Covid-19: In Cameroon, a chloroquine therapy hailed by French expert becomes state protocol

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.”

#Chloroquine : « Les dernières publications ne sont pas en faveur de ce traitement » affirme @olivierveran https://t.co/i8Hpc3RRvl

— Public Sénat (@publicsenat) April 22, 2020

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.

A chloroquine treatment

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.

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 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.”

Supply problems and a black market explosion

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.
 

This article is a translation of the original in French.