article · American Journal of Tropical Medicine and Hygiene
As COVID-19 spread across Africa, early clinical trials investigated repurposed therapies, yet clinically proven pharmacological treatments remained absent. Chloroquine, a long-established malaria treatment, and hydroxychloroquine, primarily used for autoimmune conditions, gained massive global attention despite lacking randomised clinical trial evidence for COVID-19 efficacy and safety. Uncontrolled promotion led to severe supply shortages, inflated prices, dangerous self-medication, and fatal overdoses. These disruptions heightened Africa's vulnerability to substandard and falsified medicines within already constrained healthcare systems. To mitigate these risks, African nations require a coordinated cross-continental network to manage the production, low-cost distribution, and post-marketing surveillance of any future approved therapies, potentially linking with existing global aid initiatives. Concurrently, implementing rigorous prescription monitoring schemes is critical to ensure that any off-label use remains appropriate and safe.
Premature adoption of unproven medicines during public health crises carries severe risks, including fatal poisonings and acute shortages of essential drugs for existing diseases. Understanding these systemic vulnerabilities helps health authorities protect patients from ineffective treatments and counterfeit drugs while safeguarding the supply chains of life-saving therapies.
The abstract points to system-level interventions rather than a specific commercial product. It identifies opportunities for public health authorities, pharmaceutical distributors, and monitoring agencies to establish cross-continental manufacturing networks, low-cost distribution channels, and prescription tracking schemes. These concepts remain at the conceptual and policy stage, requiring coordinated institutional backing and integration with existing global aid programmes rather than representing near-market commercial assets.
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The novel severe acute respiratory syndrome-coronavirus-2 pandemic has spread to Africa, where nearly all countries have reported laboratory-confirmed cases of novel coronavirus disease (COVID-19). Although there are ongoing clinical trials of repurposed and investigational antiviral and immune-based therapies, there are as yet no scientifically proven, clinically effective pharmacological treatments for COVID-19. Among the repurposed drugs, the commonly used antimalarials chloroquine (CQ) and hydroxychloroquine (HCQ) have become the focus of global scientific, media, and political attention despite a lack of randomized clinical trials supporting their efficacy. Chloroquine has been used worldwide for about 75 years and is listed by the WHO as an essential medicine to treat malaria. Hydroxychloroquine is mainly used as a therapy for autoimmune diseases. However, the efficacy and safety of CQ/HCQ for the treatment of COVID-19 remains to be defined. Indiscriminate promotion and widespread use of CQ/HCQ have led to extensive shortages, self-treatment, and fatal overdoses. Shortages and increased market prices leave all countries vulnerable to substandard and falsified medical products, and safety issues are especially concerning for Africa because of its healthcare system limitations. Much needed in Africa is a cross-continental collaborative network for coordinated production, distribution, and post-marketing surveillance aligned to low-cost distribution of any approved COVID-19 drug; this would ideally be piggybacked on existing global aid efforts. Meanwhile, African countries should strongly consider implementing prescription monitoring schemes to ensure that any off-label CQ/HCQ use is appropriate and beneficial during this pandemic.
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DOI: 10.4269/ajtmh.20-0290
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