Chloroquine and hydroxychloroquine for the prevention or treatment of COVID-19 in Africa: Caution for inappropriate off-label use in healthcare settings

The efficacy and safety of chloroquine and hydroxychloroquine for the treatment of COVID-19 remains to be defined. However, the promotion and widespread use of CQ/HCQ have led to extensive shortages, self-treatment, and fatal overdoses. A cross-continental collaborative network is need in Africa for coordinated production, distribution, and post-marketing surveillance aligned to low-cost distribution of any approved COVID-19 drug.
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Abstract

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.

Conflict of interest statement

Disclosure: Nachega is an infectious disease internist and epidemiologist supported by U.S. National Institutes of Health (NIH)/National Institutes of Allergy and Infectious Diseases (NIAID) grant number 5U01AI069521 (Stellenbosch University Clinical Trial Unit (CTU) of AIDS Clinical Trial Group [ACTG]) as well as NIH/Fogarty International Center (FIC) grant numbers 1R25TW011217-01 (African Association for Health Professions Education and Research) and 1D43TW010937-01A1 (the University of Pittsburgh HIV-Comorbidities Research Training Program in South Africa). He serves on the scientific program committee of the American Society of Tropical Medicine and Hygiene (ASTMH) and is a senior fellow alumni of the European Developing Countries Clinical Trial Partnership (EDCTP). Muyembe-Tamfum has been on the front lines of Ebola research since 1970s, identifying nosocomial and burial transmission as two of the major causes of disease transmission, contributing to vaccine research, developing antisera therapy, and training a new generation of disease responders and Congolese laboratory. He is now leading the COVID-19 Task Force Response in the Democratic Republic of the Congo. Sir Zumla is a co-PI of the Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET—https://www.pandora-id.net/) funded by the EDCTP, the EU Horizon 2020 Framework Program for Research and Innovation. Sir Zumla is in receipt of a National Institutes of Health Research senior investigator award. Seydi is an infectious diseases and tropical medicine expert and member of the COVID-19 Task Force Response in Senegal. Suleman is a Public Health Pharmacist supported by a NIH/Fogarty International Center (FIC) grant number 1R25TW011217-01 (African Association for Health Professions Education and Research). Dr. Sam-Agudu is a Pediatric Infectious Diseases clinician-scientist supported by the NIH/National Institute of Child Health and Human Development (NICHD) grant R01HD089866, and by an NIH/FIC award under the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA), for the Central and West Africa Implementation Science Alliance (CAWISA). Prisca Olabisi Adejumo is a professor of Medical Surgical Nursing, a nurse educator supported by NIH/Fogarty International Center (FIC) grant number 1R25TW011217-01 (African Association for Health Professions Education and Research). All authors have an interest in emerging and reemerging pathogens and declare no conflicts of interest.

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