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Ivermectin’s bumpy ride through America | International

The use of ivermectin against Covid-19 has been controversial around the world, fuelled by social media and celebrity proponents. Nominally an antiparasitic, the World Health Organization (WHO) advised against its use a few months after the outbreak of the pandemic in 2020, and noted that more studies were needed to evaluate its effectiveness against the novel coronavirus. The US Food and Drug Administration (FDA) and the European Medicines Agency have followed the WHO’s line, but at least 10 Latin American countries authorized its use during the pandemic.

Japanese biochemist Satoshi Omura won the 2015 Nobel Prize in Medicine for the discovery of ivermectin three decades earlier. The drug is highly effective against infections caused by worms and is commonly used as a topical solution to treat head lice. In the first few months of the pandemic, the world was desperately fighting against the then-unknown SARS-CoV-2, with no vaccines or treatments to turn to as the virus infected and killed thousands of people every day. Pharmaceutical companies and governments desperately searched for existing drugs that might work, and the low-cost ivermectin emerged as a potential option.

Most academics and international agencies did not jump on the bandwagon due to the lack of irrefutable evidence in the drug’s favor during the early days of the pandemic. At the extremes, ivermectin was variously seen as a “miracle drug” or completely useless against Covid-19. The United States has simultaneously become a bastion of skepticism about its use against the virus as well as a breeding ground for celebrity and social media promotion of the antiparasitic. “You are not a horse. You are not a cow. Seriously, y’all. Stop it,” one FDA tweet read, alluding to ivermectin’s veterinary use in a bid to curb its consumption. Before the pandemic, doctors were handing out 3,600 prescriptions for human use each week. Six months ago, the figure was 88,000, according to the US Centers for Disease Control and Prevention (CDC), which has warned of a sudden increase in demand.

In addition to the FDA, the National Institutes of Health, the American Medical Association and US pharmaceutical associations all advise against prescribing ivermectin for Covid, but that has not stopped vaccine skeptics taking it – with sometimes disastrous consequences. Last August, five people in Oregon were hospitalized for ivermectin poisoning, two of whom required intensive care.

“Ivermectin use has been irrational in many countries,” said biologist, chemist and pharmacologist Guillermo Barranco, an academic at the National Autonomous University of Mexico (UNAM). Barranco believes the drug has been misprescribed in terms of dose, which has led to unnecessary expense and demand for counterfeits. “Prescribing a drug is not easy,” he added. “It is not just a matter of saying ‘take it and that’s it.’ You need trained professionals.”

Brazil may offer the most pertinent example of ivermectin use and abuse in Latin America. The government of Jair Bolsonaro continues to defend using the drug against Covid-19, despite the raft of scientific evidence on its ineffectiveness and amid the deaths of 600,000 Brazilians from Covid-19. The issue remains highly politicized, and to this day the Brazilian Ministry of Health recommends so-called Covid kits, which include ivermectin and other discredited drugs such as chloroquine and azithromycin. Sales of ivermectin increased eightfold in the country during the first year of the pandemic.

A box of ivermectin in a file photo.
A box of ivermectin in a file photo.BENOIT TESSIER (Reuters)

In Peru, ivermectin has been authorized for the treatment of mild cases of Covid-19 since May 2020. Then-health minister Victor Zamora declared that one drop of the solution should be taken for every kilo the patient weighed, up to a maximum of 50 drops. Peru’s public health system also provided free “Covid kits” with the same medicines as in Brazil. Faced with the collapse of the country’s health system, thousands of people self-medicated with ivermectin in 2020, after doctors and dubious “experts” recommended it on radio programs. Some 5,000 people also took stronger doses intended for veterinary use, at the behest of evangelical groups.

Local media has reported that the Peruvian government bought 1,000% more ivermectin in 2020 than in previous years, and the official policy has ebbed and flowed as health officials rotated in and out. In February 2021, another former health minister, Pilar Mazzeti, commented there were “no definitive results” on the drug’s effects, but that doctors could “consider its use” after talking with a patient. The following month, the newly appointed (and current) Health Minister Óscar Ugarte cited the WHO in saying that studies of the antiparasitic drug “show that it does not have the positive effect it was supposed to have.” Health authorities withdrew ivermectin from its list of approved Covid-19 treatments in May 2021, but that does not mean that citizens have stopped taking it.

