Insight: The man behind Brazil's search for miracle COVID-19 cures

Kintor Pharmaceutical

14/05/2021 11:42

(Updates to add link to related story)
    By Gabriel Stargardter
    RIO DE JANEIRO, May 14 (Reuters) - Brazilian President Jair
Bolsonaro, addressing the nation last month in a social media
video, touted the latest in a string of unconventional drugs he
says can ease the country's COVID-19 crisis.
    Bolsonaro - a vaccine skeptic and promoter of discredited
treatments such as hydroxychloroquine - said this new drug,
Proxalutamide, would "soon be available to all Brazil." He
invited a little-known Health Ministry official, Helio Angotti,
to expand on its promise.
    Angotti, an eye doctor with no epidemiological experience,
cited a domestic Proxalutamide study showing a 92% decrease in
mortality risk among hospitalized COVID-19 patients. It was a
dramatic claim amid a global struggle to find effective
treatments. He said he aimed to "get it to the Brazilian
population as soon as possible."
    But the study - co-authored by a consultant Angotti hired -
hasn't been peer-reviewed or published, beyond a cursory results
presentation the authors released in a March news conference.
The drug does not have regulatory approval and isn't available
for sale.
    Alexandre Cavalcanti, director of Sao Paulo's HCor Research
Institute, said the claimed effectiveness in the study Angotti
cited far exceeds any vetted COVID-19 treatment.  urn:newsml:reuters.com:*:nL1N2N02FQ 
    "I don't believe it," said Cavalcanti, who co-authored a
major study, published last year in the New England Journal of
Medicine, that found hydroxychloroquine essentially useless for
COVID-19.
    As a comparison, Cavalcanti cited the commonly used steroid,
Dexamethasone, has been shown to reduce deaths by up to
one-third in patients with severe COVID-19. The Chinese biotech
firm that makes Proxalutamide, Kintor Pharmaceutical Limited
 9939.HK , has seen its stock soar as it touted the Brazilian
study and reported other progress, Reuters reported in a related
story https://reut.rs/3uPlT8p today.
    The appearance with Bolsonaro was the latest sign of
Angotti's rising influence amid a pandemic that has killed about
430,000 Brazilians. Current and former Health Ministry employees
say the mid-level official has quietly amassed power by
elevating what they say is questionable science to support
Bolsonaro's convictions: that masks are useless, lockdowns are
dangerous, vaccines are no silver bullet, and other miracle
cures are available or soon will be.
    Angotti declined to comment for this story. Bolsonaro's
office and the Health Ministry did not respond to requests for
comment.
    Carlos Wambier, one of the co-authors of the Brazilian
Proxalutamide study, acknowledged it lacked peer-review but said
its findings were "really very encouraging." He dismissed its
critics as "more concerned with politics than with scientific
results." 
    "If the article is published, I believe any government in
the world will pay attention," said Wambier, a dermatology
professor at Brown University who specializes in cosmetic
procedures such as Botox injections and tattoo removal.
    Reuters reviewed internal ministry documents and interviewed
over two dozen current and former officials, scientists and
politicians to chart Angotti's rise in Bolsonaro's
administration. Angotti last year became chief of the Health
Ministry's Science, Technology, Innovation and Strategic Inputs
(SCTIE) department. Among other duties, the SCTIE decides which
drugs - not including vaccines - Brazil's vast public health
system purchases. 
    The sources said his department's focus on unproven
coronavirus remedies such as hydroxychloroquine, along with its
opposition to masks and lockdowns, contributed to the explosive
spread of the infectious P1 variant, which originated last year
in Manaus, the capital of Amazonas state, and made Brazil one of
the world's worst hotspots.
    Federal prosecutors in Amazonas have accused Angotti of
administrative misconduct, in a civil proceeding that can result
in fines or job loss, for pushing health workers there to
prescribe hydroxychloroquine. Angotti declined to comment on
that accusation.
    Angotti is also under scrutiny in a high-profile
congressional probe into Bolsonaro's pandemic response. The
Senate has been grilling administration officials in public
hearings for about two weeks, and three senators have formally
called for Angotti to testify before the investigative
committee, which has not yet considered their requests. The
committee will produce written findings but has no power to
punish administration officials.
    Angotti's ascent reveals the central role that unproven
treatments continue to play in Brazil. It also exemplifies the
unconventional makeup of Bolsonaro's government, a coalition of
soldiers, free marketeers and social conservatives.
    "Helio is the face of that anti-science group that seized
control of the ministry," said Adriano Massuda, who led the
SCTIE department in 2015. "It's the ideological wing of the
Bolsonaro government that now gives orders at the Health
Ministry."
    Angotti's efforts to support Bolsonaro's pandemic strategy
came as the administration - now on its fourth health minister
of the pandemic - was widely criticized for Brazil's delayed
vaccine rollout. https://www.reuters.com/article/health-coronavirus-brazil-vaccines-idCNL1N2JW1R3
 As other nations scrambled to cut deals with pharmaceutical
firms, Bolsonaro's administration was slow to secure vaccines
for Brazil's 210 million people. About 15% of Brazilians have
now received at least one dose, compared with 36% in neighboring
Uruguay, 46% in the United States and between 20% and 35% in
many European nations, according to Our World in Data, a
nonprofit public-service research organization.
    
