As India encounters the second wave of Covid, the country is witnessing a huge spike in the number of positive cases on a daily basis. This has given rise to an increased demand for the drug Remdesivir, crucial for the treatment of Covid.
There, however, remains a disproportion in the demand and the supply of Remdesivir drugs as most of the hospitals in the covid hotspot states are running out of it. Around 8-10 single-dose vials of the drug are ideally required for treating an individual, but its lack of supply has compelled many hospitals to put on hold the treatment procedure of the patients.
Currently, only three manufacturers Microlabs, Mylan and Jubilant, are making the drug, so the demand requirements are not being fulfilled. This has induced a panic within the people. People are seen standing outside pharmacies for hours in order to buy the drug for their families. "I have been standing in line for two hours. Even then, I can see at least 200 people still waiting in front of me," said Indore resident Abhijit Singh, who had come to get Remdesivir for his father, told NDTV.
Reasons for shortage
Manufacturers like Cipla, Dr. Reddy's Laboratories, Mylan, Jubilant Generics, Hetero Healthcare and Zydus Cadila were among the companies that that tied up with Gilead Life Science for making generic versions of Remdesivir under a voluntary licence. Most of these companies further employed more contact manufacturers to provide a superior supply of the drug.
By September 8th 2020, these manufacturers had cumulatively made 2.44 million vials of the drug, according to the Ministry of Chemicals and Fertilizers. Since then the manufacturing capacity for the drug increased and around 3.16 million vials of the drug was manufactured in a month. But soon after that, the Covid caseloads started to shrink and by December 2020, the companies stopped manufacturing the drug as they were left with large piles of unused vials.
This slowdown has affected the supply chain now. Since the cycle from production to transportation to distribution was hampered, it took time for the chain to revive again and therefore the subsequent shortage of the drug emerged.
Injudicial usage of Remdesivir
There has been a reported misuse of the drug as it should not be prescribed to all the covid patients. The Indian Medical Association (IMA) had earlier sensed the irrational use of the drug and urged the medical authorities to conduct a judicial usage of the drug. The Centre urged the physicians to use the drug only on Covid patients who required oxygen support. The IMA emphasised that according to the clinical management protocol for Covid-19 which has been released by the Union Health Ministry, Remdesivir is only to be used in emergency cases and has no role in treating mild cases of covid.
Head of India's Covid-19 Task force, Dr. V K Paul even said that "It is an investigational drug. Its role has been clearly defined in the clinical management protocol. There is no question of the use of Remdesivir in home settings. It is unethical. It is only required for those hospital patients who are on oxygen. That is the pre-condition", reported The Indian Express.
The IMA said, "As there has been a cap on the cost of the drug by the government which is now available at a much less cost compared to 2020. The affordability of the drug make the public to demand it use for their kith and kin, ever when there is not an absolute indication to use. This unjustified request must be resisted by the medical professionals, as the availability of the drug will be of more benefit to a patient who has absolute indication," reported NDTV.
What is Remdesivir
Remdesivir, which was originally manufactured in 2014 for the treatment of the Ebola virus and Haemorrhagic fever, did not turn out to be very effective against either. However, it was effective to some extent against SARS-CoV-2, the virus that causes Covid-19. On June 1st 2020, the usage of Remdesivir was approved for the treatment of Covid-19. Thereafter the government issued guidelines for the usage of the drug in hospitals for treatment.
Remdesivir contains the growth of the virus at the replication stage by dissolving the RdRp enzyme necessary for its RNA replication. Therefore, the usage of the drug on patients who haven't reached the replication state does no good.