Demanding early treatment options for Manitobans: The strong case for Ivermectin
On July 15, 2021, we sent a letter to the Minister of Health and Seniors Care, Heather Stefanson, demanding access to Ivermectin. Manitoba Government Inquiry sent us an unsatisfactory response.
It is likely that you have read mixed reviews about Ivermectin. In fact, Ivermectin is safe and effective in preventing and treating COVID-19. Your best source of accurate, up to date information about Ivermectin and other drugs for COVID-19, including treatment protocols and providers, can be found on the Frontline Covid-19 Critical Care Alliance (FLCCC) website here. In addition, you can routinely visit this site here for a very detailed (technical) real time analysis of ongoing worldwide randomized controlled trials (RCTs) of Ivermectin, referenced by the FLCCC.
Many studies have been referenced in the media to discredit Ivermectin, however, meta-analytic results are considered the most trustworthy source of evidence by the evidence-based medicine literature.
Levels of Evidence". Centre for Evidence-Based Medicine (CEBM). University of Oxford. March 2009. Retrieved 21 December 2021. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009
Developing NICE guidelines: the manual (PDF). London: National Institute for Health and Care Excellence. 2014. Retrieved 21 December 2020. https://www.nice.org.uk/media/default/about/what-we-do/our-programmes/developing-nice-guidelines-the-manual.pdf
The best systematic review and meta-analysis of Ivermectin for COVID-19 happens to support the use of Ivermectin for COVID-19. It was published in a reputable peer reviewed medical journal in June 2021.
Bryant A, Lawrie TA, Dowswell T, Fordham EJ, Mitchell S, Hill SR, Tham TC. (2021). Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. American Journal of Therapeutics, 28(4):e434-e460.
https://journals.lww.com/americantherapeutics/Fulltext/2021/08000/Ivermectin_for_Prevention_and_Treatment_of.7.aspx
In our letter to the Minister of Health and Seniors Care, Heather Stefanson on July 15th, 2021, we cite the aforementioned study.
A second study, by different authors, was published in October 2021, that re-enforces the conclusion that Ivermectin is safe and effective. This second article was important in dismissing efforts to discredit the original Bryant et al (2021) article.
Neil, M., & Fenton, N. (2021). Bayesian Hypothesis Testing and Hierarchical Modeling of Ivermectin Effectiveness. American Journal of Therapeutics, 28(5), e576.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415515/
On July 15, 2021, we sent a letter to the Minister of Health and Seniors Care, Heather Stefanson demanding access to Ivermectin. Manitoba Government Inquiry sent us an unsatisfactory response (you can find it after our letter below). The response does not answer the questions we posed, and it did not provide the evidence-based rationale of the Minister of Health and Manitoba Health.
We were encouraged to learn that Manitoba MLA for River Heights, Dr. Gerrard, wrote to the Minister of Health and Seniors Care on January 27, 2021 asking about the status of Ivermectin and sharing the relevant research findings at the time. His letter and the response of Heather Stefanson are provided below:
Please join us in demanding access to life-saving treatments for COVID-19 including Ivermectin.
Addressed to the Honourable Heather Stefanson July 15, 2021
Since March 20, 2020, the Government of Manitoba has been operating under public health orders known as the Emergency Measures Act. These orders have been placed above our Canadian Charter of Rights and Freedoms. Dignity of Risk Alliance was formed with the mission of defending the autonomy of Manitobans in making informed decisions about the risks they are prepared to take for medical care. Today we are writing on behalf of citizens that have found unreasonable limitations placed on their access to treatments for COVID-19 as a result of the gatekeeping role of Manitoba Health.
Despite the fact that widespread COVID-19 inoculation has been deemed the only way out of the current state of emergency, Manitobans are told that they will continue to be susceptible to catch and transmit the SARS-CoV-2 virus, susceptible to developing COVID-19, and at risk of developing COVID-19 in the future due to variants that are likely to arise. In addition, Manitobans face the uncertainty that the current vaccines, in booster shots, will protect against the anticipated variants1. The lack of longitudinal evidence for the efficacy of the COVID-19 vaccines, and the fact that there are people who are not recommended to take the vaccine2, continues to leave our population defenseless against COVID-19. It is time to consider the latest evidence-based literature on treatment options.