In line with its neighbors, Bolivia included ivermectin in its list of essential drug treatments against Covid-19 in May 2020, even though the government acknowledged that no scientific study confirmed its efficacy. The drug had become popular, especially in the east of the country, where it had long been used to combat parasites in animals and people. Its popularity has waned over time, as more and more people died despite being treated with the drug, while some doctors have warned of an increase in cases of poisoning, although there are no official statistics. As in most other countries on the continent, ivermectin’s use has also slowed since the rollout of vaccines. The latest Health Ministry guidelines in Bolivia do not recommend it directly, but several municipalities still distribute it free of charge and its use is still widespread among conspiracy theorists and vaccine skeptics.

Some smaller Latin American countries made very ambitious bets on the drug. Guatemala also handed it out in medical kits for the population at the end of 2020, along with ibuprofen, aspirin and vitamins C and D. “Be warned that there are veterinary drugs on the market containing ivermectin,” the authorities said at the time. “These are not authorized for human use because of the imminent risk they can cause to health.” Without adequate medical supervision, ivermectin can cause nausea, vomiting, diarrhea, drops in blood pressure, allergic reactions, seizures, coma and even death, according to the FDA. Belize also authorized the antiparasitic’s use to treat Covid-19, including in severe cases, from December 2020 onwards. “It is a drug that has been used safely in humans and animals for many years,” explained Melissa Diaz-Musa, the country’s health minister, noting that the risks outweighed the benefits. “We found significant evidence that it helps reduce the replication of the virus,” she added to justify the decision and challenge the narrative that it was a so-called “miracle product.”

Panama went a step further and purchased around 450,000 doses of ivermectin in the first months of 2020, along with 2.9 million doses of hydroxychloroquine, as part of the now familiar self-medication kits, according to Nature magazine. The country later backtracked, and in December 2021 the government issued a communiqué advising citizens not to use the drugs to treat Covid-19: “The efficacy of these products against this virus has not been proven,” the statement said.

In Mexico, a dozen states and the federal district of the capital administered ivermectin, and it was an omnipresent drug in private doctors’ offices (and of some public sector doctors). “Everyone was prescribing it,” said Salvador Arteaga, a doctor in Mexico City, but added: “Many of us stopped handing it out because we saw no effects on our patients, especially in the severe cases.” The government of President Andrés Manuel López Obrador issued an order in August 2021 not to use ivermectin, and Mexico City authorities stopped distributing it, although they have defended their initial decision.

A stand in a market in Mexico City illegally selling medicines.
A stand in a market in Mexico City illegally selling medicines. Quetzalli Nicte Ha

In some countries, there are inconsistencies between national policy on the use of ivermectin and the strategy of some regional states. Ecuador has banned its use for Covid-19 treatment since February last year, but Cynthia Viteri, mayor of Guayaquil (the second most populated city in the country), became the main proponent of its use in 2021, when vaccines were still largely yet to arrive.

In Colombia, authorities have never officially recommended the use of ivermectin to treat Covid-19. As early as July 2020, President Iván Duque, who at the time had a daily television broadcast to report on the pandemic, asked the public to proceed with caution. “The Ministry of Health and Social Protection considers that in order to guarantee the effectiveness of the drug, we must wait for the results of controlled studies,” he said. That same summer, the mayor of Cali, physician Jorge Iván Ospina, defended its use, which became popular in what is the third-largest city in the country.

Ivermectin also found an ally in former Colombian president Álvaro Uribe, one of the country’s most powerful men. Uribe said publicly that he had taken it to overcome the coronavirus on the advice of his doctors, in a cocktail that also included azithromycin, acetaminophen, vitamin C and plant extracts. In June 2021, the Colombian authorities issued an alert, reporting an increase in poisoning from consuming the antiparasitic.

In Argentina, the National Administration of Food, Drugs and Medical Technology (Anmat) also declined to recommend ivermectin as a Covid-19 treatment. The medicine approval body argues that there is insufficient evidence to validate its efficacy against the virus. The drug is not available in pharmacies in big cities such as Buenos Aires, Córdoba, Rosario and Mendoza, and doctors will not prescribe it. Anti-vaccine demonstrators pushing for its use are also markedly absent.

