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Ivermectin: A missed opportunity?

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By Dr Upul Wijayawardhana

In recent times, no drug has aroused more controversy than Ivermectin, an anti-parasitic discovered in 1975, originally used in veterinary medicine. It was approved for human use in the late 1980s and is on the World Health Organization’s List of Essential Medicines. William Campbell and Satoshi Omura won the 2015 Nobel Prize in Physiology or Medicine for its discovery and applications which include mass administration in the prevention of lymphatic filariasis and river blindness. In addition to anti-parasitic activity, Ivermectin has been shown to have anti-viral activity as well as anti-inflammatory activity.

Laboratory tests showed Ivermectin activity against the Covid-19 virus at high concentrations, and, therefore, it was initially thought that toxicity might be a problem if used in very high dosage. However, as some observational studies showed benefit at normal doses, Ivermectin was promoted as a ‘miracle’ drug through social media, mostly by anti-vaxxers. A big impetus for Ivermectin came from a randomised clinical trial of 400 patients from Egypt, published in early 2021, which showed a 90% reduction of death rates. However, a British medical student who studied the trial in detail found many discrepancies including plagiarism and data manipulation, which led to the retraction of the article in July 2021.

The first step in proving the efficacy of a drug or any other intervention is by observational studies. If they show likely benefit, then Randomised Clinical Trials (RCT) are done, where one group receives the drug and the other gets a placebo of similar appearance. The most rigorous of all are the double-blind RCTs, where neither the patients nor the triallists are aware who is on what unyil the trial is concluded, and this which helps eliminate any form of bias. The validity of the trial increases as the numbers treated increase. In fact, there are instances where a drug that had been shown to be effective in small RCTs were proven to be ineffective when large RCTs were conducted. This has led to the concept of mega-trials, where thousands of patients are included. The earliest and the best known are the ISIS trials conducted by the Oxford Research Group, which showed the efficacy of clot-busters in the treatment of heart attacks.

However, it is not always easy to do large trials which could be expensive and time consuming. Therefore, statisticians have developed a new method of pooling comparable trials and analysing data, which is called meta-analysis. The August issue of the American Journal of Therapeutics carried a meta-analysis of Ivermectin trials by Bryant et al from the UK, which concluded: “Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using Ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally”. Unfortunately, this meta-analysis included data from the disgraced Egyptian study.

Another meta-analysis, also from the UK by Hill et al, published in ‘Open Forum Infectious Diseases’ initially showed positive results including a 56% reduction in mortality, but a revised publication, after deleting the data from the Egyptian trial, concluded that Ivermectin did not show a statistically significant effect on survival though it displayed a borderline significant effect on duration of hospitalisation in comparison with standard care. This clearly illustrates how the conclusions from a meta-analysis can change due to what is included in the analysis. In fact, statistics can be manipulated to get the desired result!

Perhaps, the important message from these two meta-analyses is that Ivermectin may do some good and does not seem to be doing any harm. Maybe, it was this message that Prof Saroj Jayasinghe wished to convey in his article “Ivermectin and Covid: no time to lose and lives to save” (The Island, 17 September 2021). Although some non-medical scientists were critical that his suggestions were unscientific, it is to his credit that, in a grave situation, he made sensible recommendations, giving good reasons why he was doing so. It may well be that the medical fraternity in Sri Lanka listened to the words of wisdom by a respected senior colleague of the profession, which has resulted in the relatively very low death rate in Sri Lanka. Whereas the average daily deaths are around 20 in Sri Lanka, it is around 182 in the UK: three times the rate when adjusted to the size of the population in spite of having better health care facilities and higher vaccination rates. In fact, on 8 January the UK joined the US, Brazil, India, Russia, Mexico and Peru, as the seventh country to have more than 150,000 Covid-19 deaths during this pandemic.

