Rolling out mass hydroxychloroquine prophylaxis for covid-19 in India’s slums risks eroding public trust

https://blogs.bmj.com/bmj/2020/05/01/rolling-out-mass-hydroxychloroquine-prophylaxis-for-covid-19-in-indias-slums-risks-public-trust/

 

The municipal corporation of Greater Mumbai (BMC) has decided to roll out a seven-week-long course of chloroquine (CQ) and hydroxychloroquine (HCQ) mass community prophylaxis for the people living in slums [7]. The decision is apparently backed by the announcement of the Indian Council of Medical Research (ICMR) dated 22nd of March, for the prophylaxis of asymptomatic healthcare workers involved in the care of suspected or confirmed cases of covid-19 and asymptomatic household contacts of confirmed cases [8].

This is a baffling decision for while some of the studies suggest these antimalarial drugs may be effective [9–12] as well as safe [13,14], there are also concerns [15,16] that the evidence is not robust and adverse effects will be likely if the drugs are rolled out indiscriminately for mass prophylaxis, without rigorous monitoring [17]. Contradictory statements have been issued about ongoing studies and trials for CQ and HCQ prophylaxis in India [15] and concern expressed about promoting its use as a prophylactic therapy on the basis of insufficient evidence [17]. Muddled and contradictory messages about the benefits and risk of using antimalarials for mass prophylaxis to the marginalised communities in the slums are fuelling confusion and mistrust.