Nevertheless, clinical trials have been authorized in Argentina, and the Argentine Scientific Commission found that “the administration of ivermectin at a dose of 0.6 milligrams per kilogram of bodyweight produces the fastest and deepest elimination of the virus when treatment is started in early stages.” However, it warned that this trial was not sufficiently representative and recommended further research. The drug remained banned by the national authorities after this result, but four of the country’s 23 provinces –Misiones, Corrientes, Tucumán and La Pampa – authorized its use in infected people and health personnel. Although certain European and Asian countries have granted partial authorizations and conducted ivermectin studies, the Americas have established themselves as one of the epicenters of hopes, failures and scandals over the use of ivermectin against the coronavirus.

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Women’s voices and votes loom large as pope is set to open a Vatican meeting on church’s future | International

A few years ago, Pope Francis told the head of the main Vatican-backed Catholic women’s organization to be “brave” in pushing for change for women in the Catholic Church.

Maria Lia Zervino took his advice and in 2021 wrote Francis a letter, then made it public, saying flat out that the Catholic Church owed a big debt to half of humanity and that women deserved to be at the table where church decisions are made, not as mere “ornaments” but as protagonists.

Francis appears to have taken note, and this week opens a global gathering of Catholic bishops and laypeople discussing the future of the church, where women — their voices and their votes — are taking center stage for the first time.

For Zervino, who worked alongside the former Cardinal Jorge Mario Bergoglio when both held positions in the Argentine bishops’ conference, the gathering is a watershed moment for the church and quite possibly the most consequential thing Francis will have undertaken as pope.

“Not only because of these events in October in Rome, but because the church has found a different way of being church,” Zervino said in a recent interview in her Vatican offices. “And for women, this is an extraordinary step forward.”

Women have long complained they are treated as second-class citizens in the church, barred from the priesthood and highest ranks of power yet responsible for the lion’s share of church work — teaching in Catholic schools, running Catholic hospitals and passing the faith down to next generations.

They have long demanded a greater say in church governance, at the very least with voting rights at the periodic synods at the Vatican but also the right to preach at Mass and be ordained as priests. While they have secured some high-profile positions in the Vatican and local churches around the globe, the male hierarchy still runs the show.

This 3-week synod, which begins Wednesday, is putting them more or less on an equal playing field to debate agenda items, including such hot-button issues as women in governance, LGBTQ+ Catholics and priestly celibacy. It’s the culmination of an unprecedented two-year canvasing of rank-and-file Catholics about their hopes for the future of the institution.

The potential that this synod, and a second session next year, could lead to real change on previously taboo topics has given hope to many women and progressive Catholics. At the same time, it has sparked alarm from conservatives, some of whom have warned that the process risks opening a “Pandora’s Box” that will split the church.

American Cardinal Raymond Burke, a frequent Francis critic, recently wrote that the synod and its new vision for the church “have become slogans behind which a revolution is at work to change radically the church’s self-understanding in accord with a contemporary ideology which denies much of what the church has always taught and practiced.”

The Vatican has hosted synods for decades to discuss particular issues such as the church in Africa or the Amazon, with bishops voting on proposals at the end for the pope to consider in a future document.

This edition is historic because its theme is so broad — it’s essentially how to be a more inclusive and missionary church in the 21st century — and because Francis has allowed women and other laypeople to vote alongside bishops for the first time.

Of the 464 participants, 365 are voting members, and of them only 54 are women. While organizers insist the aim is to reach consensus, not tally votes like a parliament, the voting reform is nevertheless significant, tangible evidence of Francis’ vision of the Catholic Church as being more about its flock than its shepherds.

“I think the church has just come to a point of realization that the church belongs to all of us, to all the baptized,” said Sheila Pires, who works for the South African bishops’ conference and is a member of the synod’s communications team.

Women, she said, are leading the charge calling for change.

“I don’t want to use the word revolution,” Pires said in an interview in Johannesburg. But women “want their voices to be heard, not just towards decision-making, but also during decision-making. Women want to be part of that.”

Francis took a first step in responding to those demands in 2021 when he appointed French Sister Nathalie Becquart as undersecretary of the synod’s organizing secretariat, a job which by its office entitled her to a vote but which had previously only been held by a man.

