Tag: South Africa

How Will Roe v Wade Decision Influence the World?

Photo by Andy Feliciotti on Unsplash

With the US Supreme Court’s overturning the Roe v Wade decision, abortion rights are now up to individual US states. However, while there are no legal implications for the rest of the world, it will undoubtedly have a huge influence on other countries’ abortion campaigning and lawmaking decisions. Future anti-abortion efforts in the US may also impact the country’s funding of reproductive services in regions such as Africa.

Without access to legal, safe abortion, many pregnant people will turn to unsafe methods. According to the World Health Organization, 97% of all unsafe abortions happen in developing countries. Some 4.7–13.2% of maternal deaths are attributable to unsafe abortion.

Although Roe v Wade does not have a legal effect in Africa, it was frequently invoked in abortion. Tunisia liberalised its abortion law just nine months after the Roe v Wade ruling – allowing women to access the service on demand. Additionally, in 1986, Cape Verde allowed for abortion on request prior to 12 weeks gestation which aligns with Roe v Wade holding of the same.

In South Africa, the right to abortion is not directly enshrined in the Constitution, but the 1996 Choice in Termination of Pregnancy Act greatly widened accessibility to safe, legal abortions, causing a 90% drop in abortion mortality from 1994 to 2001. The previous apartheid-era laws and their enforcement were predictably stained by racism: abortion was limited to encourage white population growth while contraceptives were promoted to control the population growth of black and coloured people. Wealthy whites could fly to England for an abortion there if they could not arrange one. The 1996 Act was met with significant opposition on religious grounds, and it is speculated that had the ANC done this with an open vote, it would not have passed with such a wide margin.

Even today, research shows that abortion remains highly stigmatised among South Africans, with 75.4% of people surveyed indicating that it was “always wrong” in case of family poverty, and 52.5% indicating the same for either foetal abnormality or family poverty. Provincial splits are apparent, with Gauteng and Limpopo having a > 1 odds ratio of being against abortion.

The 2003 Maputo Protocol adopted by the African Union requires countries to authorise medical abortions in cases of sexual assault, rape, incest, or where the health of the mother is endangered. This specific provision draws from the 1979 United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), whose clause on access to safe abortion was based on on Roe v Wade. However, 12 AU members have not ratified the protocol, and many of those who did have not fully brought their laws into line. South Africa is only one of six African nations that effectively allow elective abortions. Of these, Mozambique and Benin only fully changed their laws in 2020 and 2021.

Abortion opponents led by the Catholic Church and its affiliates enjoy widespread political and social support in many African countries. In 2020, Bhekisisa investigated African pregnancy crisis centres funded by US anti-abortion groups. These centres actively discourage abortion, exerting pressure on girls and women and are rife with misinformation, such as grossly exaggerating the size and development of the foetus in early stages of pregnancy. One NGO offered training to say that abortion would “turn” women’s partners gay if they got an abortion.

Thus, while the legal outcome of Roe v Wade being overturned will have no bearing on South Africa, it will conceivably embolden anti-abortion groups both domestically and abroad and likely to increase the influence they already exert in the country.

First Confirmed Monkeypox Case in SA

Source: Wikimedia CC0

South Africa has recorded its first case of monkeypox Thursday, 23 June. Health Minister Dr Joe Phaahla said that he received a report from the National Health Laboratory Services’ CEO that lab tests have confirmed the first case of monkeypox in South Africa, a 30-year-old man from Johannesburg.

The South African Health Products Regulatory Authority (SAHPRA) has prepared information on monkeypox symptoms and treatment. However, the pharmaceutical treatments for it (tecovirimat and brincidofovir) are not registered in South Africa.

Symptoms and epidemiology

The monkeypox virus causes symptoms similar to smallpox, but less severe. Symptoms include:

  • Skin rash
  • Headache
  • Swollen lymph nodes
  • Muscle and body pains
  • Back pain
  • Weakness

The monkeypox virus is endemic to Central and West Africa in two distinct clades with differing severities: the West Africa (< 1% case fatality rate) and the Congo Basin (11% case fatality rate). Human-to-human transmission can occur via contact with bodily fluids, skin lesions or internal mucosal surfaces such as the mouth or throat, respiratory droplets, and contaminated objects.

The polymerase chain reaction (PCR) test is the best, most reliable testing method, and the best specimens are sourced from rash, fluids or crusts. Antigen and antibody detection are not accurate.

