COVID Treatment Controversies: Unproven Remedies and Public Health Misinformation in South Asia

The Cure That Wasn't: How an Infodemic Ran Alongside the Pandemic

When Bangladesh recorded its first confirmed COVID-19 case on March 8, 2020, and its first death ten days later, the country's only testing facility was a single IEDCR lab in Dhaka for 170 million people. Into that vacuum of uncertainty — no proven treatment, no vaccine, a collapsing hospital system — poured an infodemic. Within weeks, WhatsApp groups were circulating instructions to stop eating protein to prevent infection, to gargle hot salt water to repel the virus, to drink boiling water four times a day. A study published in BMC later documented that a single piece of COVID-19 misinformation was linked to at least 800 deaths worldwide, while another caused 5,876 hospitalizations and 60 cases of complete blindness. Bangladesh was not the origin of those specific cases, but it was not insulated from the mechanism.

Globally, the WHO named the parallel crisis an "infodemic" — an overabundance of information, accurate and false, that made it difficult for people to identify what was safe and effective. In Bangladesh, the infodemic took both universal and distinctly local forms. The universal component involved drugs: hydroxychloroquine and ivermectin, two repurposed medications that were amplified globally by politicians, heterodox scientists, and social media networks before evidence-based medicine caught up with the claims. The local component involved traditional remedies and folk beliefs — Kalazira (fennel flower), hot tea, protein avoidance — that circulated through networks with deep social trust in communities where institutional trust in government health messaging was low and internet penetration was high enough to spread misinformation but uneven enough that fact-checking rarely reached the same audience.

Hydroxychloroquine: When a US President Changed Drug Demand Across South Asia

On March 19, 2020, then US President Donald Trump declared at a White House briefing that hydroxychloroquine — an antimalarial drug — showed "tremendous promise" against COVID-19. The FDA had not approved it for that use and would later warn against it. But within days, panic buying of chloroquine and hydroxychloroquine was reported from countries across Africa, Latin America, and South Asia, including Bangladesh. Patients with lupus and rheumatoid arthritis who took the drug regularly found themselves unable to obtain supplies as pharmaceutical supply chains were redirected toward COVID-19 demand. Bangladesh was among the countries where the drug entered informal COVID-19 treatment protocols: peer-reviewed accounts of early clinical practice in Bangladesh document hydroxychloroquine as the first antiviral approach used at hospitals in the initial panic phase, before its evidence base was formally established — or, as would follow, formally dismantled.

The randomized evidence against hydroxychloroquine accumulated quickly. The RECOVERY trial in the UK — the largest randomized COVID-19 treatment trial — showed no benefit and potential harm. Multiple subsequent meta-analyses reached the same conclusion. The WHO formally recommended against its use. Yet the social and institutional damage was already done: the spectacle of political leaders promoting unproven drugs over scientific authority deepened the cynicism that would later drive vaccine hesitancy. A subsequent survey of 13,438 US adults found that people who used non-evidence-based COVID treatments like ivermectin and hydroxychloroquine were more likely to endorse vaccine-related misinformation and trust institutions less. Correlation, not causation — but the pattern held across multiple studies, and South Asia's health communication challenges share the underlying trust-deficit dynamics.

Ivermectin in Bangladesh: From Clinic to Cabinet

If hydroxychloroquine was the first act of COVID-19 pharmaceutical misinformation, ivermectin was the sequel with a longer run. And Bangladesh had a uniquely close relationship with both the drug and the controversy surrounding it.

In June 2020, a team of physicians at Bangladesh Medical College — led by Professor Dr. Tarek Alam — announced remarkable results treating COVID-19 patients with a combination of ivermectin and doxycycline. Their case series of 100 patients reported that all tested COVID-19 negative, all symptoms improved within 72 hours, no serious side effects were observed, and no patients required intensive care or died. Dhaka Tribune published an interview under the headline "Have Bangladeshi doctors developed a miracle cure for COVID-19?" The story spread rapidly. The Bangladesh Medical College team's claims were published in the Journal of Bangladesh College of Physicians and Surgeons. The scientific community urged caution: the study was observational, not randomized, and had no placebo control group. But in a country facing an uncontrolled pandemic with limited formal healthcare capacity, the appeal of a cheap, locally available drug — Beximco Pharma's ivermectin tablet retailed at Tk 10 — was overwhelming.

A more rigorous icddr,b-led randomized, double-blind, placebo-controlled trial was subsequently conducted on 72 hospitalized patients in Dhaka. The results showed that five-day ivermectin treatment achieved earlier viral clearance compared to placebo — 9.7 days versus 12.7 days, with statistical significance — but showed no significant effect on clinical symptoms of fever, cough, and sore throat across the groups, and no impact on severe outcomes. The icddr,b trial provided a more careful signal than the BMC case series: there may be something worth studying about ivermectin's antiviral properties in vitro, but the clinical bar for benefit on outcomes that matter — hospitalizations, deaths — was not met.

