At the top of a Florida-based telehealth website that promises “quality meds with fast shipping”, above a menu of skin care products, erectile dysfunction medications and hair loss treatments, sits a bright orange banner with bold lettering: “LOOKING FOR IVERMECTIN? CLICK HERE,” it reads.

The telehealth site is one of numerous online providers that have moved to capitalize on the surge in demand for ivermectin as Covid-19 cases rise across the US. The drug, an anti-parasitic used in both humans and livestock, has become the latest in a series of much-hyped medications for which doctors say there is no conclusive evidence they work to treat coronavirus.

Driving the ivermectin frenzy is a cottage industry of advocacy groups, anti-vaccine activists and telehealth companies. Touting the drug as a “miracle cure” for Covid-19, these groups have rapidly risen to prominence, finding a fervent audience among conservative media figures, the vaccine-hesitant and people desperate to treat loved ones suffering from the virus.

The Centers for Disease Control and Prevention (CDC), as well as the Food and Drug Administration (FDA), put out advisories in August warning against using ivermectin for Covid-19. The February guidelines from the National Institutes of Health (NIH) state there is not enough evidence “either for or against” recommending the drug.

Still, medical advocacy groups and anti-vaccine activists have heavily promoted ivermectin online and in the media as the key to ending the pandemic and have shared lists of doctors and companies that will offer it – sometimes directing those interested to dubious medical providers. The hype has caused runs on pharmacies, with reports of people resorting to eating versions of the drug intended for horses when they can’t get their hands on its formulation for humans.

‘The solution to Covid-19’

Ivermectin has a widespread use treating parasitic diseases when formulated for humans – a discovery that won the 2015 Nobel prize in medicine. The drug is used for Covid-19 in Latin American nations as well as several European countries. But experts say there is no proven record of its effectiveness against viruses, and multiple studies have cast doubt on its uses in treating Covid-19.

“There’s really no compelling evidence it works,” said Dr Peter Hotez, a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine who previously worked on health policy for using vermectin to treat parasitic diseases.

Medical experts have also found problems with the studies that ivermectin advocates praise. One medical journal retracted a much vaunted pro-ivermectin study after doctors raised serious concerns over plagiarism and data manipulation. A review of existing studies into the drug from an international organization that reviews medical research found a lack of reliable evidence to support the drug’s use for treatment or prevention of Covid-19 outside of clinical trials and criticized the quality of studies that do exist on ivermectin. A more rigorous, large clinical trial from the University of Oxford is currently underway to see if the drug could have any benefit.

Despite outstanding questions over ivermectin’s efficacy, several advocacy organizations have been on a nearly year-long campaign to mainstream the drug. Two of the most prominent groups backing ivermectin as a Covid-19 treatment are the UK-based British Ivermectin Recommendation Development (Bird) and the US-based Front Line Covid-19 Critical Care Alliance (FLCCC).

The FLCCC started as a nonprofit network of doctors attempting to establish protocols for Covid-19 patient care in the initial days of the pandemic. The group became an early advocate for the use of steroids in treatment, and in late 2020 shifted its focus to ivermectin, arguing the drug was a low cost option that could both treat and prevent the virus while vaccines were not widely available.

Bird, a nonprofit group of doctors in the UK, took on a similar advocacy role. Its members published analyses promoting the drug, and the group started a now-defunct GoFundMe to “help us get life-saving drug approved for Covid-19”. The fund had raised around $44,000 as of last month. The FLCCC also solicits donations on its website, and in July it received a $100,000 award from a Malaysian charitable trust.

Doctors in both groups have been on a media blitz during the last year, publishing protocols and promotional material on ivermectin, giving interviews to news outlets, holding panels and appearing on podcasts.

But other doctors have cautioned the groups have relied on weak data, ignored studies that show ivermectin is not effective and made numerous misleading claims in their push for the drug – such as FLCCC tweeting last month that “this could all be over by the end of August” and one founding member comparing restrictions on ivermectin to genocide.

