The anti-malaria drug hydroxychloroquine came to global attention in March when Donald Trump hailed it as a ‘very powerful’ treatment for Covid-19. In Brazil, it was quickly embraced by President Jair Bolsonaro, a staunch Trump ally. Just two days after the American president first endorsed the drug, Bolsonaro announced that the Brazilian Army laboratory would expand production. Shortly afterwards, the Ministry of Health authorised the use of chloroquine and hydroxychloroquine for severe cases of Covid-19, as complementary treatments at the doctor’s discretion.
Although studies on the drug’s effectiveness were inconclusive at the time, Bolsonaro’s insistence only increased. In less than a month, two ministers of health were sacked, partly due to their opposition to the drug. Now run by a military man with no health credentials, the Ministry of Health has authorized prescription of chloroquine in combination with azithromycin to treat light, moderate and severe cases of Covid-19 – as long as the patient signs a consent form and states they are aware of the risks.
Over the last few months, new studies showing the ineffectiveness of chloroquine to treat Covid-19 have led respected medical and scientific organisations around the world to abandon it. These include the U.S Food and Drug Administration (FDA), which revoked the emergency authorisation of hydroxychloroquine for Covid-19 patients in mid-June. Following this, the World Health Organisation (WHO) definitively suspended clinical testing with the drug, while in Brazil medical bodies like the Brazilian Infectiology Society have also come out against it.
And yet Bolsonaro is still fighting the tide of global scientific opinion, continuing to peddle the drug in posts and live webinars on social media. In Brazil, manufacturers of chloroquine – some of whom openly support the president – saw consumption of the drug increase by 358 per cent by July.
After Bolsonaro began spreading propaganda about supposed ‘cures’ for Covid-19, a group of Brazilian doctors started promoting a controversial ‘early intervention’, involving the use of hydroxychloroquine and chloroquine together with other drugs, such as the antibiotic azithromycin.
Following reports sent in by our readers as part of an engagement reporting initiative, Agência Pública has discovered that a number of local governments in Brazil have adopted ineffective drugs as part of their official coronavirus response. In many towns and cities, these drugs have become electioneering tools in campaigns ahead of local elections on 15 November, helping to boost the popularity of mayors seeking re-election.
We investigated policies adopted in ten towns and cities in eight different Brazilian states. These cases show that throughout the country, from north to south, local governments are offering ‘Covid kits’ containing ineffective medication, while falsely promising to prevent or cure a disease which has already killed more than 150,000 Brazilians. In at least eight of the cases investigated, residents revealed that the drugs were delivered even without a Covid-19 test result.
Drugs take centre stage in election campaigns
But why distribute drugs which don’t work? Specialists interviewed by Agência Pública argue that the promotion of false cures is a deliberate election strategy.
‘The political use of treatments and vaccines has been very obvious during the pandemic,’ says Natália Pasternak, a doctor in microbiology at the Universidade de São Paulo and president of the Instituto Questão de Ciência. ‘If you say, “Look how I’m taking care of people in my city, handing out free drugs”, it’s an easy way of getting people’s sympathy and their vote.’
This is what’s happening in Natal, state capital of Rio Grande do Norte, according to Daniel Menezes, professor of the social sciences department at the Universidade Federal do Rio Grande do Norte (UFRN). Mayor Álvaro Dias, who is seeking re-election, has created at least three distribution centres for the drugs and argues that ivermectin ‘is effective in preventing coronavirus’. Such statements have landed Dias in trouble with the state Public Prosecutor’s Office, which is investigating him for use of illegal electoral propaganda.
‘My hypothesis is that he has looked at the polls and analysed the mood of the population very well. He says “People want treatment? Then that’s what I’m going to give them,”’ according to Menezes.
In July, in Paranaguá, in the state of Paraná, the local mayor – who is also seeking re-election this year – announced via his social networks the ‘mass distribution’ of ivermectin to ‘immunize the population’. The drugs were distributed in a gymnasium, a shop and even in local state schools. Each stage of the process was documented in detail on the mayor’s social media channels.
‘Here we’re beating the Chinese virus’ reads a tweet pinned to the profile of Everton Sodário, the mayor of Mirandópolis, a small, rural town in the state of São Paulo around 600 km from the state capital. Over 68% of the town’s population voted for Bolsonaro in 2018, and Sodário – a self-styled ‘Bolsonaro caipira’ (Redneck Bolsonaro) – has been following the president’s lead closely in his bid for re-election.