The DGDA nevertheless granted emergency use authorization for ivermectin during the pandemic. Millions of doses were administered across Bangladesh by prescription and self-prescription — a scale that itself became a data point. As a Bangladeshi physician wrote in a peer-reviewed commentary: between March 2020 and March 2021, Bangladesh recorded 611,296 confirmed COVID-19 cases and 9,048 deaths. Between May and August 2021 alone — after ivermectin was widely used — 889,323 cases and 17,147 deaths were recorded. The epidemiological data did not support the drug's defenders.

India's Political Ivermectin Moment — and Bangladesh's Warning

Bangladesh was not alone in South Asia. India's handling of unproven COVID-19 treatments became one of the pandemic's most studied public health failures. Multiple Indian states — Goa, Uttarakhand, and others — included ivermectin in mass prophylaxis programs at various points. Indian medical councils issued conflicting guidance. The second wave in April-May 2021, which killed an estimated 3 to 5 million Indians in excess mortality according to subsequent academic analyses, unfolded while significant institutional energy was directed at defending ivermectin and other unproven treatments rather than accelerating vaccination and oxygen supply. The Indian Medical Association eventually issued statements against unproven COVID-19 protocols, but the institutional fragmentation had already undermined coordinated response.

Pakistan saw similar dynamics: traditional remedies, political endorsements of unproven drugs, and a fractured public health communication environment in which WhatsApp misinformation spread faster than official guidance. Sri Lanka experienced herbal remedy promotion from political figures. Nepal saw its own cycles of miracle-cure rumors. The regional pattern was consistent: health systems under pressure, public trust in institutions contested, social media operating without verification infrastructure, and pharmaceutical treatments with plausible-sounding mechanisms but no rigorous evidence being promoted by figures with social authority.

What Made Bangladesh Specifically Vulnerable

Several structural factors amplified misinformation's reach and harm in Bangladesh specifically. The country's internet penetration — roughly 100 million users — created a vast social media audience. Facebook and WhatsApp, not television or newspapers, are the primary information channels for most Bangladeshis, especially outside Dhaka. This infrastructure is excellent for spreading information but provides minimal friction against misinformation: content that is emotionally compelling, simple in its message, and validated by social trust networks travels faster than corrections from the DGDA or the Directorate General of Health Services.

Bangladesh's healthcare system structure compounds this. A significant portion of primary healthcare in Bangladesh is delivered outside formal facilities — through informal drug sellers (known locally as pharmacy operators or "drug shop owners") who dispense medications without prescriptions, through community-level practitioners with variable training, and through kabiraj (traditional healers) whose practice is culturally embedded. During the pandemic, these networks became distribution channels for misinformation-endorsed drugs, including ivermectin at Tk 10 per tablet. The drug's price was a feature, not a bug: accessibility made it feel democratic and trustworthy compared to expensive hospital treatment that millions couldn't access.

A BMC-published letter from Bangladeshi researchers documented the breadth of specific local misinformation claims: protein avoidance, hot liquid protocols, Kalazira remedies, alongside denial of COVID-19's existence and vaccine hesitancy amplified by nationalist narratives about Western pharmaceutical agendas. These were not simply ignorant folk beliefs — they were information products shaped by fear, structural inequality in healthcare access, and decades of justified skepticism toward institutional authority that pandemic misinformation exploited.

The Science's Verdict and the Lessons It Leaves

By 2022, the scientific consensus on the pandemic's most widely promoted unproven treatments was clear. WHO guidelines recommended against ivermectin for COVID-19 outside clinical trials. Multiple large randomized controlled trials — the TOGETHER trial in Brazil, the ACTIV-6 network in the United States, the PRINCIPLE trial in the UK — found no clinically significant benefit on outcomes that matter. The Colombia trial of 400 patients found no effects on escalation of treatment or mortality. The Argentina trial found no significant effect on preventing hospitalization. The in-vitro antiviral properties that made ivermectin initially interesting required concentrations several times higher than what can safely be achieved in the human bloodstream — a fundamental pharmacological limit that lab studies cannot overcome. Ivermectin's in-vitro promise did not translate to in-vivo benefit.

The global ivermectin episode also produced a secondary scandal: multiple studies that had driven early enthusiasm were found to have methodological flaws, data errors, or in some cases outright fabrication. A Bangladeshi-authored study that had been cited extensively was retracted. The researcher who had originally found positive ivermectin signals and later revised his assessment received death threats online — primarily from the United States. Science's self-correcting mechanism worked, eventually. But the correction arrived slower than the original misinformation and reached a smaller audience.

For Bangladesh's pandemic preparedness planning — and for H5N1 or the next novel pathogen that will eventually test the system — the misinformation question is not separate from the medical question. It is the medical question. A health system that cannot communicate evidence-based guidance faster than WhatsApp can spread a miracle-cure claim is a health system that will lose patients to information failure even when the clinical knowledge exists to save them. The post-COVID preparedness agenda in Bangladesh requires investment in the IEDCR's public communication capacity, regulatory clarity from the DGDA on emergency use authorization thresholds, media literacy infrastructure scaled to social media's reach, and the harder institutional work of rebuilding public trust that misinformation corrodes.

win-tk.org is a wintk publication covering global affairs and culture for Bangladeshi and South Asian audiences.