Since 15 June 2022, 2 103 laboratory confirmed cases of monkeypox, one probable case, and one death have been reported to the World Health Organisation (WHO) from 42 countries.  Endemic countries include Benin, Cameroon, Central African Republic, DRC, Gabon, Ghana, Ivory Coast, Liberia, Nigeria, Sierra Leone and South Sudan. To date all cases have been identified as being infected by the West African Clade.

Cases have been identified in South Africa, Australia, Belgium, Canada, France, Germany, Italy, The Netherlands, Portugal, Spain, Sweden, UK, and the USA.

Information suggests that this is common among homosexual men and who seek treatment and care at healthcare institutions. Furthermore, those at risk are individuals who have had physical contact with someone with monkeypox.

Monkeypox management and treatment

Any patient with suspected symptoms should be investigated, and if confirmed, isolated until such time that their lesions have crusted, scabs have fallen off and a fresh layer of skin has formed.

According to the National Institute Communicable Diseases (NICD), this type of infection does not require specific treatment as the disease does resolve on its own. Currently in South Africa, there is no specific vaccine registered for monkeypox; however, the Varicella Zoster is registered for smallpox.

There are no specific treatments for the Monkeypox infection, but outbreaks can be controlled. The Food and Drug Administration (FDA) has approved tecovirimat (TPOXX) and brincidofovir (TEMBEXA) for the treatment of smallpox; however, these have not been registered in South Africa.

It is important to note that most human cases of Monkeypox resolve within 2–3 weeks of being infected without side-effects. Also, an infected person is infectious at the start of the rash/lesions through the stage when scabs form. However, when these scabs fall off, the person is no longer contagious.

Source: SAHPRA

How Effective was Masking for SA in Preventing COVID?

Image by Quicknews

COVID restrictions have finally come to an end altogether in South Africa, as Health Minister Joe Phaahla gazetted a number of changes to the rules, as reported by BusinessTech. This means the end of mask use requirements, social gatherings restrictions and COVID border testing. Prof Shabir Madhi was welcoming of the move in a recent tweet, having criticised SA’s lockdowns as overly harsh and economically damaging. Around the world, many had questioned the widespread use of masks, or their use by some subset of the population, such as children – and even questioned locally by a scientist who argued that it didn’t and wouldn’t work in a South African setting, where people are less adherent to regulations.

Professor Salim Abdool Karim likened such a viewpoint to saying Africans with HIV can’t use ARVs because they didn’t have watches to take them at the right time, reminiscent of “a colonial mentality”.

The case for public mask use is well established. Experiments had shown that even simple cloth masks were moderately effective at hindering the transmission of SARS-CoV-2–containing aerosol particle from infected individuals, though they were less effective at protecting a wearer against infection. Predictably, N95 masks and others are better at doing the job than simple cloth face coverings.

There are no real-world studies for South Africa comparing mask use vs non-mask use as mask wearing was compulsory from the early stages of the outbreak. It would have been downright unethical to ask people to not wear masks, although some people may have had exemptions due to medical conditions or other important reasons. There is a country with good COVID surveillance and a distinct division in mask wearing – the United States. Implementation of mask mandates in the US was down to local authorities, which provides a basis for comparison.

One US study, published in Health Affairs, found that, compared to nonmasking counties, masking counties saw a daily case incidence decline by 25% at four weeks, 35% at six weeks after introduction of masking mandates. The reductions were strongest in Republican-leaning counties, which is notable since Republican voters were less in favour of lockdowns and mask mandates.

Another study found a 16.9% drop in cases four weeks after counties introduced masking mandates. Real-world data also show mask use was effective in preventing infection. A case-and-control study done in California by the CDC showed a 29% drop for surgical mask/respirator use “some of the time” and a 56% drop for “all of the time”.

While a direct comparison between a wealthy country like the US and South Africa as a middle-income country is impossible, it is easy to believe that masking mandates reduced cases by a significant percentage, perhaps saving tens of thousands of lives especially against the country’s possible true COVID death toll of 300 000.

High Court Wrong about Law on Foetuses under 26 Weeks, Concourt Rules

Gavel
Photo by Bill Oxford on Unsplash

The Constitutional Court has declined to confirm the constitutional invalidity of sections of the Births and Deaths Registration Act. This comes after the Pretoria High Court found that the Act denied parents the right to bury the remains of a foetus less than 26-weeks.

