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HCQ, Donald Trump and India

Hydroxychloroquine, HCQ illustration.
Image credit: molekuul / 123rf

U.S. President Donald Trump has sparked shock and alarm with his announcement that he is personally taking hydroxychloroquine (HCQ) – a drug that has been much-discussed in the fight against COVID-19 and one of particular significance with regard to India. 

HCQ is a drug used in the treatment of a number of diseases, among them malaria, lupus, and rheumatoid arthritis. It has garnered much publicity amidst the global pandemic of COVID-19 – the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly referred to simply as the coronavirus. 

“I happen to be taking it,” Trump said of HCQ during a meeting with reporters on Monday. The White House has since confirmed that Trump, 73, is taking the drug. This is despite the fact that the U.S. Food and Drug Administration (FDA) – headed by Dr Stephen Hahn, a Trump appointee – said at the end of April that “hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.”

The FDA did note that “they are being studied in clinical trials for COVID-19. we authorized their temporary use during the COVID-19 pandemic for treatment of the virus in hospitalized patients when clinical trials are not available, or participation is not feasible.” However, it cautioned that “hydroxychloroquine and chloroquine can cause abnormal heart rhythms such as QT interval prolongation and a dangerously rapid heart rate called ventricular tachycardia.” 

India is no stranger to the controversy surrounding HCQ, but this has not stopped the drug from becoming what an Al Jazeera article described in April as “a tool of India’s diplomacy.” The Times of India echoed this sentiment, describing India’s “medicine diplomacy” including dispatching HCQ supplies abroad.

India is a major exporter of HCQ, the Al Jazeera article noted; its yearly exports of the drug are worth US$50 million. India is the chief supplier of HCQ to the World Health Organization (WHO).

However, the early frenzy that HCQ could represent, as Trump said, a “game-changer” in the fight against COVID-19 has subsided amidst increased scientific scrutiny of its merits for application for COVID-19 – either as a treatment or a prophylactic. This has not stopped India from continuing to supply HCQ globally in voluminous amounts. In April, it was reported that India was to supply HCQ to 55 countries affected by COVID-19. 

At the end of April, India dispatched fifty million tablets of HCQ to the U.S. alone. India had earlier banned exports of HCQ, but reversed course after a plea from President Trump who subsequently praised Prime Minister Narendra Modi on Twitter for the move. However, as far as HCQ goes in the COVID-19 context, there is still room for doubt and so there is a way to go. As previously reported by Health Issues India

“It is important to remember that [HCQ’s] use is in the context of public health and that, for state-sanctioned consumption, there must be a robust body of scientific evidence to back it up. It is unsurprising, therefore, that concerns have been expressed as of yet concerning the absence of such evidence….

“…The use of hydroxychloroquine has suffered from great expectations and short deadlines. In theory, as a relatively commonly used medicine and inexpensive in its generic form, it could be the ideal counter to coronavirus, especially in low-to-middle income countries. However, its use, as of yet, is based on only partial evidence that does not even fully support the conclusion seemingly reached by governments across the globe. A treatment, and indeed a hope, is vitally needed in the face of the pandemic, but it is important to wait for the evidence.”

Trump’s announcement that he is taking HCQ seems not to be based on the above-mentioned “robust body of scientific evidence.” When asked what his evidence for HCQ’s benefits, Trump responded “here’s my evidence: I get a lot of positive calls about it.”

The embrace of HCQ by Trump is “likely to be welcomed in India”, an Associated Press report states. It noted that, at the time India lifted the prohibition on HCQ exports, shares of HCQ manufacturers leaped as the Union Government directed that production of tablets be increased. However, the ostensible full-throated embrace of HCQ belies what the Associated Press report characterises as a “flimsy study with little to no evidence that it prevents or treats COVID-19.” Dr Bharath Kumar, cited in the report, opines “we should do a trial. I think that is the right way to come to [an] answer on this question. But the government made our job harder.” 

It is unsurprising that a treatment for COVID-19 is highly sought-after. But adoption of any measure, as a treatment or a prophylactic, should be based on more than hype. Trump’s announcement that he is self-medicating may serve only to amplify such hype – and so it is imperative that the experts continue to speak out, that research be ongoing, and that needless risks with unproven treatments not be undertaken. 

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