chloroquine have previously been used to treat cancer patients for longer periods.

“Our study raises enough red flags to stop using high doses of chloroquine because the risk of toxic effects overcomes the benefits,” Lacerda wrote in the Journal of the American Medical Association.

“The only conclusion you can take from the study is that this drug, when used in high doses, is not safe.” This finding has led to Lacerda facing a judicial investigation into his team’s clinical trials.

Responding to the threats received by the research team, the Brazilian Society of Virology said, “Only good science can save us in this pandemic of the new coronavirus, thus we supplicate, leave scientists alone to do their work.”

Brazilian military takes leading role

Brazil, a nation of 210 million people, still has no outlook on when the virus peak might arrive. Instead, unrest has prevailed as Bolsonaro openly clashes with local authorities who have implemented lockdown measures against his advice.

The president’s pursuit of the treatment and his refusal to support social distancing measures has cost him two health ministers, with Brazil’s health ministry now run by a military officer unexperienced in healthcare.

The army has distributed nearly three million chloroquine pills across the nation, along with guidelines for their use. Street clashes have broken out in Brazil's most populous city, Sao Paulo, where Bolsonaro supporters faced off with pro-democracy demonstrators.

A volunteer walks past a mural of the Brazilian flag in April 2020 as he disinfects an area in Rio de Janeiro, Brazil.
A volunteer walks past a mural of the Brazilian flag in April 2020 as he disinfects an area in Rio de Janeiro, Brazil. AFP/File

“Just as society in general has been mobilised, a lack of governance has caused the scientific community to mobilise even more,” said Fernando Bozza, an infectious diseases expert at the Oswaldo Cruz Foundation, the country's leading public health institute.

A race against time

Faced with ongoing chaos and suspicions that an underreporting of cases means the health situation is actually far worse, Brazilian researchers are running out of time to identify the most effective treatments.

Bozza, a member of the crisis cabinet formed by specialists to help Rio de Janeiro's state government fight the outbreak, deplores what he calls the "excessive politicisation" of the crisis at a time when efforts to reduce the impact on the population should be united.

“The federal, state and municipal governments must work in the same direction… There is too much conflict between the views of the federal government, governors and often mayors, which has led to an absence of coordination,” he told RFI's Brazilian service.

With winter approaching in Brazil and the virus having migrated from wealthy regions to more vulnerable areas with already fragile health structures, the country's deepening crisis is showing no sign of easing anytime soon.

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