The application was brought by The Voice of the Unborn Baby NPC and the Catholic Archdiocese of Durban against the ministers of Home Affairs and Health.

The applicants argued that the Act was “insensitive, hurtful and disrespectful” as it only allows for a death certificate to be issued in “stillborn” cases when the foetus is more than 26-weeks.

High Court Judge Nomonde Mngqibisa-Thusi agreed and ruled that sections of the Act are unconstitutional on the basis it “deemed a foetus less than 26-weeks to be medical waste that must be incinerated”.

However, the Constitutional Court, in a unanimous judgment, said the judge was wrong. Acting Judge Pula Tlaletsi said the applicants had submitted that the provisions of the Act had the effect that no burial order could be issued for foetuses lost through miscarriage before the 26-week mark, and that the regulations only made provision for the burial of corpses and human remains, but not foetal remains.

“While it may be true, as the applicants argued, that throughout the years the practice has been to deny parents this right in the apparent belief that this is what the law provides, matters not. The Act contains no such prohibition,” Judge Tlaletsi said.

“The relevant sections cannot be declared inconsistent with the Constitution because of such omission … the Act does not stand in the way of that burial,” he said, noting that the Act only regulated the burial of “dead human bodies or still-born children”.

The Judge said that the court was not in a position to grant the relief.

Read the judgment here

The question as to what medical staff at public hospitals must do if parents expressed the wish to bury or cremate pre-viable foetal remains was not clear, he said.

“Such a burial or cremation would no doubt require the cooperation of healthcare professionals and public hospitals would be expected to allocate the necessary resources.

“Because of the way the case was pleaded, we do not have the necessary evidence to evaluate considerations relating to how hospitals would manage this … There may be other restrictions, for example, limitations imposed by municipal regulations (regarding cemeteries and crematoriums).”

The Catholic Church, arguing that its members held “sincere religious beliefs” that they become parents from the moment of conception, said the burial right should also extend to lost pregnancies “due to human intervention”, including termination of pregnancies.

But two amici in the case — the Women’s Legal Centre Trust and the Sexual and Reproductive Justice Coalition — said this would have a profound impact on the termination of pregnancy services offered to women, and the attached confidentiality.

This burden, they said, would lead to a decrease in facilities offering termination and a diminution of sexual and reproductive rights.

However, the apex court did not comment on this.

By Tania Broughton

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Will NHI Mean the End of Medical Aid in South Africa?

Once again, concerns are being raised over the implementation of the proposed National Health Insurance (NHI) scheme. This time, it is over the future of private healthcare and medical aid under the contentious Section 33 of the Bill.

Many previous discussions have focused on the NHI’s affordability, accountability, the potential mass flight of healthcare professionals from the country, and even whether NHI is even possible to achieve given South Africa’s challenges.

In a new healthcare stakeholder opinion report [PDF] published by Section 27 and the Concentric Alliance on Monday, 20 June, it is noted that private healthcare is a major contributor to the economy. May public and private sector respondents believe it could play a significant role in achieving health reform thanks to its resources and capacity.

However, Section 33 of the NHI Bill states that medical schemes may only provide “cover that constitutes complementary or top-up cover and that does not overlap with the personal health care service benefits purchased by the National Health Insurance Fund on behalf of users”.

This basically means medical schemes which are not gap cover will no longer operate – something which does not sit well with the private sector respondents in the report, who argue that even in countries with the best developed public health systems, private healthcare funders still exist.

A carrot vs stick approach

An academic respondent suggested incentivising people into switching to a public healthcare funder, rather than removing private healthcare funding. A private sector respondent also suggested the idea of competition with private funders as a means to improve the NHI’s efficiency. Indeed, it may even be necessary the NHI to function well.

The report makes note of Section 33 of the NHI Bill becoming “something of a hill to die on”. The report says that “During the six-a-side engagements between Business Unity and the National Department of Health, urgent discussions on NHI were nearly derailed by demands that Section 33 be re-opened for discussion and one respondent in the NDOH stating that the Bill was now before parliament. This respondent stated that they would rather see this point litigated, than back down. The current approach to this draft provision has the potential to undermine the implementation of the NHI and delay urgent reform to the health system.”

