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Vaccines and Drugs

Bacillus Calmette-Guerin (BCG) vaccination and ivermectin treatment for parasitic infections have been proposed as possible explanations for the low COVID-19 burden in Africa. BCG is known to have nonspecific benefits against other infections,31 and it may have protected Africa from COVID-19 in the same way. In an analysis of COVID-19 cases, Sharma et al32 noted that the incidence and mortality of COVID-19 were lower in countries where BCG is commonly given. However, in this study countries were not matched based on other contributing variables such as median age. Moreover, a randomized clinical trial of revaccination of BCG among health workers in South Africa showed no protective benefits of BCG against COVID-19.33 Other BCG clinical trial results are pending and may help us understand the effect of BCG in the COVID-19 pandemic.34

Ivermectin is an antiparasitic drug commonly given as a prophylaxis for parasitic infections. In an ecological study, Guerrero et al35 found lower mortality and infection rate of COVID-19 among African countries that use ivermectin as prophylaxis for parasitic infections. However, there was no control of confounding factors between these countries and it is not confirmed if the countries have given ivermectin in the immediate weeks before the pandemic. Although ivermectin has shown in vitro activity against SARS-CoV-2, the calculated effective human dose is much higher than the dose commonly given for parasitic infections.36,37 The World Health Organization and the Food and Drug Administration have only recommended the use of ivermectin only in clinical trials because there is no evidence of efficacy.38,39 This negates the role of ivermectin in reducing the COVID-19 burden in African countries

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