CDMX government spent $29 million pesos on unauthorized COVID treatment

The Government of Mexico City spent 29 million 290 thousand pesos in the purchase of 293 thousand boxes of ivermectin, 100 thousand of acetylsalicylic acid and 93 thousand of azithromycin, medicines not recommended or approved for the treatment of Covid-19 by the federal government, but that in Mexico City were delivered to about 200 thousand people who tested positive for the virus.
Acquired between 2020 and 2021, through the Public Health Services, these drugs are not authorized by the World Health Organization (WHO), the highest health authority worldwide, and even the Clinical Guide for the Treatment of Covid-19 in Mexico – which was carried out by the federal Ministry of Health – says that ivermectin has not shown any benefit.
On December 28, 2020, and even without any study endorsed by the WHO, in Mexico City medical kits began to be delivered to people who tested positive for the virus and contained, mainly, ivermectin and acetylsalicylic acid.

Read more | Ivermectin is given in CDMX to COVID patients, despite doubts from doctors and institutions about its use
To defend the effectiveness of this measure, specifically the use of ivermectin, the Digital Agency for Public Innovation (ADIP), the local Ministry of Health (Sedesa) and the Mexican Institute of Social Security (IMSS), reported that they had carried out a “quasi-experimental” analysis that showed that those who received ivermectin were 68% less likely to develop symptoms that required hospitalization.
“Here the really important thing is to validate that the public policy that Mexico City implemented in a massive way, (…) the medical kit was an important factor in reducing hospital admissions and, of course, possible deaths; so it was important to share the analysis with them,” said the head of the ADIP, José Antonio Peña Merino, at a press conference on May 14, 2021.

That day it was also announced that the results of this analysis were contained in a paper that was published on the SocArXiv website. To date, the document has been downloaded more than 11 thousand times, however, the same site discredited it last December and defined it as a paper “of very poor quality and deliberately false and misleading”.
Politifact and Estadão Verifica, which are dedicated to detecting false information and have their headquarters in the United States and Brazil, also discredited the “quasi-experimental” analysis made by Mexico City, which they also described as “misleading.”
In total, according to information provided through a request for transparency, the capital government delivered 429,432 medical kits: 233,000 were delivered by the Secretariat of Inclusion and Welfare (SIBISO) and did not contain ivermectin, the remaining 196,432 kits were distributed by the Public Health Services of the capital and did contain this drug.
Although in theory no public institution provides these drugs to people infected with Covid-19, Animal Político confirmed that, for example, the IMSS in Mexico City still delivered kits with ivermectin in January 2022.