Child Welfare NGO One of Many Defunded by Government

Photo by Chayene Rafaela on Unsplash

Christelike Maatskappy Raad Noord (CMRN), an NGO in Gauteng which focuses on children’s welfare through the use of social workers, has been defunded by the government. This amounts to just over half of its funding, according to marketing manager Anya le Cornu. Other NGOs have also had their funding cut, she said, as heard via the Auditor General’s office.

This comes in the wake of the COVID pandemic as CMNR had to cope with continuing to deliver services amidst lockdowns. If other NGOs are similarly impacted, . Founded in 1936, CMRN aims to eradicate child abuse and neglect, providing a wide range of child protection service from its 16 centres.

The NGO assists a large number of families of children: 6000 beneficiaries received material or skill support in 2020–2021, its Child Protection Awareness campaign reached 14 500 people, 622 children were protected through the legal system, and 900 children received speech or play therapy.

However, these services are obviously under threat from the significant loss of provincial government funding, which at R7 million, accounted for 53% of its income.

In order to cope, CMNR has been forced to restructure, reducing costs wherever possible. Unfortunately, it has having to slash its social workers from 28 to 17 as of 1 July.

Due to the lack of subsidy and other challenges, areas such as statutory work may be impacted.

According to le Cornu, CMRN will try and secure funding through every means possible. “We will maintain and strengthen our relationship with the NG church, our other funding partner,” she says. “We will also continue with our marketing and fundraising initiatives. Professional fees will also be applied where possible. We will also reach out to schools and other institutions where part time social work services are needed and contract these services out to generate an income stream.”

The organisation remains hopeful despite these challenges. “We do wish to have a good relationship with the Department of Social Development and would apply for government funding in specific programs where the objectives of these programs are aligned to our own and the communities we serve,” says le Cornu.

“The CMR North believes that we will survive this crisis and hope to be a beacon of light for other NGOs who might suffer the same fate. It is our passion to continue bringing hope to the vulnerable and we see these events as an opportunity to re-invent our services so that they can have a broader and positive impact in the communities we serve.”

Hopefully, additional funding can be found so that CMRN can continue to provide its services, but if this is part of a wider pattern, people in South Africa who are most in need and depend on these services will suffer the most.

Another Fire Breaks Out at Steve Biko Academic Hospital

Source: Pixabay CC0

On Sunday evening, another fire broke out at Steve Biko Academic Hospital – the second in two weeks. The fire damaged linen and prompted an evacuation but fortunately, there were no injuries resulting from the incident, Times Live reported.

Gauteng health department spokesperson Kwara Kekana said the cause of the latest fire was due to till-burning cigarette butts discarded by patients which “touched the ward linen room lights, burning the steel shelves and linen.”

Kekana said the damage was limited to a few items of linin. The fire started at around 6.15pm in a linen closet in a medical ward.

“The fire was quickly extinguished by staff. Patients were temporarily evacuated as a safety precaution because of smoke. By 8.15pm, patients were returned to the ward after the City of Tshwane declared the site safe,” Kekana said.

The previous fire at the hospital broke out at around 1:20am in a temporary storage area for COVID medical waste and as an in-transit corpse area. That fire affected temporary structures outside the hospital casualty area, and forced the evacuation of 18 patients.

This is the latest in a string of fires in Gauteng hospitals, such as the devastating fire at Charlotte Maxeke hospital – something which has caused concern for Gauteng Health MEC Nomathemba Mokgethi.

Speaking about the previous fire, she said that, “It looks like every year in the Department of Health we have to deal with fires. I will be getting a report the afternoon from the law enforcement agency, especially on the Charlotte issue.”

The problem of hospital fires is not confined to Gauteng: exactly a week earlier, a blaze broke out at Chatsmed Hospital in Durban.

Source: Times Live

Whistle-blowing Paediatrician at Rahima Moosa Suspended

Photo by Christian Bowen on Unsplash

The whistle-blowing paediatrician Dr Tim de Maayer who spoke out about appalling conditions at Rahima Moosa Mother and Child Hospital (RMMCH) was suspended yesterday, apparently in a retaliatory move.

In the widely-read open letter appearing on the Daily Maverick, he spoke of the preventable tragedy of babies dying due to lack of resources. This came shortly after a viral video showed pregnant mothers sleeping on the floor.

Presciently, the Daily Maverick, which broke the story, stated that there were two options: act to change the situation for the better, or “shoot the messenger”. As the newspaper wryly noted as it broke the news on Friday, 10 June, the option of shooting the messenger has been taken.

