Remdesivir Crunch Is Due To Bad Science, Bad Politics: Ex-president, Indian Medical Association

Hospitals are supposed to provide critical Covid patients with Remdesivir or Tocilizumab, two critical emergency drugs, but family members are being made to run around the city trying to latch on to the hope that one of the many helplines being circulated would provide relief.
For the fortunate family members who do manage to find the elusive injectable emergency drugs, the price is often too steep as it is being sold from Rs 10,000 to Rs 40,000 per vial, according verified reports.

The demand for oxygen cylinders has risen so much that non-Covid patients requiring it at home are finding it difficult to get supplies. Even Fabiflu, another Covid drug, for those recovering at home, has been in very short supply or even elusive for the last one week, mostly due to hoarding and black marketing, people in the medical fraternity suspect.
“Remdesivir is in great short supply mainly due to bad science and bad politics as many doctors are prescribing this emergency medicine even in cases it is not required as if it is a panacea for all,” says Dr Ravi Wankhedkar, former national president of Indian Medical Association (IMA).

Cipla’s Remdesivir is recommended at a particular stage when the patient is in the ICU and the oxygen level drops. Unfortunately, the Cipla customer helpline suggests inability to supply the drug for the next four to five days due to non-availability given the “unprecedented demand”.

Wandhedkar stresses that there is considerable misuse of the drug with a hype being created as if it is the only treatment to prevent death due to Covid when the fact is that thousands of patients have recovered without having to take this injectable drug. “Unfortunately doctors not qualified to undertake critical care treatment are advising use of this drug particularly in slum colonies and in rural areas leading to hoarding, black marketing and artificial short supply of the drug, an end result of bad policies of both the central government and the state governments,” says the medical practitioner.

In the case of Remdesivir, though efforts to ramp up production have started, it will take at least another fortnight to see improvement on ground as the processes involved are lengthy, says Sudarshan Jain, secretary general of Indian Pharmaceutical Alliance.

“We are trying to ramp up the production from 70 million doses a month to 100 million a month by May and further to 120 million by June,” says Jain, stressing that the present shortage is due to unexpected demand, compounded most likely due to hoarding and black marketing.

In the case of Roche’s Tocilizumab, Mahesh Doshi, national president of Indian Drug Manufacturers’ Association, says the shortage is due to the fact that it has to be imported by Cipla from Switzerland. The arrangement necessitates that hospitals have to place their demand with Cipla before it imports.

Industry experts stress that the shortage is more due to mismanagement by the administrators. They cite the example of Maharashtra where the state government has issued orders that Remdesivir should be supplied directly to the hospitals. Though the directive is not being implemented effectively in many places within the state, but where district collectors are closely monitoring demand and supply to hospitals there is no shortage or black marketing of the drug.

Unfortunately, the steep rise in demand for Covid emergency drugs is seeing copycat or spurious medicines arriving in the market as indicated by arrests made in Baramati and Indore, which could be only the tip of the iceberg.

Solidarity trial conducted by WHO in 55 countries has recommended steroids and oxygen as frontline treatment for Covid. Though steroids are available, a premium is being charged for oxygen cylinders due to severe shortage. Over the last few days patients in some private hospitals have had to face difficulty due to oxygen supplies running out, relatives have reported.

While the medical fraternity is happy everyone above 18 years will have the option to get vaccinated, they feel the pace of vaccination so far is slower than the rise in the number of Covid cases.

Members of the medical fraternity feel it is unfortunate that the government focus is more on treatment rather than prevention. To ensure this there should be no red tape in giving approvals for import of vaccines and also no politics in the allotment of the vaccines across the country, stresses Wankhedkar.