Avoid justifying purchases
The purchase of ivermectin, azithromycin and acetylsalicylic acid was made through three contracts formalized by the Public Health Services of the capital.
On December 23, 2020 — five days before the delivery of kits began and one day before the first Covid-19 vaccine was applied in the country — the first contract to acquire ivermectin and azithromycin was signed. Of each drug, 93,000 boxes were ordered.
According to the contract SSPCDMX-SRMAS-JUDCCM-ADQ-252-20, this purchase – which amounted to 12 million 090 thousand pesos and was delivered through a direct award by exception to the legal entity Zerifar S.A. de C.V– was carried out at the request of the Ladislao de la Pascua Dermatological Center, the Directorate of Medical Care, the Directorate of Epidemiology and Preventive Medicine.
Annex 2 of the contract explains that the boxes of ivermectin – with a unit cost of 70 pesos – had to contain 6 tablets and those of azithromycin, which had a unit cost of 60 pesos, had to be delivered in a container with 3 tablets each. Likewise, it was agreed that the requested medicines should be received no later than December 31 at the central warehouse of the Public Health Services located in the Atlampa neighborhood, Cuauhtémoc mayor’s office.
The resources for this purchase, the contract reads, were taken from the budget item “2531.- Medicines and pharmaceutical products”.
In the first part of the contract, “Background”, a series of 8 sections is provided in which the reason for this is explained in broad strokes. purchase and which are repeated in the other two contracts. They mention that the Covid-19 virus was initially located in Wuhan, China on December 31, 2019, that to contain the spread of this virus different sanitary and medical measures have been adopted, that on March 11, 2020 the WHO declared the pandemic… but in no space is there a substantiated explanation of why to buy ivermectin and azithromycin to treat patients with Covid-19. It is only stressed that the procedure – given the moment of emergency that was lived – would have to be carried out through a direct award.
The second purchase of these drugs was made on February 4, 2021. For 50 thousand boxes of ivermectin – each with 4 tablets and with a unit price of 87 pesos – another 4 million 350 thousand pesos were paid.
No evidence
Faced with the doubts and misinformation that spread about the drugs that could be used -or not- in the treatment of the virus, the federal Ministry of Health drafted the Clinical Guide for the Treatment of Covid-19 in Mexico, which was presented to the governors of the country on August 5, 2021.
During the presentation of the document, the federal undersecretary of health, Hugo López-Gatell, explained that the scientific evidence on the treatment of Covid-19 had changed as new therapeutic options appeared, so the guide showed the most recent knowledge.
The 66-page document contains an extensive list of medicines that are divided into three main groups: those that can be used in the treatment of Covid-19; those that should not be used under any circumstances and those that can only be used in research studies.
Azithromycin, of which the capital government acquired 93,000 boxes, is located in the section of drugs that should not be used at any time because no benefit has been demonstrated. The document even lists 20 adverse effects in case it were used, for example, metabolic, psychiatric, nervous system, ocular disorders, among others.
Ivermectin and acetylsalicylic acid are only recommended in research studies. On ivermectin details that it has no proven benefit and that acetylsalicylic acid reported a decrease of 1 day in the duration of hospitalization and a 1% greater probability of being discharged on day 28. “The least 0.6% had a thromboembolic event,” the document details.
An extensive list of side effects of these medicines is also provided. Blood, cardiac, respiratory, gastrointestinal, skin and renal disorders.
WHO call ignored
On March 31, 2021, the World Health Organization (WHO) issued a statement advising against the use of ivermectin to treat Covid-19.
“Current data on the treatment of Covid-19 with ivermectin are inconclusive. Until more data are available, WHO recommends using this drug only in clinical trials,” the top health authority said.
As ivermectin drew international attention to the possibility of using it to treat Covid-19, WHO convened a group of independent international experts to develop guidance in this regard. The group was composed of clinical care experts from various specialties, an ethicist and representatives of patient associations.
The results obtained after conducting 16 randomized controlled trials that had included a total of 2,407 outpatients and hospitalized with Covid-19, were “very unreliable”, so they called on the population not to take this drug.
Despite this, the capital government insisted on the effectiveness of administering ivermectin, a drug that is mainly used for the treatment of parasitic diseases, as well as scabies, according to the WHO.
On May 14, at a conference led by the Head of Government, Claudia Sheinbaum, the first results on the use of ivermectin in Covid-19 positive patients in Mexico City were presented, a public policy that had begun just 4 months ago.
The head of the ADIP, José Antonio Peña Merino, explained that, with a base of 220 thousand observations, that is, people who received or did not receive the kit, measured the impact that ivermectin had.
“Whoever received the kit has a 68% lower chance of developing symptoms that require hospitalization. This is a statistically significant effect that also agrees – this paper, this analysis – (…) with the evidence that is now being published in many journals specialized in public health,” said the official.
Despite the WHO’s call, on 22 July 2021 the capital government, through the Public Health Services, finalized the most important purchase of ivermectin, which was confirmed through the contract SSPCDMX-SRMAS-JUDCCM-ADQ-100-21 under the concept “Goods required for kits for patients diagnosed with Covid-19”.
It was a purchase of 12 million 850 thousand pesos and included 150 thousand boxes of ivermectin with 4 pills each, and 100 thousand boxes of acetylsalicylic acid. To receive the 150,000 boxes of ivermectin, the contract stipulated a schedule of weekly deliveries that included between July 22, the day of the signing of the contract, and August 30.
The lack of rigor in the studies conducted on the effectiveness of ivermectin was also pointed out by the federal Ministry of Health in the Clinical Guide for the Treatment of Covid-19 that it published on August 2, 2021.
“Research related to ivermectin in Covid-19 has important methodological limitations that result in very low certainty of the evidence. Several websites and journals have published systematic reviews and meta-analyses without following methodological guidelines or standardized reports.
“These websites do not include protocol recording with methods, search strategies, inclusion criteria, quality assessment of included studies, or certainty of the evidence from pooled estimates. Prospective registration of reviews is a key feature to provide transparency in the review process and ensure protection against information biases, “says the federal agency.
Still, this drug is still provided.
This is the case of Fabián, 28, who after returning from the holidays was infected with Covid-19 in the call center where he works.
In a telephone interview he said that the discomforts were increasing to such a degree that on January 5 he could no longer go to work, so he decided to go to Clinic 20 of the IMSS to have a test done and in case of being positive to process his disability.
“The doctor told me to take a daily pill of acetylsalicylic acid, paracetamol every 8 hours and I was given ivermectin. He told me ‘of these are two shots: one today and the other in 24 hours,'” he shared.
“I did keep thinking because I had done a little research and I knew that it is not scientifically proven that ivermectin works against Covid and less that it has favorable results, on the contrary, I think it even damages kidney function, so I did worry.”
The young man received these medicines in a kit, which also contained 10 masks and an oximeter that they anticipated he had to return in his next consultation.
Fabián shared with Animal Político the prescription issued by the doctor on Thursday, January 6, in which the specific indications for taking ivermectin and acetylsalicylic acid are read.
Recipe for use of ivermectin
According to what the young man narrated, while he was waiting for the Covid-19 test to be taken, he was able to notice that the patients who tested positive were receiving the same medical kit that was given to him shortly after.
When asked why he had been provided with these medicines, the young man consulted a trusted friend who is a doctor.
“He told me ‘the only thing that serves you from there is paracetamol, the rest omit it.'” And so it was, Fabian preferred to follow the instructions that his friend gave him.
The boxes of ivermectin and acetylsalicylic acid were stored in a drawer in his house. Fabian rested, hydrated and says that after four days he began to feel better. At the end of his incapacity he returned to his job.
Animal Político sought the IMSS to know why ivermectin continues to be prescribed and delivered to patients who test positive for Covid-19, however, at press time there was no response.
“Seriously, stop”
Before the World Health Organization (WHO) itself called for not using ivermectin as a treatment for patients with Covid-19, some nations had already done the same, for example, the 27 countries that make up the European Union (EU). 
“The European Medicines Agency (EMA) has reviewed the most recent evidence on the use of ivermectin for the prevention and treatment of Covid-19 and concluded that the available data do not support its use for Covid-19 outside of well-designed clinical trials,” the agency said in an official communication issued on March 22, 2021.
“Although ivermectin is generally well tolerated at doses licensed for other indications, side effects could increase with the much higher doses that would be needed to obtain concentrations of ivermectin in the lungs that are effective against the virus. Therefore, toxici cannot be excludedwhen ivermectin is used in doses higher than those approved.”
In the United States, the Food and Drugs Administration (FDA) also called on its population to avoid taking ivermectin. Faced with the rapid spread of false or uncorroborated information about this medicine, mainly on social networks, this office decided to draw attention to the risks involved in taking this drug through a tweet.

