Amid global controversy, Greece moves forward with chloroquine

Seemingly unaffected by the controversy in the global scientific community, Greece has resumed production of chloroquine to treat cases of coronavirus and is conducting clinical trials with a "calm and distant approach", scientists there say.

Chloroquine, an anti-malarial drug, and hydroxychloroquine, a related compound normally used to treat arthritis, have been among the most high-profile drugs being tested for use against COVID-19.

But last week a major UK trial run by Oxford University halted its tests of the drugs, saying there was no evidence they worked against the new coronavirus in hospitalised patients.

The move came just after the World Health Organization (WHO) resumed its own trials after briefly suspending them in response to a now-retracted study in The Lancet.

But the ongoing debate over the drugs has had little impact in Greece, where epidemiologists consider chloroquine effective, especially in the early stages of COVID-19.

Renewed licence

Evangelia Sakellariou, a chemist responsible for quality control in a laboratory in the Athens suburb of Nea Kifissia, was one of the first scientists to have tested the chloroquine tablets used in Greek hospitals.

As the scale of the pandemic became apparent earlier this year, the company Uni-Pharma moved quickly to renew an old manufacturing licence for the drug, which was exported to Africa in the 1990s for the treatment of malaria.

The licence was reactivated in March, just days before Greece closed its borders to contain the spread of the virus, Spyros Kintzios, Uni-Pharma's development director, told AFP.

Five tonnes of raw material were imported from India and the laboratory went into "high-alert", Sakellariou said.

"On the weekend of March 21 we were working constantly, we were under pressure and in 30 hours we produced 24 million doses, which were then offered to the Greek national health system," she said of the pills, made under the brand name Unikinon.

"When I saw the first tablets, I felt relieved and happy to have made this effort for a good cause," Sakellariou added.

At the time, there were only six coronavirus deaths and 464 recorded infections in Greece. The country has remained one of the least affected in Europe, with 182 deaths and under 3,000 official cases so far.

Against a backdrop of international competition, "the resumption of chloroquine production in Greece has had a positive effect on local industry, whose exports have increased in recent years," said Markos Ollandezos, president of the Panhellenic Union of the Pharmaceutical Industry.

The Greek industry is mainly specialised in the manufacture of generic drugs and some commonly used medicines.

'We wait and see'

The debate on chloroquine in other countries has not affected its use in Greece, where it has been administered to hospitalised patients in combination with the antibiotic azithromycin.

In April, the Athens Medical University started a study on "the activity of chloroquine phosphate in patients with SARS-CoV-2 virus infection", to test how the drug could prevent or improve symptoms of pneumonia.

There has been little debate on treatment in the country because coronavirus has caused so few deaths, said Ollandezos.

"People in Greece—the public, healthcare professionals, people within institutional roles—they maintain a very calm and distant approach to chloroquine," said Kintzios at Uni-Pharma.

"So the idea is that we wait and see, we wait for the results," he said.

Globally, chloroquine and hydroxychloroquine have been swept up in a politically charged debate amid the pandemic, with hydroxychloroquine endorsed by public figures including US President Donald Trump.

At a press conference in May, Greek health ministry spokesman Sotiris Tsiodras said "chloroquine's action is still contested".

Last week's retraction of the Lancet study—which had found the drugs had no benefit in treating coronavirus, and even increased the likelihood of patients dying in hospital—rocked public opinion and the scientific community.

However, the manufacture of both medications has continued in many countries in Europe.

France's Sanofi produces hydroxychloroquine sulfate at a site in Hungary. The drug itself, under the brand name Plaquenil, is manufactured at two large production sites in Spain and France.

Plaquenil is exported to several countries where hydroxychloroquine is not produced, such as Greece, Poland and Estonia.

In Bulgaria, chloroquine from the state laboratory Bul Bio is used for treating COVID-19 patients.

Poland, which also authorises its use, is considered a major producer of chloroquine with company Adamed producing it under the name Arechin.

Questioned by AFP, a Hungarian government spokesman stressed that the drug was not administered to new patients but only to those who have already started treatment.