Explained: What is Causing the Sudden Shortage of Remdesivir?
With COVID cases rising in India, so has the demand for this medicine. Why is the supply chain unable to keep up?
Aditya Karpe of Pune was getting his coronavirus-infected brother and father treated at Surya Hospital in Shikarpur.
Ten days ago, his father was prescribed the antiviral drug Remdesivir, which Aditya got from the hospital.
But 3 days ago, when his brother needed it, he could no longer buy the medicine at the hospital because they had run out.
The pharmacy nearby, too, turned him away, saying the medicine was out of stock.
Ultimately, Aditya had to buy the medicine by paying double the price.
Aditya ended up having to spend 7.5 thousand rupees on Cipla’s Cipremi and 10 thousand rupees on a vial of Mylan’s Dersem, while the actual cost is 4 thousand rupees and 4.8 thousand rupees per vial respectively.
Now that Aditya's COVID report has also come up positive and he too has been admitted to the same hospital, they are worried that after spending on so many family members' treatment already, he will no longer be able to afford medicine for himself.
How Does Remdesivir Help COVID Patients?
For someone who has been infected with COVID, Remdesivir is considered to be the most effective drug in dealing with the more severe symptoms.
A COVID patient needs 5 shots of Remdesivir. Buying the medicine in black can take one’s total expenditure up to 45 thousand rupees.
Speaking to FIT over the phone, Aditya says that even the family members of other patients admitted with him are not getting this medicine.
This has been the situation for the last three to four days.
The number of patients in the hospital has increased, and as a result, the medicine is getting scarce, forcing desperate patients to buy it in black.
The increasing number of COVID patients has subsequently led to a shortage of Remdesivir in private and government hospitals in Mumbai, Thane, and Abernathy in Maharashtra, Bhopal, Indore, Gwalior in Madhya Pradesh and Ahmedabad, Surat, Rajkot in Gujarat is.
A senior medical officer of Indore, while speaking with FIT, confirmed that there is a severe shortage of medicine in his district as well.
District Collector of Indore, Manish Singh, gave a statement to the media on 8 April, saying, "With the increase in cases in Maharashtra and Gujarat, there is a shortage of Remdesivir with us."
“There is a manufacturing company in Maharashtra, but in view of the growing case there, the state government has stopped its supply.”Manish Singh, District Collector of Indore
Dr Rahul Ghule, Founder and CEO of 1 RUPEECLINIC is running a '1500 Bed Covid Hospital Setup' in Mumbai. He has made his number public on Twitter so that people seeking his help can call him directly.
Dr Rahul Ghule, who has been helping the COVID patients and their families in Mumbai since the onset of the epidemic, told FIT that "the patient's family is suffering double the trouble."
“Patients are not able to provide beds and even if they are getting beds, then they are not getting Remdesivir medicine. Stock is out in hospitals. The drug is being marketed black. “Dr Rahul Gule, Founder and CEO of 1 RUPEECLINIC
On 7 April, he also tweeted this:
How is Maharashtra Tackling the Rise in Demand?
Expecting a triple increase in demand for this antiviral drug by the end of the month, Maharashtra Public Health Minister Rajesh Tope has requested pharmaceutical companies to speed up production, according to a Times of India report.
According to Tope, given the surge of COVID in the state, by 30 April, about 1.5 lakh doses may be required daily.
In the current situation, 50 thousand doses are required daily.
On Thursday, 8 April, he held a meeting with senior officials of pharma companies and said that companies have increased production but it will take at least 20 days for new batches to arrive.
In order to stop the black marketing of drugs and to keep the prices in the reach of the common people, the government has decided that the price of Remdesivir dose should be restricted to 1100 to 1400 rupees per dose.
Why is There a Shortage?
Due to the second wave of COVID, the number of patients to be admitted to hospitals and the demand for the medicine has increased.
The past couple of days has seen the situation go from bad to worse with new cases crossing the 1 lakh mark on 5 April. Since then we have only been seeing record highs in daily cases.
As of 8 April, 1,31,968 new cases were registered in India. Maharashtra alone has 5,22,762 corona active cases, while Madhya Pradesh has 28,060 active cases.
This has left the governments of Maharashtra and Madhya Pradesh scrambling to procure this medicine.
There is a plan by the government of Madhya Pradesh to give these injections free of cost to the economically weaker COVID patients.
With the increase in cases, the gap between rising demand and supply has created a shortfall.
All India Organization of Chemists and Druggists (AIOCD) General Secretary Rajiv Singhal said in a conversation with FIT:
“As the cases started decreasing in the beginning of the year, the demand for Remdesivir decreased, so companies stopped manufacturing or slowed down because its expiry date was up to 3 months. After 10 March, the cases started increasing and the demand increased too.”Rajiv Singhal, All India Organization of Chemists and Druggists (AIOCD)
"Manufacturers say that they have to keep the medicine in incubation or bubble for 18 to 20 days, only then can they supply it in the market. For this reason, the supply of medicine is not being able to keep up with the pace of the demand," he added.
According to Singhal, the situation is expected to return to normal in 2-3 days as the pharma companies, which are continuously producing the drug, will start offloading their stock in the market by 10 April, in view of the increase in the case in March.
What Is Its Production Capacity?
In India, this drug is produced by 7 pharma companies - Cipla, Zydus Cadila, Hetero, Mylan, Jubilant Life Sciences, Dr. Reddy’s, and Sun Pharma.
Union Minister of State (Chemicals and Fertilizers) Mansukh Mandavia said on 7 April that these companies have been asked to increase production.
Currently, their production capacity is 31.60 lakh vials monthly.
Out of 31.60 lakh vials, Hetero produces 10.50 lakh vials a month, Cipla produces 6.20 lakhs, and Zydus Cadila 5 lakhs.
Remdesivir's Rocky Journey
Remdesivir is an antiviral drug, made by American pharmaceutical giant Gilead Sciences. It was created over a decade ago to treat hepatitis C and respiratory syncytial viruses or RSV, but was never approved to market.
'Antiviral drugs' are medicines used to treat viral infections.
COVID-19 brought this drug into the discussion again.
Several generic versions of Remadesivir have been introduced in the market in India, this drug is part of the protocol of the Ministry of Health for management of Covid-19.
In November 2020, the World Health Organization (WHO) issued a recommendation against the use of Remdesivir.
Interim results from its solidarity trial, which was looking at repurposing existing anti-viral drugs to manage Covid-19, found that “there is currently no evidence that Remdesivir improves survival and other outcomes in these patients.”
But Remdesivir can potentially have some, though very limited, benefits.
Taking off from the WHO trial, a study published in The Lancet journal in November 2020 suggests that the drug is effective only when administered to those who are diagnosed with a risk of hyperinflammation, before 10 days into the infection.
A US Food and Drug Administration (FDA) guideline from February suggests that though the use of Remdesivir can reduce the recovery time in hospitalised patients, there are some risks that one should be wary of.
(The article was first published in FIT and has been republished with permission)
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