He has encouraged the local population to ignore lockdown protocols, instead distributing a ‘Covid kit’ containing hydroxychloroquine, azithromycin, ivermectin, zinc and vitamins C and D. Eduardo Bolsonaro, one of the president’s sons, tweeted his support for the municipality’s purchase of these drugs.
With Pantanal fires exacerbating pandemic, mayor promises fake cure
In Cáceres, in the state of Mato Grosso, where thick smoke from the Pantanal forest fires has only exacerbated the advance of the pandemic, the local government has chosen to invoke a higher power. Inside packaging containing two ivermectin pills distributed to the local population, the government included a religious message reading ‘This is the Lord Jesus’ fight. Together we will defeat Covid-19 – Cáceres Municipal Health Ministry’.
In a video published on Facebook by the local government on 21 July, Mayor Francis Maris invited anyone who had yet to take the medication ‘as coronavirus prevention’ to pick it up at the town’s conference centre.
In Vilhena, a municipality in the Amazonian state of Rondônia, in a Facebook post announcing his return to work after having recovered from Covid-19, the mayor wrote, ‘We believe it’s important to take the kit of chloroquine, ivermectin and azithromycin close to five days after the appearance of the first symptoms, to cure the disease or halt its progress.’ The post had more than 500 likes and around a hundred positive comments.
In Porto Feliz, in the state of São Paulo, the city government’s health strategy even stated that it would give legal support only to doctors who prescribed these ineffective drugs, though this passage was later deleted. The document was signed by Mayor Cássio Prado, a surgeon and intensivist. One of the first doctors to endorse hydroxychloroquine, azithromycin and ivermectin in Brazil, he became known as the poster boy for ‘early intervention’.
Citizens in need have no access to medicine
Not only has the promotion of these drugs been ineffective in controlling the advance of the pandemic in Brazil, it has prevented them from reaching those in genuine need, like Sueli Souza Santos, a housewife who suffers from an autoimmune condition.
‘When the pandemic began, I stopped receiving my medicine. Even in compounding pharmacies we couldn’t get hold of any. They said they could only send the drugs to hospitals. This meant I had to go without,’ she told Agência Pública. She went 40 days without access to the treatment she needed. ‘Your whole body hurts. You get a fever and have to stay in bed because the pain is so bad.’
The propaganda around hydroxychloroquine has also led people around the country to demand it from the local authorities, as we observed in Palmeiras de Goiás, in the state of Goiás, and Joinville, in the state of Santa Catarina.
According to Joinville’s health secretary, there has been ‘conflict’ between part of the population, who want to take chloroquine, and doctors who refuse to prescribe it. With concern about people self-medicating, the local government’s solution was to create a ‘centre for early intervention’, bringing together ‘those who want to prescribe and those who want to receive’ the drug.
‘Just because people want to take it, we’ve gone to the extreme of creating a place to prescribe – albeit under supervision – a drug which is toxic, instead of explaining to people its risks and why it’s ineffective’, says the doctor Fábio Gaudenzi, president of the Santa Catarina Infectiology Society.
In some of the cases investigated by Pública, municipal authorities justified their controversial health policies by arguing that something had to be done to combat the spread of coronavirus, even if the drugs available weren’t the perfect weapon. ‘We’re the ones on the frontline, in contact with those who are sick’, said Leonel Nulman Szterling, clinical director of the Hospital de Clínicas de São Sebastião.
There are also accounts of frontline health professionals and patients who felt pressured into taking chloroquine and other drugs proven ineffective as treatments for Covid-19.
“Little bags of delusion”
‘I call these kits “little bags of delusion”. They make no sense’, says Margareth Dalcolmo, a pneumologist, teacher and researcher at Fundação Osvaldo Cruz (Fiocruz), one of the most respected public health institutions in the world. ‘The distribution of these drugs ahead of elections is just absurd. Their use is political and demagogic.’
Both the World Health Organization and the global scientific community have stated repeatedly that there is no scientific evidence that chloroquine, hydroxychloroquine and ivermectin are effective treatments for Covid-19. All over the world, their use has been discouraged.
And aside from the serious side effects that chloroquine can have for cardiac patients, the specialists interviewed by Pública warned of the potential for ‘social damage’ caused by ivermectin, a drug distributed in at least six of the towns and cities covered in this investigation.
‘It can generate a false sense of security. People think that the kit is protecting them. So they think there’s no need to wear a mask, they can go and visit their elderly parents and they can congregate in large groups, without having to worry about social distancing’, warns Pasternak.