It was clearly true that some of last year’s skepticism about the purported benefits of hydroxychloroquine as a treatment for covid-19 was a function of President Donald Trump’s enthusiastic promotion of it.
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By late April 2020, the federal government had authorized the drug’s disbursement under emergency use rules — an authorization that was later revoked as research showed potential cardiac risks and little benefit in combating the targeted disease. By that time, though, there was also little reason to assume that Trump was making decisions about the trajectory of the pandemic that were centered on treating the virus seriously. His brief endorsement of containment measures had been jettisoned in favor of restarting economic activity before the midterm elections. He had a demonstrated interest in portraying the pandemic as imminently resolved, an interest that included casting hydroxychloroquine as something in the vicinity of miraculous. If Americans thought there was a silver bullet that would soon be broadly available, there would be less concern about taking measures to prevent spread of the virus.
So as Trump hyped the drug, a significant portion of the response was less “Let’s wait and see” than “Why should we trust Trump on this?” The Food and Drug Administration formally warned against use of the drug the day after Trump elevated a different miracle treatment for the virus: injecting disinfectants into the body. By late summer, Google search interest in the drug (and in the related medication chloroquine) had plunged.
In the past few months, though, Americans have latched onto a new maybe-miracle drug: ivermectin. There are now as many searches for it as there were for hydroxychloroquine for most of 2020. It’s been the focus of more search attention than hydroxychloroquine consistently since the end of last year.
You’ve no doubt heard of ivermectin. It’s an anti-parasite medication that, like many drugs, has been included in efforts to combat covid-19 and the spread of the coronavirus. Unlike most drugs — but very much like hydroxychloroquine — it has been identified by a number of prominent individuals as potentially game-changing in its effects, something medical research has not yet demonstrated.
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The reason you’ve probably heard of it, though, is that it’s actually available for purchase and so people are purchasing it — often through livestock or veterinary suppliers, since it’s most commonly sold to treat infected livestock. News reports have documented medical emergencies that have resulted from ingesting the drug; some of those news reports, like one over the weekend, have been misinterpreted or overstated.
It doesn’t take much for things to become intertwined with partisanship in America these days, so this has. In recent weeks, MSNBC has talked about ivermectin far more than has Fox News, for example, presumably not from a standpoint of endorsement. That an increasing percentage of its mentions are in the context of horses — the medicine is often described pejoratively as “horse paste” — suggests that the coverage is mostly critical.
This has spurred a meta-critique of how the subject has been treated. Is the conversation about the use of ivermectin simply a function of coastal elites treating rural Americans with condescension? Were incorrect claims about the extent of negative side effects in Oklahoma and Mississippi the mainstream media looking to yuk it up at the expense of conservative Americans? Is this just another situation in which politics is coloring the response to a medical question?
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There are some substantial differences between the discussion of ivermectin and that of hydroxychloroquine. One is that there is no central Trumpian figure hyping the drug repeatedly; instead, it’s largely a function of a collective effort to encourage its use. Another difference is the one stated above. Ivermectin is broadly available, albeit in forms intended for ingestion by animals, so people are actually taking it, often prophylactically. Third and most important is that the pandemic isn’t where it was last spring. Now, there are vaccines that are demonstrated in their effectiveness at preventing infection and ameliorating the effects of covid-19 — but people are instead ingesting medicine intended for deworming horses that hasn’t been shown to be similarly effective.
This isn’t to say that there’s no overlap with politics. There is. The states with the most search interest in ivermectin are also ones that voted heavily for Trump in 2020. The six states that have searched for ivermectin the most in the past 90 days supported Trump by an average 27-point margin. The list includes Oklahoma and Wyoming, states where one might assume that there would be searches for ivermectin because of its intended use for farm animals. But, while the other states in the list do have large rural populations, it excludes rural states with smaller recent increases in coronavirus cases. As a rough measure of the natural demand for ivermectin, we’ve indicated the number of actual horses in each state on the graphs below; there’s no connection to ivermectin search interest.
In each of the states where ivermectin searches are the most common, there are still far more searches for vaccines. But the ratio of one to the other is lopsided: In the six states where the number of searches for ivermectin is the highest, there are about six searches for coronavirus vaccine information for every search about ivermectin. In California, the state with the second-most horses in the country, the ratio is 13 to 1.
Since vaccination rates correlate to the 2020 vote — bigger Trump margin, lower rates — it’s also the case that the places where ivermectin information is in higher demand are places where vaccine is in lower demand.
You’ve probably noticed that the six states with the most searches include Oklahoma and Mississippi, where news reports overstated the number of people who had become sick from ingesting the drug. In other words, despite those reports, there’s a clear indication (beyond anecdotal descriptions of stores running out of stock) that residents of those states are looking into ivermectin. It’s also true that Oregon, a Democratic-voting state hit hard by the delta variant, particularly in its more conservative counties, is in the top seven.
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Last year, the overlap between hydroxychloroquine and politics was centered on Trump. Now, the overlap appears to be more on vaccine hesitancy. The idea that institutional recommendations about the pandemic can’t be trusted is itself downstream from Trump’s rhetoric, of course, but criticism of ivermectin use is usually less directly about rejecting a political approach. Instead, it’s immediately about people making the conscious choice to reject an authorized and proven vaccine in favor of buying a livestock-dewormer at a feed store that can cause serious or deadly side effects. Plus, we’ve been here before. There’s a reason that people aren’t searching for hydroxychloroquine much anymore, and it’s not that it’s been shown to be super effective.
Media criticism of its use has spurred an enemy-of-my-enemy response, with critics of the media — including many on the right — lining up to defend the right of Americans to ingest the medication. Consider, for example, this tweet from Rep. Thomas Massie (R-Ky.). The governor of his state said Sunday that the pandemic situation there was “dire,” yet Massie decided to rise to the defense of the livestock medication.
It’s true that the researchers who discovered ivermectin were awarded the 2015 Nobel Prize for medicine, though, of course, that award was focused on its treatment of parasites. It’s also useful to note that those researchers shared the prize with another researcher who had discovered an effective way to combat malaria, given the decline in effectiveness of the existing treatment for the disease.
That waning treatment was hydroxychloroquine. But the 2015 winner may itself soon be surpassed, given another treatment for malaria that appears to be on the horizon: mRNA vaccines such as those proved to be effective against the coronavirus.