Bird founder Tess Lawrie told the Guardian that Bird is a crowd-funded initiative aimed at getting ivermectin approved for Covid-19, and that it stands by its claims that the drug could end the pandemic in weeks if used for prevention and treatment.

The FLCCC did not respond to the Guardian’s request for comment.

Both the FLCCC and Bird have drawn further scrutiny from other medical professionals for affiliating with prominent anti-vaccine organizations. In September, the FLCCC and Bird sent open letters to health departments in Australia, New Zealand, Iceland and the Cayman Islands advocating for the use of ivermectin for a variety of Covid-19 treatments. Listed as partner organizations on the letters were several international anti-vaccine groups, including the organization of prolific anti-vaxxer Robert F Kennedy Jr.

“For an organization that is not anti-vaxx it seems to be incredibly comfortable co-promoting organizations that are anti-vaxx,” said Dr Kyle Sheldrick, a Sydney-based doctor who has raised alarm over unethical conduct in pro-ivermectin studies. “As a doctor myself, I would not be part of any group that keeps the sort of company that FLCCC keeps.”

Co-founder and president of FLCCC, pulmonary care specialist Dr Pierre Kory, has also found allies among influential politicians and media figures who have spoken critically of Covid-19 vaccines.

At a December 2020 hearing chaired by Senator Ron Johnson, who has falsely claimed that natural immunity is better than vaccine immunity and made misleading statements about vaccinations causing death, Kory called ivermectin “the solution to Covid-19”. The appearance boosted Kory’s online following and led to appearances on several popular podcasts that have questioned vaccinations. In June, Kory was a guest on Joe Rogan’s top-rated podcast, telling Rogan’s millions of listeners that his “dream is that every household has ivermectin in the cupboard” while suggesting that technology companies were censoring discussion of the drug.

Pierre Kory did not respond to the Guardian’s request for comment.

Lawrie, the Bird founder, told the Guardian the group considers its affiliates’ stance on vaccination “irrelevant to the global need for early safe and effective treatment for Covid-19”.

A conservative rallying point

Public interest in ivermectin ballooned following Joe Rogan’s podcasts. “On a national level Rogan’s podcast was a tipping point,” said Keenan Chen, an investigative researcher with First Draft News, an organization that tracks misinformation. (Rogan, who has previously expressed hesitancy to vaccines, announced in September he had contracted Covid-19. He claimed to be taking ivermectin among several other treatments.)

As interest in ivermectin spread, opinions on the drug became subsumed into a broader culture war. As health authorities dismissed it, some advocates increasingly claimed that there was a wide-ranging conspiracy against the drug, accusing tech platforms and big pharma of censorship. Some FLCCC members appeared in YouTube videos promoting conspiracy theories, with titles such as “Exposed! FDA, CDC & WHO is hiding this from you?” In one video, the hosts claimed, “There is a conspiracy to block and ban discussion of treatments that will not make any money for the big pharmaceutical companies.”

Fox News hosts, including Tucker Carlson and Laura Ingraham, featured guests promoting the drug and deriding public health officials for cautioning against its use. Conservative radio hosts joined in recommending the drug, including one host who has since died of Covid-19.

As ivermectin turned into a conservative rallying point, some groups began to take advantage of its new audience. At least three telehealth sites offering ivermectin have ties to America’s Frontline Doctors, a rightwing political group that went viral in July 2020 after far-right media outlet Breitbart shared video of a press conference in which members falsely claimed unproven treatments as cures for Covid-19 and stated people did not need to wear masks.

Donald Trump, his son Donald Trump Jr and numerous QAnon conspiracists shared the video, and within hours it was viewed millions of times before social media platforms removed it for violating public health policies. The group’s founder, Simone Gold, is facing charges for taking part in the 6 January riot at the Capitol. AFD recently promoted ivermectin to its more than 170,000 subscribers on Telegram.