When it was announced in June that Ivermectin is to be investigated as a possible treatment for COVID-19 in Oxford’s PRINCIPLE trial, there was optimism that the issue of effectiveness of Ivermectin would be resolved, at last. This was because of the reputation of the Oxford Group, which has done pioneering research during the pandemic, in addition to producing the most widely used vaccine with the collaboration of AstraZeneca. However, when I searched for an update, I found this disappointing headline in ‘Medpage Today’ website: “Ivermectin Arm of PRINCIPLE Trial Put on Hold — Trial website cites supply issues”. It went on to state:

“The website does not offer any details on what caused the Ivermectin supply difficulties in PRINCIPLE, which is investigating possible treatments for COVID-19 and being led by the University of Oxford in England. A full response from the trial’s press team was promised, but had not reached MedPage Today by press time.

Ivermectin manufacturer Merck did not directly comment on the supply issues affecting PRINCIPLE. However, as part of a longer statement on the drug provided to MedPage Today via email, the company said that it has “concluded that the probability of ivermectin providing a potentially safe and efficacious treatment option for SARS-CoV-2 infection is low and have prioritised internal efforts towards the development of alternate candidates that provide a higher probability of success for the treatment of COVID-19.”

The alternative candidate they refer to, of course, is Molnupiravir which would be hugely profitable for Merck unlike Ivermectin, which is off-patent. Although initial studies suggested a 50% reduction of hospitalisation with a course of Molnupiravir tablets, final data shows only a modest reduction of 30%. Merck has allowed Indian drug firms to manufacture and sell Molnupiravir at low cost in developing countries. Still, a course will cost around Rs. 4,000 whereas a course of Ivermectin costs less than Rs 200!

It seems very surprising that Oxford Group has difficulties in obtaining a cheap drug and I do not know whether they are obliged to obtain their supplies from the original manufacturer. It is even more interesting that no other news channel has highlighted this problem. On 6 October 2021, BBC website printed a lengthy investigative report titled “Ivermectin: How false science created a Covid ‘miracle’ drug”. I would have expected these investigative journalists to follow the progress of Ivermectin studies but they seem to be silent!

Let us hope Oxford Group obtains supplies and concludes the trial. Otherwise, their reputation too will be at stake. It would be interesting if Ivermectin, a repurposed drug, outperforms Molnupiravir, a targeted drug developed specifically for Covd-19. Repurposing is not a new phenomenon. Many drugs introduced for one purpose sometimes become more useful in other conditions. Thalidomide, introduced as a cure for morning-sickness, fell into disrepute as it caused foetal deformities but has found a new life as an anti-cancer drug. Of course, the best known is Sildenafil, a vasodilator that was trialled by Pfizer for angina; it produced an interesting side effect, which led to it being marketed as Viagra, one of the biggest money-spinners for Pfizer!



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‘There are no private universities in Sri Lanka’ – some considerations for higher education reform

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Academics involved in education policy like to say that there is no such thing as a private university in Sri Lanka. The only ‘universities’ in the country are state universities; anything else offering degrees is a private higher education institution (HEI). This position is technically accurate. Yet, in the discourse and imagination of the public, private universities are very real – people teach in them, students register in them, families pay fees, and such degree holders enter job markets in Sri Lanka and outside.

For decades, activists concerned for public higher education have ignored or resisted looking at private HEIs, as if such scrutiny would taint them. Others have worked in both types of institutions, carrying practices from each to the other. The apex body governing state universities, the UGC, has, meanwhile, ignored the concept of conflict of interest and appointed individuals in private higher education in committees and leadership positions. It is unsurprising then that some of the ideologies informing private higher education appear in reform agendas in the state sector.

This is a good time then to consider the varying types of private HEIs around us, and to take a look at some of the issues within them in the hope that higher education reform agendas will include private, as well as state higher education.

What is a ‘private university’?

First, some clarifications. In the public imaginary, a ‘private university’ is typically an institution that provides a foreign or local degree for which the student makes a payment. But this broad classification encompasses a host of diverse institutions and types of degrees which I detail below.

The Non-State Higher Education Division (NSHE) of the Ministry of Education has recognised 295 degrees by 32 institutions. Most of these are private companies and include a handful of established, well-known private HEIs that are ‘university like’. The degrees are local degrees conferred by the institutions accredited by the NSHE Division. While private HEIs conferring local degrees must be accredited by the NSHE Division, there appears to be no legal consequence for not doing so. In addition, there are several permutations of the private degree that miss the net of this Division and the Standing Committee on Accreditation and Quality Assurance (SCAQA) that assists this Division.