Becquart has in many ways become the face of the synod, traveling the globe during its preparatory phases to try to explain Francis’ idea of a church that welcomes everyone and accompanies them.

“It’s about how could we be men and women together in this society, in this church, with this vision of equality, of dignity, reciprocity, collaboration, partnership,” Becquart said in a June interview.

At previous synods, women were only allowed more marginal roles of observers or experts, literally seated in the last row of the audience hall while the bishops and cardinals took the front rows and voted. This time around, all participants will be seated together at hierarchically neutral round tables to facilitate discussion.

Outside the synod hall, groups advocating for even more women’s representation in the church are hosting a series of events, prayer vigils and marches to have their voices heard.

Discerning Deacons, a group pressing for the pope to approve female deacons, as there were in the early church, sent a small delegation and the issue of female deacons is formally on the synod agenda. Other groups pressing for women’s ordination to the priesthood are also in Rome, even though the pope has taken the subject of women priests off the table.

“I’m hopeful that there is room in that space for these bold conversations, courageous conversations, and particularly that the voices and experiences of women called to the priesthood are brought to the synod,” said Kate McElwee, director of the Women’s Ordination Conference.

Zervino’s group, the World Union of Catholic Women’s Organizations, a Vatican-based umbrella organization of 100 Catholic associations, conducted a survey earlier this year of Catholics who participated in the synod consultations. While a few women in North America and Europe called for female priests, there was a broader demand for female deacons and the call is featured in the synod’s working document.

Francis listens to Zervino, an Argentine consecrated woman. He recently named her as one of three women to sit on the membership board of the Dicastery for Bishops, the first time in history that women have had a say in vetting the successors of Christ’s Apostles.

Zervino says such small steps like her nomination are crucial and offer the correct way of envisioning the changes that are under way for women in the church, especially given all the expectations that have been placed on the synod.

“For those who think that there’s going to be a ‘before the synod and after,’ I bet they’ll be disillusioned,” she says. “But if women are smart enough to realize that we’re headed in the right direction, and that these steps are fundamental for the next ones, then I bet we won’t be disillusioned.”

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Assessing The Potential of The India-Middle East-Europe Economic Corridor (IMEC) Against China’s Belt And Road Initiative (BRI)

(THE VOICE OF EU) – In a recent address, Indian Prime Minister Narendra Modi hailed the newly unveiled India-Middle East-Europe Economic Corridor (IMEC) as a transformative force poised to shape global trade for centuries. While the IMEC undoubtedly presents a significant development, it’s vital to scrutinize its potential impact compared to China’s ambitious Belt and Road Initiative (BRI).

The IMEC was jointly announced by US President Joe Biden and Saudi Crown Prince Mohammed bin Salman at the G20 summit in Delhi. Designed to fortify transportation and communication networks between Europe and Asia via rail and shipping routes, the project not only holds regional promise but also reflects a strategic move by the US in its geopolitical interests, particularly concerning China.

However, the IMEC faces a formidable contender in the form of China’s BRI, which celebrated its tenth anniversary this year.

Despite facing some headwinds, including a slowdown in lending due to China’s economic deceleration and concerns raised by nations like Italy, Sri Lanka, and Zambia regarding debt sustainability, the BRI remains a monumental global undertaking.

With investments surpassing a staggering $1 trillion and over 150 partner countries, the BRI has transformed from a regional initiative to a near-global endeavor.

Comparatively, the IMEC may not immediately match the scale or ambition of the BRI. While the US, Japan, and the G7 nations have introduced similar initiatives like the Global Gateway and Partnership for Global Infrastructure and Investment, none have achieved the expansive reach or influence of the BRI.

The emergence of these projects over the past five years, however, demonstrates the BRI’s pivotal role as a catalyst for global economic growth.

Viewing the IMEC solely through the lens of opposition to the BRI may not provide a comprehensive understanding of its potential.

Instead, the IMEC contributes to a broader trend of transactional partnerships, where countries engage with multiple collaborators simultaneously, underscoring the complex and interconnected nature of global trade relations.

Yet, realizing the IMEC’s aspirations demands meticulous planning and execution. A comprehensive action plan is expected within the next 60 days, outlining key governmental agencies responsible for investments, allocated capital, and implementation timelines.