You are not a horse. You are not a cow. Seriously, y’all. Stop it.
— U.S. FDA (@US_FDA) August 21, 2021

“You are not a horse. You are not a cow. Seriously, everyone. Stop,” they wrote on the social network on August 21, 2021.
“In the case of humans, ivermectin tablets are approved in very specific doses to treat some parasitic worms, and there are topical formulations (on the skin) for lice and skin conditions such as rosacea. However, the FDA has received multiple reports from patients who have required medical attention, including hospitalization, after self-medicating with ivermectin intended for livestock,” the agency added in a statement.
Other countries that issued different communications calling on their population not to use ivermectin as a treatment for Covid-19 were Kazakhstan, Norway, Serbia and Colombia, for example. 
Paper “deliberately false and misleading”
Through the results of a “quasi-experimental” analysis developed by the Digital Agency for Public Innovation (ADIP), the Ministry of Health of the capital (Sedesa) and the Mexican Institute of Social Security (IMSS) is that the capital government validated its public policy.
The paper was published on the SocArXiv site on May 3, 2021 under the name “Ivermectin and the probabilities of hospitalization for Covid-19: evidence from a quasi-experimental analysis based on a public intervention in Mexico City.
On December 8, 2021, the founder and director of the site, Philip N. Cohen, sociologist and demographer, published a clarifying note under the title “When SocArXiv has bad papers”, in which he calls the analysis made by the capital authorities misleading.
“Depending on the review you prefer, the article is of very poor quality or deliberately false and misleading,” says Philip N. Cohen.
He stresses that the analysis was not peer-reviewed or published in a peer-reviewed journal, in addition to taking up the reviews made by PolitiFact and Estadão Verifica that also discredited the analysis.
“We don’t think it provides reliable or useful information, and we’re disappointed that it’s been very popular,” says the Director of SocArXiv.
As of January 31, 2022, the paper had been downloaded 11,267 times.
Given these facts, the researcher continues, the Steering Committee saw the need to clarify its moderation processes, which do not involve a peer review or a substantial evaluation of the research works that are published on the website.
“Publishing an article on SocArXiv is not in itself an indication of good quality,” they acknowledge.
“In the case of the article on ivermectin, the authors stated that their data is publicly available with a link to a Google sheet (as well as a Github repository that is no longer available).”
This medium entered the Github repository where, according to José Antonio Peña Merino, head of the ADIP, the code of the analysis made was found and in fact, it is not available. The database – with 233,850 observations – and that he himself published in a tweet on May 14, 2021, is still possible to consult.

In today’s conference we also presented this analysis that SEDESA/IMSS/ADIP did on the impact of Ivermectin on the probability of hospitalization in Mexico City.
I tell you context and main findings (1)
— Jose Merino (@PPmerino) May 14, 2021

“We don’t have a policy to remove documents like this from our service … however, we could develop one…. this is an open discussion,” they add.
Animal Político sought the Ministry of Health of the capital (Sedesa) and the Digital Agency for Public Innovation (ADIP) to know what type of follow-up was given to patients who received ivermectin and thus confirm or rule out possible sequelae, to know if they have updates of the “quasi-experimental” analysis, as well as to know what drugs were not purchased because they privileged the acquisition of ivermectin, azithromycin and acetylsalicylic acid.
The ADIP declined to take the interview because it said that it was an issue that corresponded to the Sedesa, however, until the close of this edition that agency did not respond either.
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Original source in Spanish

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