Coronavirus and chloroquine: Is there evidence it works?
By Jack Goodman and Christopher Giles
BBC Reality Check
15 May 2020
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Drugs developed to treat malaria have been touted by President Trump as treatment for Covid-19, despite scientists saying there's no definitive evidence they work.
Studies are underway to examine the efficacy of chloroquine and its derivatives, but the World Health Organization says it's concerned by reports of individuals self-medicating and causing themselves serious harm.
These safety concerns have been echoed by a former top US health official.
Dr Rick Bright, who was removed from his post in April leading the government's vaccine development efforts, says President Trump's focus on these drugs has been "extremely distracting to dozens of federal scientists".
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Dr Rick Bright, former director of the Biomedical Advanced Research and Development Authority
As a result of the publicity given to these drugs as a possible treatment, there has been a global surge in demand for them.
What do we know about these drugs?
President Trump has frequently referred to the potential of hydroxychloroquine in White House briefings. At one press conference, he said: "What do you have to lose? Take it."
Brazilian President Jair Bolsonaro claimed in a video that "hydroxychloroquine is working in all places",although that was subsequently removed by Facebook for breaching its misinformation guidelines.
Following Mr Trump's reference to the drugs in late March, there was a sharp increase reported in prescriptions in the US for both chloroquine and hydrochloroquine, although demand has since declined.
Tablets containing chloroquine have long been used in the treatment of malaria to reduce fever and inflammation, and the hope is that they can also inhibit the virus that causes Covid-19.
There is insufficient evidence at the moment from current trials as to their effective use in treatment of patients with Covid-19.
There are also risks of serious side effects, including renal and liver damage.
"We need larger, high-quality randomised clinical trials in order to better evaluate their effectiveness," says University of Oxford's Kome Gbinigie, author of a report on anti-malarial testing for Covid-19.
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Hydroxychloroquine: "What do you have to lose? Take it."
Over 20 trials are being carried out, including in the US, UK, Spain and China.
In the US, various trials are under way for a combination of drugs including chloroquine, hydroxychloroquine and an antibiotic called azithromycin, for treating Covid-19 patients.
Which countries have authorised their use?
In late March, the US Food and Drugs Administration (FDA) has granted "emergency use" authorisation for these drugs in the treatment of Covid-19 for a limited number of hospitalised cases.
That does not mean the FDA is saying they definitely work. But it does mean that in specific circumstances, hospitals can request and use the medicines from government stockpiles for use in Covid-19 treatment.
But on 24 April, the FDA, which licenses medicines in the US, also issued a warning about the dangers of using the substances because of reports of heart rhythm problems in patients.
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American scientists have begun a trial to see if chloroquine will help treat coronavirus
The US government has said that 30 million doses of hydroxychloroquine have been donated to the national stockpile by a German-based pharmaceutical company.
Other countries are also deploying these anti-malarial drugs to varying degrees.
France has authorised doctors to prescribe them for patients with Covid-19, but the country's medical watchdog has warned of side effects.
India's health ministry has recommended the use of hydroxychloroquine as a preventative treatment for healthcare workers, as well as households in contact with confirmed cases if they have a prescription from a doctor.
However, India's government research body has warned against the unrestricted usage of the anti-malarial drug and said it was "experimental" and only for emergency situations.
Several Middle Eastern countries have authorised its use or are conducting trials. This includes Bahrain (which claims it was one of the first countries to use hydroxychloroquine on coronavirus patients), Morocco, Algeria and Tunisia.
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Is there enough chloroquine available?
As interest in these drugs has grown as a potential treatment for Covid-19, many countries have seen high demand and shortages.
Chloroquine and its derivatives have long been widely available in pharmacies, particularly in developing countries, for the treatment of malaria.
This is despite their declining efficacy against malaria, as the disease has become increasingly resistant.
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Jordan has banned the sale of hydroxychloroquine in pharmacies to prevent stockpiling. Similarly, the Kuwaiti Health Ministry decided to withdraw all medicines containing the drugs from private pharmacies and limit them to hospitals and health centres.
Kenya has banned over-the-counter sales of chloroquine, so it is now only available on prescription.
India is a major producer of these anti-malarial drugs, and at one point imposed a ban on exports.
But it lifted the ban after President Trump made a personal plea to India's Prime Minister, Narendra Modi.
Unregulated use can be unsafe
In Nigeria, households still regularly use tablets containing chloroquine for treating malaria, even though it was banned in 2005 for first-line use because of its declining effectiveness.
News of a February study in China about the use of chloroquine for the coronavirus had already sparked lively debate in Lagos, so people began stocking up.
Following Mr Trump's reference to it as a coronavirus treatment, this ramped up, and shops and chemists sold out of the drug very quickly.
But the Nigerian Centres for Disease Control told people to stop taking it. "The WHO has NOT approved the use of chloroquine for #COVID19 management."
Bala Mohammed, governor of Bauchi state, recommended people use chloroquine and Zithromax, after taking it himself.
Officials in Lagos state said there have been a number of people poisoned from overdoses of chloroquine.
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