On June 17, 2021, Bryant et al. published a peer-reviewed paper in the American Journal of Therapeutics entitled Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines3 where the authors assessed the quality of evidence from several randomly controlled clinical trials (RCTs) and combined the RCTs in a Meta-analysis concluding:
Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally.
Prior to this publication, several internationally recognized research institutes have weighed in on Ivermectin as a treatment for COVID-19. Most notably, the U.S. National Institutes of Health (NIH) does not restrict the use of Ivermectin for treating COVID-194. Given the continued risk of COVID-19, and the findings of Bryant et al. (2021), Dignity of Risk Alliance considers the decision to restrict access to Ivermectin unethical.
Dignity of Risk Alliance is now asking that Manitoba Health review this evidence which supports the adoption of Ivermectin in treatment protocols. Alternatively, should you consider the evidence insufficient, we are demanding that Manitoba Health provide Ivermectin to Manitobans in the interim while proactively engaging in or supporting randomized clinical trials (RCTs).
RCTs of Ivermectin were recommended in a February 8, 2021 report by the Canadian Agency for Drugs and Technologies in Health (CADTH) where they stated:
Well-conducted, dose-response trials are needed to provide reliable conclusions regarding the benefit and harms of Ivermectin for the treatment and prevention of COVID-195.
It is important to note that this recommendation was made prior to the Bryant et al. (2021) paper. Recommendations, similar to those of CADTH, were made following systematic review of Ivermectin in treating COVID-19 in a variety of international organizations including Canada’s Alberta Health6, the Australian National COVID-19 Clinical Evidence Taskforce (NCCET)7, and the World Health Organization (WHO)8.
We would like to recommend that Manitoba Health consider the Ivermectin study protocol published by Popp et al. (2021), and available in the Cochrane Library9.
The protocol for a Cochrane Review (intervention) has the objective:
To assess the efficacy and safety of ivermectin compared to standard of care, placebo, or any other proven intervention (1) for prevention of an infection with SARS‐CoV‐2 (post‐exposure prophylaxis), and (2) for people with COVID‐19 receiving treatment as outpatients or inpatients.
If Manitoba Health does not adopt Ivermectin into treatment protocols and decides not to actively participate in or support RCTs of Ivermectin, we are asking for a response explaining its decision. In that response, we would like to know how Manitoba Health regards international agencies that do not restrict the clinical use of Ivermectin, and which support the use of Ivermectin in clinical trials. Your response will constitute an important public document that outlines the framework for the decision-making process used by Manitoba Health and will assert that its decision is evidence-based.
We have shared this letter with the group of doctors known as Doctors Manitoba as they appeared to be unaware of the latest research available on Ivermectin when they addressed Manitobans’ questions during four YouTube Livestream town halls that are now available on their website10.
We trust you can recognize the significance of the Bryant et al. (2021) publication and that you will support the adoption of Ivermectin as a standard of care in treating COVID-19. We have attached the Bryant et al. (2021) paper to this email. In closing, we anticipate that you will understand the importance of your follow-up with the public and the scientific community regarding the significance of this timely research, and, if not, that you will explain to Manitobans why they will continue to be restricted from Ivermectin as a lifesaving therapy.
https://protectmb.ca/qa
See Medical Exemptions: https://gov.mb.ca/asset_library/en/covidvaccine/clinical_practice_guidelines.pdf, pg. 15.
https://journals.lww.com/americantherapeutics/fulltext/2021/08000/ivermectin_for_prevention_and_treatment_of.7.aspx
https://covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin
https://cadth.ca/sites/default/files/covid-19/RC1336%20-%20Ivermectin%20for%20COVID-19%20v6.4.pdf, pg. 13.
https://albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-ivermectin-in-treatment-and-prevention-rapid-review.pdf
https://app.magicapp.org/#/guideline/5477, 6.3.3.2 & 6.3.3.3.
https://who.int/news-room/feature-stories/detail/who-advises-that-ivermectin-only-be-used-to-treat-covid-19-within-clinical-trials
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017/information
