In the last month, India went from reporting around 25,000+ Covid-19 cases to 1,85,000+ cases. The beds are filling up quickly, and though India has done exponentially well in the first wave, the second wave is testing not only the governments and health system but the public in general too.
Though the so-called intellectuals and elite are pushing for another lockdown, India cannot afford another nationwide lockdown. Hence, the union and state governments are pushing for micro containment zones, night curfews, tracing and vaccination.
Amidst the increasing numbers, the demand for the ‘miracle drug’ Remdesivir has increased by several folds. While the manufacturers like Cipla have already announced that they are increasing the production, more manufacturers are getting permission to manufacture the drug to meet the demand in the market. To understand why there is so much demand and if it is actually a miracle drug against Covid-19, it is important to understand what this drug is, how it works, when it was tested for Covid-19, what experts say and why there is a need to control the panic caused by its ‘shortage’.
What is Remdesivir?
Remdesivir is an antiviral medication that was created by an American organisation Gilead Sciences. It was developed in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The aim was to identify therapeutic agents for treating RNA-based viruses that can result in a global pandemic. initially, it was tested against hepatitis C and a cold-like virus called respiratory syncytial virus (RSV). The drug was not effective in either cases. However, it showed promising results against other viruses. During the Ebola virus outbreak in 2014, the assembled library for the drug Remdesivir was utilised to identify and prioritise compounds with efficacy against the Ebola virus. Further studies in cells and animals suggested that it was effective against viruses in the coronavirus family, such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).
How Remdesivir works?
The drug belongs to a class of antiviral drugs that defeat the infection by posing as legitimate chemical building blocks of a DNA or RNA sequence. They get themselves stitched into the nascent strand and mess up the whole replication process of the virus. In short, Remdesivir poisons the viral replication process. The interesting part of the whole process is that it does not mess up with the human cells’ own polymerases. Though Remdesivir is much better than many other antiviral medicines available in the market, according to experts, it is far from perfect.
When was Remdesivir first tested against Covid-19?
In May 2020, the US Food and Drug Administration (FDA) issued an emergency use authorisation for Remdesivir for the treatment of Covid-19 in adults and children hospitalised with severe disease. In India, the Drug Controller General of India (DCGI) gave permission for the trial of Remdesivir in May 2020. On June 4, DCGI had approved the use of Remdesivir lyophilised powder for emergency use in patients hospitalised with severe COVID-19.
What are experts’ views about Remdesivir?
Though the drug has shown promising results against severe Covid-19 infection, the experts believe that it is far from being the perfect cure. According to the results of a study published by the National Institute of Health, the final results showed that the treatment using Remdesivir was beneficial. The patients who received the drug were quicker to recover. The study also found that there was an improvement in mortality rates for those receiving supplemental oxygen.
The study suggested that the use of Remdesivir may prevent patients from progressing to more severe respiratory disease. Dr John Beigel of NIAID said, “Our findings show that Remdesivir is a beneficial treatment for patients with COVID-19. It may also help to conserve scarce health care resources, such as ventilators, during this pandemic.” However, the study added that the drug alone was not sufficient treatment for all patients.
WHO had warned against usage of Remdesivir
In November 2020, World Health Organization (WHO) recommended against the use of Remdesivir in Covid-19 patients stating that there was no evidence that the drug can improve survival. Recently, while talking to India Today, Dr Soumya Swaminathan, Chief Scientist at WHO and its Technical Lead on COVID, Dr Maria Van Kerkhove, recommended against it. Swaminathan said, “Based on available evidence, there were about five trials… which essentially showed that Remdesivir given to hospitalised patients, didn’t reduce mortality, it didn’t reduce the duration of hospitalisation, and it didn’t affect the progression of the disease”.
She further added that there is a silver lining with the use of the drug, though. She said, “there are smaller studies that have shown, in some small subgroups, perhaps some marginal benefits, like some patients who need low flow oxygen, the NIH trial showed that there was perhaps a marginal mortality benefit, but that is a very small subgroup of patients.” As WHO is still waiting for the results of more studies, it is not recommending the use of Remdesivir in Covid-19 patients.
Why is there a shortage of Remdesivir in India?
Several factors have caused the shortage of Remdesivir. The first being the suddenly increased number of Covid-19 cases in the country, especially in Maharashtra. The state alone has reported over 60,000 cases in a single day on April 13. The other states like Uttar Pradesh, Chhattisgarh, Gujarat, Kerala, Tamil Nadu, Rajasthan, Karnataka and others are reporting a large number of cases that have suddenly increased the demand for the drug in these states.
As a result, black marketers and hoarders saw an opportunity and started using the spike in cases as a way of earning illegitimate money. On April 9, Mumbai Crime Branch recovered 272 injections of the drug in a shop in Andheri. The drug should cost between Rs.1,000/- to Rs.2,000 as per the price set by the governments and manufacturers, in black, the same drug goes for Rs.7,000/- and above. Some reports suggest the price is even higher in some cases. According to a report in Money Control, in a letter to the DCGI, LocalCircles said that many posts and comments received from various cities of India have quoted the drug was being sold for as high as Rs 50,000 that was over ten times the retail price of the drug.
What are the governments and manufacturers doing about the shortage?
To control the panic that has built up around the availability of the drug, the union government and state government have capped the price of the drug in the market. On April 11, the government of India banned the export of Remdesivir from ensuring the availability of the drug. On March 24, Zydus Cadila, one of the manufacturers, dropped the price of the drug to Rs.899/- per injection. On April 8, the Maharashtra government capped the price between Rs.1,100/- to Rs.1,400/-. On April 9, Nagpur collector issued an order capping the price of the drug to 10% above MRP.
The leaders are working on the local level as well to ensure the drug is available in the market. On April 11, Union minister Nitin Gadkari requested Sun Pharma to arrange 10,000 injections for Nagpur. On April 13, Cipla announced that it would double the production of Remdesivir to meet the demand in the market. On the same day, Dr Reddy’s Laboratories (DRL) got permission to produce the drug. On April 14, UP CM Yogi Adityanath directed the health department to urgently acquire the drug from Ahmedabad. The government of India has issued an order that suggests Remdesivir should only be used for the patients on oxygen.
Though the governments and manufacturers are doing their best to ensure the drug is available in the market, it is essential for the public not to create a panic. The law enforcement agencies must speed up the process to track hoarders and take strict action against them as per the law.
It is also very important to take the precautions as suggested by the Health Ministry and avoid going out unless it is necessary.