The Washington PostDemocracy Dies in Darkness

Study: Trump counties more likely to seek ivermectin, hydroxychloroquine prescriptions

Hydroxychloroquine pills (John Locher/AP)

President Donald Trump wanted it all to go away.

He was confident that the 2020 election was his to lose, given the strength of the economy, but his advisers were warning that the sudden arrival of the coronavirus was putting that at risk. So Trump began insisting that everything would be back to normal imminently and that people should go about their lives as normal.

First, it was that warm weather would stamp out the virus, which it didn’t. Then it was that the country was on the brink of effective therapeutical treatments that would make illness nothing more than an inconvenience. And then he announced that there were wonder drugs that could cure covid-19 or even prevent infection, most notably the anti-malarial drug hydroxychloroquine. Over and over he hyped it, explicitly offering Americans hope in lieu of evidence, contrasting his unfounded optimism with the rational caution of people such as Anthony S. Fauci.

Hydroxychloroquine and, later, ivermectin, an anti-parasite drug that was similarly promised to quickly alleviate covid-19 symptoms, became partisan markers of how to deal with the pandemic. It wasn’t just that they were seen as more effective. It was that they were seen as acts of rebellion, siding with the people against the pharmaceutical companies, standing with Trump once again against the elites. Hydroxychloroquine became a marker of faith in Trump. Ivermectin, which emerged late in Trump’s administration, became a symbol of opposition to the vaccines that President Biden (and, quietly, Trump himself) were advocating instead.

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New research from a team representing the Harvard T.H. Chan School of Public Health, Brigham and Women’s Hospital and Harvard Medical School shows the extent to which consideration of those two drugs in particular became intertwined with partisanship.

“In late 2020, the number of new prescriptions for hydroxychloroquine and ivermectin was higher in counties with higher Republican vote share,” the authors write, “whereas in early 2020, before revocation of the Food and Drug Administration’s emergency use authorization, prescribing volume for hydroxychloroquine was higher in counties with a lower Republican (ie, higher Democrat) vote share. These findings were absent before the COVID-19 pandemic and for 2 control drugs.”

In other words, the FDA’s temporary approval of hydroxychloroquine as a treatment (show at point 1 on the first graph below) led to more prescriptions in counties that voted less heavily for Trump later that year. This makes sense, given that the virus was far more common in blue states like New York, New Jersey and California at that point. After the FDA withdrew that authorization, though (point 2), the counties that supported Trump the most saw far more prescriptions written.

A similar pattern happened for ivermectin. Point 1 on the lower graph shows an initial study suggesting a possible benefit to the drug. Point 2, a government recommendation against its use. Point 3 indicates the release of a now-retracted study purporting to show high efficacy, and Point 4, a Senate hearing in which the drug’s use was promoted. Despite the lack of robust evidence for either medication, Trump-voting counties in particular seized on them.

Note where those graphs (and the paper’s research) concludes. It goes through the end of 2020, meaning just as vaccines were being rolled out. In other words, this data excludes the hype cycle that ivermectin enjoyed in 2021, powered by popular voices like podcaster Joe Rogan. But it does overlap slightly with the beginning of the vaccine rollout in the United States.

That’s the flip side of this research, of course. Trump counties were more likely to embrace the use of hydroxychloroquine and ivermectin; they were also less likely to embrace coronavirus vaccines.

This suggests that pattern isn’t simply that more-red places saw more enthusiasm for unproven treatments. It shows enthusiasm for unproven treatments even while rejecting an effective pandemic response. So it’s not that those places were disproportionately eager for any solution to the coronavirus. It seems safe to assume that they were looking for treatments that aligned with their political position before ones that aligned with expert recommendations.

The toll was stark. The Kaiser Family Foundation estimates that 163,000 covid-19 deaths in the second half of 2021 could have been prevented had those infected been vaccinated. The surge in cases that accompanied the delta variant hit less-vaccinated and more-Republican-voting states (indicated in red below) significantly harder.

During the omicron surge that began in December, the correlation to vaccination was less stark. That’s in part because the omicron variant was more effective at infecting vaccinated people. But there was still a demonstrated benefit to vaccination.

The research released on Friday falls less into the category of “revealing something unexpected” than it does “confirming suspicions.” To this day, Trump — still eager to demonstrate victory over the eggheads and the elites — insists that he was right about hydroxychloroquine. To this day, Republican legislators are scoring political points by defending the use of ivermectin. And all while 2,300 people are still dying every 24 hours despite the availability of a free treatment that will with near-certainty keep you alive.

In part because Trump hoped that disparaging experts while promising a surefire cure would help him win an election he lost anyway.