The telehealth site MyFreeDoctor, which heavily promotes pro-ivermectin sources on its website, is founded by AFD member Ben Marble and employs many members of the group. Another site, SpeakWithAnMD, is frequently mentioned on pro-ivermectin social media channels and works in partnership with America’s Frontline Doctors. It charges $90 for consultations.

Dr Stella Immanuel, another member of America’s Frontline Doctors, posted on her medical practice Facebook page this month that “we went from 100 to 700+ a day signing up for telehealth in three weeks” and are “totally swamped” with patients seeking ivermectin.

Immanuel became infamous last year as a high-profile promoter of hydroxychloroquine, an anti-malaria drug that the FDA warns is not safe or effective against Covid-19 but which became a rightwing rallying point, as well as for her claims that common illnesses were the result of people having sex with demons in their dreams and that “reptilians” run the government. Her consultation fee is also $90.

Stella Immanuel, Ben Marble and America’s Frontline Doctors did not return requests for comment.

A potentially dangerous distraction

As advocacy groups and conservative media promoted ivermectin in recent months, their message has found an eager audience online. On Telegram and other messaging platforms, pro-ivermectin communities have become hubs for anti-vaccine misinformation, with members sharing tips for pharmacies and telehealth providers who will order them the drug. In pro-ivermectin Facebook groups, members have promoted the drug’s use, condemned its opponents and discussed taking legal action against doctors who won’t administer it.

“These doctors are misleading the people. Ivermectin works,” one user commented in a private ivermectin Facebook group with over 28,000 members. “Make sure you get IVM now already before you need it. Your family’s health depends on it,” another user posted.

“Just got into a fight with my mother this morning bc she said that they’re no reliable peer reviewed studies showing the benefit and that WHO warns against it,” one member complained, only to be reassured of their beliefs by others in the group.

Facebook has stated that it will enforce violations of its policies on Covid-19 information and vaccines, which includes prohibiting claims that ivermectin is a guaranteed cure or ads for the drug. “We remove content that attempts to buy, sell, or donate for ivermectin,” a spokesperson told the Guardian. “We don’t allow ads promoting ivermectin as a treatment for Covid-19.”

The hype over ivermectin caused the CDC to last month report a 24-fold increase in US prescriptions compared with pre-pandemic levels. Livestock suppliers, who carry a non-prescription version of the drug formulated for use on horses and other animals, say they are facing unprecedented demand. Poison control centers in multiple states have received a spike in calls from people taking ivermectin not intended for human consumption, including Mississippi reporting last month that at least 2% of its recent calls were due to the drug. (The FLCCC has, for its part, put out statements directing people not to take the version of ivermectin intended for livestock, but blamed health authorities for the confusion.)

The American Medical Association, American Pharmacists Association and American Society of Health-System Pharmacists have issued a joint statement strongly opposing ivermectin prescription, ordering and distribution outside clinical trials.

Barring new data that proves ivermectin’s efficacy in treating Covid-19, many health experts view the drug as a potentially dangerous distraction.

“There are lots of promising treatments that are much farther along the research and development pipeline than ivermectin,” said Dr Jorge Caballero, co-founder of Coders against Covid, an organization that analyzes Covid data. “Let’s focus on the library of things that we do know work. We know that vaccines work.”

But despite health warnings and scant evidence that ivermectin is the miracle cure that its adherents want it to be, the idea of a quick and easy solution to the pandemic has proven to have enduring appeal.

“It’s much easier to come along and sell a message where the answer is simple: there is a cure, it’s what you wanted to believe anyway and the power is in your hands,” said Sheldrick. “It actually doesn’t matter how poor the evidence base is. If that is your message, you will find an audience.

This article was amended on 13 September 2021. An earlier version said that 70% of calls to poison centers in Mississippi concerned ivermectin. The state’s department of health originally gave that figure to the Associated Press; AP and the health department later corrected this to 2%.