    THREE CONSULTANTS AND A RESEARCH MEMO
    Angotti taught at a university in southeastern Brazil before
he joined the Health Ministry in 2019, when Bolsonaro took
office. He served as a health education manager before being
promoted last June. Like Bolsonaro, Angotti is an avowed
follower of the esoteric Brazilian philosopher Olavo de
Carvalho, who promotes false conspiracy theories including a
claim that Pepsi used the cells of aborted fetuses as sweetener.
    Bolsonaro, who took hydroxychloroquine when he contracted
the virus last July, has questioned the safety and effectiveness
of vaccines and declined to take a shot himself. Angotti
declined to comment to Reuters on whether he considers vaccines
effective.
    By November of last year, Angotti had hired and assigned
three consultants to find evidence to support Bolsonaro's
medical claims, according to a Nov. 19 memo Angotti wrote. The
memo, reviewed by Reuters, hasn't been previously reported.
    Among the consultants were Ricardo Zimerman, an
infectologist with some 60,000 followers on Instagram, where he
regularly posts news about experimental COVID-19 treatments and
photos of himself pumping iron. The two others were Bruno De
Souza, a management professor at the Federal University of
Pernambuco who also has a doctorate in psychology; and Rute
Costa, a medical researcher.
    The consultants did not respond to requests for comment.
    Angotti's Nov. 19 memo instructed the consultants to "list
and criticize the protocols and articles related to the
different immunization proposals." The consultants were also to
update the ministry protocol for treating COVID-19 with a
cocktail of anti-malarials, such as hydroxychloroquine, along
with other drugs. Angotti told them to add "the newest proposed
therapies," showing how they can "save many lives."
    The memo also directed the consultants to produce a
"comprehensive assessment" of lockdowns, focusing on the "social
and economic impacts of social isolation." In March, the
consultants co-authored a study that went beyond examining
social-isolation impacts and concluded that lockdowns were
"associated" with the emergence of the P1 variant in Manaus,
asserting that the virus had mutated in cooped-up households.
    In early December, the consultants shocked some staffers on
the ministry's coronavirus operations desk with a presentation
on why masks don't work to control virus spread, according to
two people present. Others were less surprised: When Bolsonaro
visited the desk in October, officials were told not to wear
masks, according to a person in attendance.
    
    HYDROXYCHLOROQUINE TO THE RESCUE
    As Angotti's team chased evidence for unproven treatments,
the P1 variant exploded in Manaus, accounting for three-quarters
of the city's cases by the end of January, according to a study
by Fiocruz, a federally funded biomedical institute. The city's
hospitals quickly ran out of oxygen; the variant soon spread
across Brazil.
    The Health Ministry sent at least 120,000 hydroxychloroquine
pills to Amazonas state and flew 12 medical professionals to the
city of Manaus to push healthcare workers to use anti-malarials.
Zimerman, De Souza and Costa were in the group, according to a
Feb. 23 statement sent by one of Angotti's colleagues to federal
prosecutors in Amazonas, responding to their inquiries about the
ministry's handling of the Manaus crisis. Angotti's SCTIE
financed their trips, the statement says.
    The ministry also deployed a short-lived phone app that
purported to help medical professionals diagnose COVID-19 with a
symptoms questionnaire - then instructed them to prescribe
anti-malarials like hydroxychloroquine. The app was based on a
diagnostic tool that Angotti's consultants helped to develop.
    Less than two weeks after its January launch, Brazil's
Federal Council of Medicine (CFM), which licenses and regulates
medical professionals, asked the Health Ministry to deactivate
the app because it claimed "scientific validation for drugs
without international recognition." The council said the app had
been available to people who were not doctors and that it
encouraged them to self-medicate. The ministry shut the app
down.
    The focus on hydroxychloroquine in the Manaus crisis was
emblematic of the Bolsonaro administration's failed pandemic
response, said Felipe Naveca, one of the first scientists to
study the P1 variant and the deputy research director at the
Fiocruz Amazônia biomedical institute, the organization's
outpost in Manaus.
    "The scale of the problem was never taken seriously," he
said. "So they focused on a miraculous solution that doesn't
exist." 
    Amid the chaos in Manaus, one of Angotti's consultants,
Zimerman, joined with other researchers to launch the study of
Proxalutamide, the drug Bolsonaro and Angotti would later tout
on the social media video. On March 10, just weeks after
starting the study, the authors called a news conference in
Manaus to announce their results.
    "As a researcher, I can confirm that I've never seen
anything like this - and I conduct a lot of trials," said
Cadegiani, one of the study's co-authors. "We're not kidding
around." 
    Cadegiani declined to comment on the criticisms of the
study.
    Cavalcanti, the Sao Paulo scientist, said the presentation
of findings for the still-unpublished study didn't meet the
standards for such research.
    "That study is amateur," he said. "The way it was announced,
how the data were presented, those guys are amateurs."

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Chinese firm's COVID-19 drug claims draw scientists' skepticism 
  https://reut.rs/3uPlT8p
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 (Reporting by Gabriel Stargardter; editing by Brian Thevenot)
 ((gabriel.stargardter@thomsonreuters.com))