For one, degrees conferred by foreign universities offered, via these same private HEIs, are not vetted by the NSHE Division. Secondly, there is a growing plethora of private HEIs which have either no physical presence locally or only a dubious presence. The University Grants Commission has notified the public, through their website, that foreign universities listed in the Commonwealth Universities Yearbook and the World Higher Education Database are recognised, but refrained from giving any other details – which degrees? Offered by what modes? These details are not known. Some of the foreign universities in the lists may be legitimate entities in their own land but the degrees conferred locally, in their name, may not adhere to curriculum or teaching specifications of the NSHE Division or the UGC.

Another troubling phenomenon is the ‘top up degree’, which appears to work on the same principle as that of a pre-paid mobile connection: if I have a Diploma or an HND of a sort, I am eligible to complete a course of study which provides me with a degree, usually from a foreign university. The idea that someone who does not initially qualify for a degree programme should be able to work their way towards one is a progressive notion. This is the concept that open and distance learning (ODL) was based on initially, but which is now sadly exploited. ODL models are expected to provide opportunity for learning for those who may be excluded from traditional learning institutions. In Sri Lanka, however, we have seen ODL become a marketplace offering easy to obtain, for-fee qualifications by institutions with little commitment to superior teaching and learning.

Finally, a perusal of the many types of private HEIs and their varied degrees bring to mind another question – how should the private degrees, provided by state institutions (that are not educational institutions), be regulated? Who should do so?

All of these create a host of problems for the public – for hopeful students and parents and trusting employers. For the higher education sector, recruitment of academic staff, too, has become difficult due to this plethora of ambiguous higher education qualifications, as I discussed in a previous Kuppi article (‘Recruiting academics to state universities’).

Some issues in private HEIs – a bellwether for change in state universities

In this second part of this article, I will discuss some aspects of work in private HEIs – albeit the more established institutions – given that such issues may appear in reform agendas in future.

Across state universities, all permanent staff of a specific category are paid according to the same criteria. The picture is not so clear when it comes to private HEIs since they are different entities legally, typically companies. Private HEIs have salary scales and financial incentives that are different to each other. The more established private HEIs reportedly have attractive renumeration packages, possibly a reason for academics of state universities migrating eagerly to such institutions during sabbatical years and on retirement. This may not of course be the case with other less established, or improperly registered HEIs of which we know little. Academic staff of these more accepted private HEIs seem to value the high financial remuneration they receive (in comparison to state universities) as something that makes their work rewarding.

Attractive remuneration is important to sustain the good life and is at times seen as the institution’s way of encouraging good work. Yet, this has implications for the future of the institution: to continue to deliver on promised financial packages, institutions must continue to have large profit margins. One strategy has been to enroll multiple cohorts of students per year, even up to three or four intakes per year. This can result in exploitative work conditions, since staff must cater to all these cohorts in that same year. If there is inadequate staff, employees are further burdened. On the other hand, if there is a sudden drop in enrolments (degrees can go out of fashion) unexpected layoffs occur. Similar to other sectors that employ short-term contract staff – including state universities – in private HEIs, too, individual teachers, who are on short term contracts that need regular renewal, can feel pressured to work under difficult or exploitative conditions.

At the same time, even in the more established private HEIs, work norms differ from those of state universities in that they include promotional work that keeps the institution’s name in the eye of the public. The Marketing (or similarly named) unit comes up in conversations as one of the most important departments. It appears to weigh in on decision-making related to the number of staff, the amount of re-sits per exams, and other pedagogically important matters. This is a worrying example of how financial rationales interfere with pedagogically or academically sound processes, resulting in problematic results in the classroom. On the plus side, junior colleagues, who had experience in both state and private HEIs, also felt that they faced less harassment in private HEIs – primarily due to the private HEIs ability to take swift action in reported cases of harassment. This is a real indictment on state institutions and their reluctance to address chronic issues of harassment in our universities.

