The power behind chloroquine
Image by Rodrigo Picón
Kings, armies, and governments have fought over the control of chloroquine to cure malaria. It has been tested against the coronavirus, but scientific studies indicate that it does not benefit patients.
When Hitler invaded the Netherlands in 1940, Germany seized almost the entire quinine inventory available in the world to treat malaria. Two years later, Japan occupied the island of Java, where the remaining quinine was produced. To prevent American soldiers from dying of malaria while fighting in the Pacific, the administration of President Franklin D. Roosevelt ordered that new drugs be tested to cure the disease. Doctors tried Atabrine first, but a rumor spread saying that it caused impotence and so soldiers refused to take it. They decided to try a drug made from quinine and synthesized it in Germany: chloroquine.
Soldiers suffering from fevers improved after taking chloroquine, and mortality dropped over the weeks. The researchers found that it prevented the reproduction of malarial parasites in red blood cells. Fueled by the adrenaline rush of World War II, American physicians dubbed chloroquine “the magic bullet” because it caused few side effects and worked against all four species of the parasite.
Eighty years later, driven by the political backing of another American president, some governments and scientists pinned their hopes of finding an effective treatment for COVID-19 on chloroquine. Donald Trump supported the use of antimalarials—especially hydroxychloroquine, a chemical derivative of chloroquine made with an oxygen atom and a hydrogen atom. Its formulation makes it more “agile” to inhibit the reproduction of infectious agents such as viruses and parasites, explains Venezuelan virologist José Esparza.
Ten days after the World Health Organization declared the outbreak a pandemic, Trump said that hydroxychloroquine and azithromycin offered a “real opportunity” to become one of the greatest game-changers in medical history. A group of French researchers reported improvements in twenty COVID-19 patients treated with the drugs, and in vitro cell tests indicated that antimalarials helped to slow down the reproduction of the virus.
Upon testing positive for COVID-19, Brazilian President Jair Bolsonaro recorded a video of himself taking a hydroxychloroquine pill. In Venezuela, Nicolás Maduro congratulated the scientists working on the local production of chloroquine diphosphate, and the Ministry of Health ordered medical professionals to treat COVID-19 patients with chloroquine when the lockdown started on Monday, March 16, 2020.
Chloroquine and hydroxychloroquine were included in one of the four groups of drugs that the WHO incorporated into Solidarity, a global clinical trial aiming to test the effectiveness of known and available treatments for other diseases, against COVID-19. Other drugs include remdesivir, which has been used for Ebola and respiratory syndromes, lopinavir/ritonavir, used for HIV, and interferon β-1a, which treats multiple sclerosis.
Even though researchers warned about the lack of scientific evidence showing that antimalarials were effective against the coronavirus, on Monday, May 18, Trump confirmed that he was taking hydroxychloroquine to prevent contagion. Four days later, the scientific journal The Lancet published a study attributing “an increase in the risk of ventricular arrhythmias and an increased risk of hospital death” in COVID-19 patients to the use of chloroquine and hydroxychloroquine. The finding forced the WHO to temporarily suspend the drugs from the Solidarity program.
A group of 174 physicians, scientists, statisticians, and ethicists questioned the quality of the data and the methodology used to support the findings in The Lancet study. The group cited the study’s use of medical records of 96,032 patients treated in 671 hospitals, records which were collected by an unknown international consulting firm called Surgisphere. They demanded clarification on the terms of the data sharing agreements between Surgisphere and the governments and hospitals that provided the patient information, but the authors refused. In a letter to the editor of The Lancet, they asked the WHO to conduct an independent verification of the data. The journal retracted the study; suspicions that chloroquine and hydroxychloroquine were harming the patients receiving coronavirus treatments still remained.
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