While the debate is raging in France on the recommendation of Professor Didier Raoult of a mixture of chloroquine (an antimalarial) and azithromycin (an antibiotic) to treat patients with Covid-19, some African countries have taken it very seriously. This is the case in Cameroon, which has adopted the French teacher’s treatment method.
Although having authorized treatment in a very limited manner for severe cases, France has shown skepticism with regard to a dual therapy combining chloroquine (an antimalarial), or its derivative hydroxychloroquine, and azithromycin ( an antibiotic used for lung and ENT infections and angina) to treat patients with Covid-19. On April 22, French Minister of Health Olivier Véran declared that the most recent publications of clinical studies were not in favor of dual therapy. Six days later, during a speech on France’s strategy to lift its Covid-19 lock, Prime Minister Édouard Philippe clearly reaffirmed the government’s position: “To date, no treatment has proven effective “.
The debate around the protocol of Dr Didier Raoult, director of the Institut Hospitalier Universitaire (IHU) Méditerranée Infection in the southern city of Marseille, continues to divide the country’s medical community. But while some French professionals consider the treatment too toxic and doubt its effectiveness, many African countries, already used to antimalarials, have declared themselves in favor of the researcher and professor. This is particularly the case in Cameroon, which has adopted Raoult’s dual therapy.
Although the country has increased its knowledge of epidemics following the appearance of Ebola in the region, its medical capacities remain limited and a European-type scenario, with an increase in serious cases of Covid-19, could lead to a disaster . In mid-March, as the epidemic began to spread across Cameroon and European countries, already hard hit, launched lockdown plans, Raoult’s first video selling the effectiveness of his protocol was widely shared on Cameroonian social networks, raising great hopes. In a country where part of the population still has great difficulty accessing health care, the prospect of treatment with accessible, inexpensive and familiar medicines seems to be a blessing.
On March 27, in a memorandum from the Cameroonian Ministry of Health, the country’s scientific council proposed widespread use of the chloroquine treatment. Deemed “promising”, the treatment could reduce viral load and contagiousness, even if the group of scientists recognized a “lack of conclusive data”. Finally, the council wished to combine the treatment, as recommended by Raoult, with azithromycin to avoid the risks of secondary infections. On April 9, the protocol was validated for the management of all types of patients with Covid-19 positive tests, from asymptomatic cases to patients suffering from severe infections.
“With the arrival of the first cases, the clinicians were tempted to try the protocols themselves, and it was necessary to give clear and rapid instructions to organize the response,” explained Dr Alain Etoundi, director of the fight against diseases, epidemics and pandemics at the Ministry of Health of Cameroon, at FRANCE 24.
“The issue of the alleged toxicity of chloroquine was addressed and rejected by the board. So far, the results that have come down to us seem satisfactory, but the evaluation of the treatment is under way, ”he said.
A “national hero”
Professor William Ngatchou is a cardiovascular surgeon at the general hospital in Douala, the economic capital of Cameroon. When FRANCE 24 asked him if he had heard of Professor Raoult, he replied with amusement: “Everyone knows Professor Raoult in Cameroon! Some even consider him a national hero. “Like many health professionals in the country, Ngatchou thinks that the effectiveness of dual therapy combining an antimalarial and an antibiotic has been proven:” It has been almost two months since this protocol is used for patients with Covid-19 . I myself have noticed significant improvements in patients with its use, and the debate about the side effects of chloroquine seems very exaggerated to me. “
Seven weeks after the detection of the first Covid-19 case on Cameroonian soil, there are more than 2,050 confirmed cases in the country. The progression of the virus seems, as in many African countries, to be much slower than indicated by scientific modeling. Nevertheless, Etoundi said that treatment is only one element of a global health policy and that it is far too early to claim victory: “We are in a phase where the disease is on the increase and the peak has not yet been reached. Everything is still possible. “
Supply problems and black market explosion
Beyond a public health resolution, the choice of dual therapy represents a logistical challenge in Cameroon. Because if chloroquine was massively used in the country at one time, it has been several decades since it lost its effectiveness in the fight against malaria and was replaced by other more effective drugs. “Stocks were completely exhausted, we had to place large orders abroad and revive national industrial production,” said Etoundi.
In Cameroon, public hospitals have been selected to centralize Covid-19 patients. In theory, the stocks of chloroquine and azithromycin are sufficient there, although a source within the medical services, contacted by FRANCE 24, reported occasional shortages. But the situation is more complex in the pharmaceutical sector. Private pharmacies, very important in Cameroon, sometimes play the role of doctor, and they are not authorized to sell chloroquine.
“As soon as we started talking about the disease in March, a lot of people wanted to buy chloroquine from us, some aggressively. Others came to try to sell us “, explained to FRANCE 24 a pharmacist in a popular district of Douala.” Here, the demand for Covid treatment explodes, we quadrupled our sales of azithromycin between March and April . Since we don’t have chloroquine, customers switched to similar antimalarials like Artequin, which is already out of stock at wholesalers, “she said.
The black drug market, already flourishing in normal times in Cameroon, is booming with the Covid-19 crisis. The authorities have already issued several alerts concerning the circulation of false chloroquine within the health network.
Finally, another subject which worries the government is the disappearance of hydroxychloroquine, the derivative of chloroquine, also recommended by Professor Raoult. It was previously sold over the counter in pharmacies and was used very little because it was used only to treat specific illnesses such as rheumatoid arthritis and lupus. “The shelves were stolen very quickly, but the patients are dependent on these drugs. They are now destitute and we must find solutions to protect them, ”said Etoundi.
This article is a translation of the original in French.