Although there appeared to be an initial positive response, Dr Maayer gave notice on Thursday evening that he was not able to come into work on Friday as he was being placed on suspension. RMMCH doctors then contacted the Daily Maverick.

His suspension leaves the hospital without its only paediatric gastroenterologist, according to an anxious doctor who got in touch with the Daily Maverick late Thursday night. The news has spread like wildfire across social media, with other doctors quick to come to Dr de Maayer’s defence.

A petition on Change.org to reinstate the paediatrician is being circulated by ordinary citizens and clinicians including Professor Shabir Madhi, who has been vocal in his support of Dr de Maayer.

Guy Richards, critical-care professor at Wits University tweeted that it was a “shocking response”.

The Progressive Health Forum (PHF) called for the suspension of Dr de Maayer to be overturned.

“Dr de Maayer has been suspended on the grounds that he has a voice, a conscience and a professional ethic and being a committed public health clinician. This pattern of victimisation has been repeatedly applied to clinicians who dare call out inadequacies of the administration and negative impact on clinicians and on the lives of patients,” the PHF said in a statement.

Source: Daily Maverick

SA’s Dwindling Nursing Skills Threaten Primary Healthcare and NHI

Photo by Hush Naidoo on Unsplash

The delivery of the primary healthcare approach and the achievement of any semblance of universal health coverage are moot if South Africa does not rapidly address the critical skills shortages and working conditions of nurses, especially those with specialised skills, including midwives.     

“The pandemic very clearly highlighted the crucial role that nurses play in the frontline of healthcare, and how important they are in ensuring that patients have access to quality health services and disease prevention, management and education. However, a combination of factors is stymieing attempts to grow our nursing capabilities and skills – from changes in the nurse training curriculum, limitations of and delays in the accreditation of training facilities, poor working conditions and workplace safety, lack of equipment and resources, low remuneration by global standards, the regulatory uncertainty around NHI, changing social dynamics which has seen declining nursing recruits, as well as the significant mental health deterioration that nurses have battled for two years of being on the frontline of the pandemic. Add to this the fact that we have a significant number of experienced nurses heading for retirement age without the commensurate follow through of new nursing talent coming through, and we have the makings of a serious crisis,” warns Paul Cox, Managing Director at the Essential Group of Companies including health insurance provider, EssentialMED.     

“Making matters worse, South Africa’s nurses are in huge demand in many first world countries that suffer the same skills shortages. These countries offer significantly higher pay and better working and living conditions to attract talent to their shores. This is a significant risk as South Africa is losing some of its most experienced nurses and healthcare workers to emigration, and with it we lose vast amounts of institutional knowledge, specialisation, experience, training investment and mentoring and training skills,” he adds.

Data published by the South African Nursing Council (SANC) in 2021 shows that the country has a nursing staff contingent of one nurse to 213 patients – the World Health Organisation recommends a ratio of 1 nurse to 5 patients in a general hospital. While there are currently around 280,000 nurses in active employment and a further 21 000 nurses in training, the 2030 Human Resources for Health Strategy projects a shortage of 34 000 nurses in primary healthcare by 2025 if nothing is done to attract new talent to the nursing sector. According to SANC’s 2020 statistics, the ageing population of South Africa’s nursing population is another looming crisis.  Its statistics show that less than a third of the registered nurses and midwives are under the age of 40, while 47% of registered nurses will have retired within the next 15 years. Primary healthcare will take a big hit given the important role of nurses in primary healthcare delivery, and TB, HIV and diabetes management programmes are likely to falter, with patients in remote and rural areas impacted the most. 

Perplexingly,  despite these serious skills shortages and looming crisis, nurses never made it onto the Critical Skills List released by the Department of Home Affairs at the end of February 2022, despite the huge demands that Government’s drive to NHI will make on already stretched and overburdened healthcare human resources.