Establishing a streamlined customs and trade infrastructure is equally critical to facilitate seamless transit, a challenge highlighted by the Trans-Eurasian railway’s 30-country passage through Kazakhstan.

Navigating geopolitical complexities between partner countries, particularly the US, Israel, and Saudi Arabia, poses another potential hurdle.

Ensuring these nations maintain a unified strategic vision amid differing priorities and interests requires careful diplomatic coordination.

Furthermore, the IMEC will compete directly with the Suez Canal, a well-established and cost-effective maritime route.

While the IMEC may enhance relations with the UAE and Saudi Arabia, it could potentially strain ties with Egypt, prompting critical assessments of the project’s economic viability.

Beyond trade and economics, the IMEC ambitiously aims to incorporate diverse sectors, from electricity grids to cybersecurity.

This multi-dimensional approach aligns with discussions held in security forums like the Quad and, if realized, could significantly contribute to a safer, more sustainable global landscape.

As we contemplate the potential of the IMEC, it is with hope that the lofty ambitions outlined in New Delhi will culminate in a tangible and positive transformation for the world.

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Global Affairs

Safe Mobility Initiative Faces Challenges In Delivering On Its Promises For Latin American Migrants

In June, the United States introduced the Movibilidad Segura, or Safe Mobility, program, a new immigration initiative aimed at expanding legal routes for refugees and migrants from South and Central America.

The program’s objective is to reduce irregular migration and strengthen transportation and communication links between the Americas. While the intentions behind Safe Mobility are commendable, its execution has faced several challenges, leaving thousands of applicants in limbo.

For many hopeful migrants like Eliezer Briceño, a 40-year-old Venezuelan residing in Ciudad Bolívar, Colombia, the application process has proven to be a complex and tedious endeavor.

Briceño’s experience highlights the technological barriers that applicants face, emphasizing the need for reliable internet access and suitable devices for successful registration.

Unfortunately, these prerequisites pose significant challenges for those without adequate resources.

Migrantes Darién
Migrants cross a river in the Darién rainforest, October 2022.Fernando Vergara (AP)

The overwhelming response to the program has led to the temporary closure of the website in Colombia, further complicating the application process. With quotas quickly filled during the limited application periods, the backlog of hopeful migrants has grown, exacerbating the frustration and uncertainty surrounding Safe Mobility.

Of the nearly 29,000 applicants from Colombia, less than 1% have progressed through the U.S. Refugee Admissions Program (USRAP) as of August 28. This statistic underscores the significant delays and challenges faced by applicants. Eliezer Briceño, like many others, anxiously awaits news about his application status, armed only with a receipt indicating a forthcoming call.

Safe Mobility, while a response to the migration crisis in Latin America, is one of several initiatives addressing the challenges faced by millions of displaced individuals.

Its collaboration with the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees (UNHCR) demonstrates a multi-lateral effort to find solutions to the region’s complex humanitarian, political, and economic issues.

Migrantes Tapón del Darién
A group of Haitian migrant women & their children wait to board a boat from Necocli, Colombia to Capurgana & then cross the Darién Gap to Panama.

However, the program’s operational secrecy, with undisclosed office locations, underscores the challenges faced by its administrators.

The need to protect both applicants and program staff from potential overcrowding and disruptions mirrors the situation in Tapachula, Mexico, where large groups of migrants have sought assistance, albeit without violent incidents.

The interview process for Safe Mobility applicants introduces another layer of complexity, marked by confidentiality agreements.

While applicants are required to sign agreements consenting to share personal data with program partners, the imposition of non-disclosure clauses appears unusual and unprecedented.

The UNHCR argues that confidentiality is crucial for the protection of individuals in need of international refuge.

The uncertainty persists even after interviews, as those rejected receive prompt notifications while others remain in a state of perpetual waiting. The apparent randomness of selections and the lack of clear communication only heighten the frustrations of applicants.

As Safe Mobility nears the midpoint of its announced six-month pilot period, questions about its effectiveness and future persist.

While the initiative addresses a critical need, its slow start and operational challenges highlight the complexity of addressing the migration crisis in the Americas.

Cooperation from multiple nations, alongside initiatives like Safe Mobility, will be essential in finding lasting solutions to this pressing global issue.

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