While debate rages in France over Professor Didier Raoult's
recommendation 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.
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| The general hospital of Yaoundé, one of the centres of the fight against Covid-19 in Cameroon |
Such is the case in Cameroon, which has
embraced the French professor's method of treatment.
Despite having authorised treatment in a very
restricted manner for serious cases, France has shown scepticism regarding 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
suffering from Covid-19.
On
April 22, France's Health Minister Olivier Véran said the most recent
publications from clinical studies were not in favour of the dual therapy. Six
days later, during a speech on France’s strategy for lifting its Covid-19
lockdown, Prime Minister Édouard Philippe clearly reaffirmed the government's
position: “To date, no treatment has proven effective.”
The
debate surrounding the protocol of Dr Didier Raoult, the director of the
University Hospital Institute (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 accustomed to anti-malarial
drugs, have decided in favour of the reseacher and professor. This is notably
the case in Cameroon,
which has adopted Raoult's dual therapy.
Although
the country increased its knowledge of epidemics following the appearance of
Ebola in the region, its medical capacities remain limited and a European-style
scenario, with a multiplication of serious Covid-19 cases, could lead to a
catastrophe. In mid-March, as the epidemic began to spread across Cameroon and
European countries, already hard hit, launched lockdown plans, the first video
of Raoult 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 major difficulties in
accessing healthcare, the prospect of a treatment based on accessible,
inexpensive and familiar drugs appeared to be a blessing.
On
March 27, in a memorandum from Cameroon’s Ministry of Health, the country’s
scientific council proposed the widespread use of chloroquine treatment. Judged
“promising”, the treatment could make it possible to reduce viral load and
contagiousness, even if the group of scientists acknowledged 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
positive Covid-19 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 instructions quickly
to organise the response,” explained Dr Alain Etoundi, director of the fight
against disease, epidemics and pandemics at Cameroon’s Ministry of Health, to
FRANCE 24.
“The
question of the supposed toxicity of chloroquine has been addressed and dismissed
by the council. So far, the results that are coming to us seem satisfactory,
but the evaluation of the treatment is ongoing,” he said.
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 responded with amusement: “Everyone knows Professor Raoult
in Cameroon! Some even consider him like 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’s
been almost two months that this protocol has been in use 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
progress of the virus seems, as in many African countries, to be much slower
than indicated by scientific modelling.
Nevertheless,
Etoundi asserted that treatment is only one element of a global health policy
and it is far too early to claim victory: “We are in a phase where the disease
is on the rise and the peak has not yet been reached. Anything is still
possible.”
Beyond a
public health resolution, the choice of dual therapy represents a logistical
challenge in Cameroon. For while 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 totally exhausted, we had to place large orders abroad and restart
national industrial production," explained Etoundi.
In
Cameroon, public hospitals have been selected to centralise Covid-19 patients.
In theory, stocks of chloroquine and azithromycin are sufficient there,
although a source within 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
stocks of chloroquine from us, some aggressively. Others came to try to sell us
some,” a pharmacist in a working-class neighbourhood in Douala told FRANCE 24.
“Here,
demand for the Covid treatment is exploding, we quadrupled our sales of
azithromycin between March and April. Since we don't have chloroquine,
customers have switched to similar antimalarial drugs like Artequin, which is
already out of stock at wholesalers,” she said.
The black
market for drugs, already flourishing in normal times in Cameroon, is on the
rise with the Covid-19 crisis. The authorities have already issued several
alerts about the circulation of fake chloroquine within the health network.
Finally,
another subject that worries the government is the disappearance of
hydroxychloroquine, the chloroquine derivative, also recommended by
Professor Raoult. It was previously sold over the counter in pharmacies and was
very little used, because it was reserved for the treatment of specific
diseases such as rheumatoid arthritis and lupus. “The shelves have been robbed
very quickly, yet patients depend on these drugs. They now find themselves
destitute and we must find solutions to protect them,” Etoundi said.
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