Yet, while we hear much about problems in state universities, we hardly hear of problems that staff in private HEIs face. One rationale for a lack of public expressions by staff is that expressions of discontent might lead to trouble given the importance of reputation for private HEIs. The worry about reputational damage is a growing concern in state universities, too, as evidenced by social media policies and internal conversations on reputational damage, consequent to negative publicity. Institutional worries of reputational damage are harmful in the long run since these impact not only freedom of expression by student and staff, but also research that is possible in and about the education sector.

Some thoughts at the end…


A close look at the private higher education sector is important given its strong presence in the country. Impending reform needs to regulate this diverse array of higher education offerings in the private sector, as well as the state institutions that offer privately-funded options of higher education (a topic for a separate Kuppi on its own). It is time we carefully considered how to build a whole system of higher education out of this broken mess.

Kaushalya Perera is a senior lecturer at the University of Colombo.

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.

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Ready for solo spotlight

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Nish Peiris: Excited about future plans

Singer Nish Peiris is set to take the next big step in her music journey.

The talented vocalist, who has been seen and heard in the scene here for a short while, and was also featured with the now-defunct band, Inner Vision, has announced that she will be fully committing to her solo career, after completing her degree this year.

“I’m finishing my degree this year, and after that I’ll be fully committing to my solo music career,” Nish told The Island.

“I’ve already got a few tours lined up for next year, so I’m really excited for what’s ahead.”

Fans, no doubt, will remember Nish for her smooth voice and stage presence, and the good news is that she is now ready to chart her own path and bring new music to audiences at home and abroad.

With tours already planned for 2027, the year 2026 promises to be an exciting year for the young artiste as she steps into the spotlight on her own.

We wish Nish every success in this new chapter!

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Exclusive musical evening for Sri Lankans in Toronto

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Toronto Ceymphony Live Band, with Sri Lankans doing the needful

While Sri Lankan music lovers, in Dubai, are eagerly looking forward to being a part of the action on Saturday, 25th July, with Rajiv Sebastian in the limelight, Sri Lankans, in Toronto, Canada, are equally excited and are anxiously awaiting the arrival of Sri Lanka’s famous singer/entertainer Sohan Weerasinghe.

Having done the needful with The X-Periments, the legendary performer has now embarked on an exciting new chapter – a solo career – and Toronto, Canada, will see him do the needful, on Friday, 31st July, 2026, from 8.00 pm to 12.00 am, at the Angus Glen Golf Club.

Sohan Weerasinghe: In Canada, and ready to do the needful on 31st July

Reports indicate that it’s a ‘sold out’ event – naturally with Sohan in the spotlight.

Gamini Hemalal: Creating all the excitement for Sri Lankans in Toronto

Having built his reputation through years of unforgettable performances, and hits that became part of our musical fabric, Sohan is ready to bring his own vision, sound, and stories directly to the audience, in Toronto, Canada, backed by the phenomenal Toronto Ceymphony Live Band.

Says Gamini Hemalal, who has been instrumental in reviving the Sri Lankan entertainment scene, in that part of the world:

“The countdown begins for the most exclusive musical event of the summer! Join us for a premium night of incredible music, elite hospitality, and a lavish buffet as the legendary Sohan Weerasinghe takes the stage live in Toronto!

“This is a high-end event, designed for those who appreciate exceptional entertainment and great food.”

Gamini, who is also a member of the Toronto Ceymphony Live Band, mentioned that it’s going to be an intimate musical evening with the celebrated Sohan Weerasinghe.

From packed auditoriums to intimate shows, Sohan continues to prove why he remains one of Sri Lanka’s most beloved entertainers.

For decades, Sohan Weerasinghe has been a household name in Sri Lankan entertainment.

Known for his captivating smooth voice and charismatic stage presence, Canada will experience it all on Friday, 31st July.

Next on the list of events, Gamini Hemal is working on, is Halloween night and he says “what we plan to do will be very interesting and unique … with a surprise guest star, as well!”

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