“The implications of the current skills shortages and deteriorating working and safety conditions, notably in the public sector which takes care of more than 80% of the population, are plain to see.  We already have a situation where healthcare facilities are struggling to fill posts – there are some 21,000 specialist medical personnel posts vacant across all provinces and which the Department of Health has thus far been unable to fill. What more then will the implications be for healthcare delivery under the proposed universal healthcare system of NHI?  The Department of Health has acknowledged that the NHI will need skilled personnel to function not only across healthcare professionals, but general skilled human resources to underpin the health system. Right now, even the most fundamental of primary care delivery is in crisis due to skills shortages, exacerbated by the deleterious state of many public healthcare facilities and regular medicine stock-outs. More skilled and experienced nursing professionals are heading offshore, and at the same time, the sector is struggling to attract and train new nursing recruits to a profession and working environment that are increasingly unattractive to young South Africans.  The planned introduction of the National Health Insurance scheme adds further grist to the wheel, with industry experts warning of a mass exodus of healthcare skills due to the valid concerns around the lack of financial and operational clarity of the plan,” adds Cox.

The current and future dwindling nurse staffing levels are a serious threat to patient health, safety and quality of care.  Equally so to the health and safety of nurses due to increasing pressure on the remaining workforce to meet ever growing healthcare needs, fatigue and burnout, mental health issues and deteriorating work conditions. Poor resource allocation and poor maintenance of healthcare facilities need to be urgently addressed, and there needs to be the political will to dramatically improve the working conditions of the nurses who form the backbone of healthcare delivery. It is crucial that both public and private sector stakeholders collaborate to help bridge the skills challenges.  A major acceleration of training is needed, and to do this it’s essential to fast-track the new education requirements and processes and accredit more nurse training colleges, allowing the private sector to contribute to closing the skills gap. 

“Nurses are the single largest group of healthcare providers in our country representing 56% of all healthcare providers.  The performance of our healthcare system – both public and private – is dependent on the quality of care provided by these professionals. Nurses are central to addressing the complex burden of disease, achieving the primary healthcare (PHC) approach as purported under universal health coverage, as well as improving health system performance across both the public and private healthcare sectors. The pandemic has shown unequivocally the need to value our nurses, to invest in nursing, resolve the nursing education challenges as a matter of priority, as well as address their working conditions, remuneration, practice environment, resources, management and leadership. Without a strong, skilled and growing nursing profession, any semblance of NHI and universal health coverage success in South Africa is questionable,” concludes Cox. 

End of the Road for Ivermectin as COVID Treatment in South Africa

Stop sign

South Africa’s medicines regulator has officially terminated the special dispensation to use Ivermectin as a treatment for COVID, stating that “there is currently no credible evidence to support a therapeutic role for Ivermectin” in the treatment of the disease.

On Monday 30 May, the South African Health Products Regulatory Authority (SAHPRA) officially withdrew its authorisation [PDF], bringing to end something of a saga which saw vocal proponents pitched against the scientific and regulatory establishment.

The antiparasitic Ivermectin gained considerable notoriety as the COVID pandemic went on, based on preliminary studies that seemed to demonstrate its effectiveness. Pressure born out of desperation for some kind of treatment led to SAHPRA – amidst its own apparent misgivingsgranting compassionate use authorisation under strict guidelines in January 2021. Use was allowed under Section 21 guidelines without having to wait for Section 21 authorisation, which was misinterpreted as full authorisation by some media sources.

The social media furore and misinformation surrounding Ivermectin led to dangerous instances of COVID self-treatment, with hospitalisations and even deaths reported.

In its terribly botched response to COVID, Brazil adopted Ivermectin on a mass scale, and essentially became a living laboratory for its effectiveness. Despite even administering Ivermectin as prophylaxis, Brazil’s health system was overwhelmed with COVID patients during the surge caused by the Gamma variant.

Studies turned up scant evidence in favour of Ivermectin’s effectiveness, with serious flaws and even outright data fabrication were picked up in a number of studies that seemed to show a significant benefit – even flying right through the peer review process only to be picked up at a later stage. This lead to a major meta-analysis by Hill et al. showing a effectiveness instead being retracted, which SAHPRA noted in its decision.

Finally, the I-TECH and the Together randomised clinical trials of 2021 showed no effect. Like hydroxychloroquine before it, Ivermectin prescribing was found to be driven by political interests. Thus, Ivermectin quietly disappeared from the media as viable antivirals such as Paxlovid came into the market.

The termination comes after a distinct decline in demand for Ivermectin use in South Africa, with no new applications for importation of unregistered Ivermectin products place since August 2021. SAHPRA also noted a marked decline in the number of health facilities applying for permission to hold bulk stock after August 2021.

Furthermore, no individual named patient applications have been approved since December 2021. Finally, there was little in the way of reporting of outcomes achieved by the treating healthcare providers.