Merck’s Covid Pill VS Ivermectin and Anti-Vax Misinformation

Thirty-five years ago drug manufacturer Merck & Co. invented a groundbreaking treatment for river blindness, a disease that affects millions of people in Africa. The company donated billions of doses and frequently touted its philanthropy, building a narrative about the good a drugmaker can do.

Few people had ever heard of the tropical disease treatment until this year. Now that antiparasitic—ivermectin—is a household name, and the story is well out of Merck’s hands. In the midst of the Covid‑19 crisis, anti-vaxxers embraced it as a treatment for the virus despite a lack of scientific evidence to support its use. Merck has recently developed molnupiravir, a Covid treatment the company hopes will soon become a key tool in stemming the pandemic, even though it’s entering a world in which rampant misinformation could undermine the use of new drugs. So it’s in the odd position of telling the public both that molnupiravir works against Covid and that ivermectin doesn’t.

The pharmaceutical industry hasn’t found effective ways to combat misinformation thus far. Merck took a stab when it became obvious that people were turning to ivermectin—mostly known in the West as a medicine for livestock—as a Covid treatment after lab research showed it could inhibit replication of the virus. Studies in humans didn’t prove it worked.

In an unusual move, Merck put out a press release about the use of ivermectin, saying in February there was “no meaningful evidence” it was effective against the coronavirus and noting “a concerning lack of safety data.” The statement had no discernible effect: Ivermectin sales took off after that, with the biggest spike taking place over the summer months. Average monthly prescriptions this year in the U.S. are nearly 150,000, up more than sevenfold from 2019 levels of about 20,000.

Conspiracy theorists have gone so far as to suggest Merck is actively downplaying ivermectin, a generic drug that costs around $35 for 20 tablets, in favor of urging patients toward molnupiravir, for which it’s charging the U.S. government $700 for each 40-pill course of treatment.

Still, the company has been muted in its rebuttal to the nagging claims. “We have a randomized, double-blind trial that is global with clear evidence of efficacy with molnupiravir,” says Dean Li, president of Merck’s research division. “Misinformation—I can’t speak to that. I can only speak with regards to information.”

Pfizer Inc., which also has a new Covid pill it hopes will soon get authorized, has faced similarly baseless claims. Some have even called the pill “Pfizermectin,” implying the product is just a repackaged version of ivermectin. The company said in a statement that its antiviral “is not similar to that of an animal medicine and is not the same mechanism” as ivermectin. As far as tamping down on the rumors? A spokesperson declined to comment on that.

These incidents highlight pharmaceutical companies’ vulnerability to misinformation and how little they’ve done to disprove such falsehoods. “For a company to clearly state that there’s a use of their product that is not accepted would be very powerful,” says Peter Lurie, a former U.S. Food and Drug Administration official who leads the Center for Science in the Public Interest. In other words, one press release isn’t enough. Merck, he says, “could do it more, and it needs to reach the local level,” such as by taking out ads advising against the use of ivermectin to treat Covid.

For now, Wall Street doesn’t see misinformation posing a big financial risk for the new Covid antiviral drugs, which are poised to bring in more than $5 billion for Merck and $10 billion for Pfizer through 2022, says Damien Conover, director of health-care equity research for Morningstar Inc. Because sales will initially come through government contracts, he says, the drugs may simply sit on pharmacy shelves if people are reluctant to take them.

The company making money off ivermectin isn’t Merck—the giant drugmaker accounts for less than 1% of the ivermectin prescribed in the U.S., according to data from IQVIA Holdings Inc. Private-equity-owned Edenbridge Pharmaceuticals LLC, which manufactures a generic version of the pill, makes the rest. A product that brought in just shy of $800,000 in monthly sales on average in 2019 raked in revenue of $42 million in August alone, the IQVIA data shows. As far as misinformation goes, Edenbridge noted in a press release that ivermectin is not approved by the FDA to treat Covid. But a spokesman says it’s supporting research into the drug’s use for Covid by donating it for studies.

Part of the reason ivermectin’s use has even been possible in the highly regulated U.S. health-care system is because of a practice known as off-label prescribing, in which a doctor is allowed to write a prescription for an unapproved use. Ivermectin has been approved in the U.S. for parasitic infections, rosacea, and head lice. When prescribed for purposes beyond those, the FDA doesn’t get involved. “It is part of the practice of medicine,” an agency spokesperson says.

Although doctors are usually the gatekeepers, ivermectin developed a life of its own with celebrities who have remained unvaccinated such as Joe Rogan and Aaron Rodgers saying publicly they’ve used the drug as a Covid treatment. That’s helped send patients to doctors asking for the antiparasitic. And they can easily find a prescriber by using an online directory featuring more than 300 clinicians, run by an ivermectin-promoting group called the Front Line Covid-19 Critical Care Alliance.

Others have sought out veterinary formulations, which is dangerous because they typically come in doses meant for large animals. “You are not a horse. You are not a cow. Seriously, y’all. Stop it,” the FDA tweeted in August, at the height of the craze. A rare joke from the federal agency, the tweet went viral. Nonetheless, some 144,000 ivermectin prescriptions were dispensed by pharmacies in October of this year, up from about 27,000 during the same month in 2019.

Surgeon General Vivek Murthy recently put out a 22‑page toolkit on misinformation and the role individuals, educators, health professionals, and others can play, encouraging empathy, question-asking, and direction to reputable sources. The report stated more work needs to be done to figure out the most effective strategies to combat the problem.

The factors that keep people unvaccinated and draw them to ivermectin aren’t going away, says Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. Medical boards need to crack down on the practitioners pushing it for Covid, he says. “I don’t see many of those individuals who are touting the benefits of ivermectin suddenly abandoning ivermectin in favor of the antivirals that actually work,” he says. “Some will, but I think many of them actually won’t.”

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