Monday Musings: When the state-controlled sale of a drug is a good thing

PUNE On Sunday afternoon, when the entire city was locked-in and roads were deserted as part of the weekend shut down, a video went viral. The video was of a woman crying inconsolably when she failed to get Remdesivir for her family member, despite standing in a long queue for hours, from 5 am, at the medical association’s office in Shukrawar peth, the heart of Pune.

The woman was not the only one to have made desperate attempts to procure the antiviral drug for their near and dear ones in the last few days. For the past one week, Pune has witnessed a terrible shortage of this expensive, and much- hyped drug, which is being prescribed on a large scale by doctors, leading to its scarcity.

This in effect has led to black marketing and overcharging.

Those with money and connections could easily procure it, while others, sans both, are left to scramble.

In the absence of any other specific medicine that can cure Covid-19, Remdesivir was first touted as an efficient antiviral against the Coronavirus in the United States.

In India, it was made part of the treatment protocol for Covid–19 under emergency use authorisation since July 2020.

In November 2020, interim results from trials conducted by the World Health Organisation revealed four of the commonly used drugs – Remdesivir, malaria drug hydroxychloroquine (HCQ), an anti-HIV combination of lopinavir and ritonavir, and the immunomodulatory, Interferon – provide little or no benefit in reducing fatalities in hospitalised patients.

The interim results showed “there is currently no evidence that Remdesivir improves survival and other outcomes in these patients”.

Yet doctors in Pune and the rest of the state have been prescribing it, while the Maharashtra government too has sought an additional supply of antiviral drug from six companies that produce it.

On April 8, Maharashtra health minister Rajesh Tope chaired a meeting with manufacturers of Remdesivir. During the meeting Tope asked manufacturers to double the production for the state, which is getting around 50,000 doses each day. According to Tope, the state will start getting around 75,000 doses from April 15. At the same time Indian government has banned export of Remdesivir and Remdesivir active pharmaceutical ingredients (API) till the Covid-19 situation in the country improves, as per an order issued on Sunday.

In fact, the March 23, 2021, guidelines issued by the Maharashtra government retained Remdesivir for severe cases battling Covid-19. The protocol prescribes Remdesivir 200 mg on day 1 followed by four doses of 100 mg for the next four days.

While the medical world may have been divided on the use of Remdesivir, it’s the patients who are now seeking the drug, which they consider life-saving, even when their kin are not in critical situations.

Many believe the drug can save patients from the killer Coronavirus and go in for panic buying. Even as study published in The Lancet journal in November 2020, said, “For patients with mild or moderately severe Covid-19 and no need for respiratory support, Remdesivir does not offer significant benefit at day 28 and its use is not recommended. For individuals at high risk of hyperinflammation, who are diagnosed early during illness (≤10 days) and require supplemental oxygen, Remdesivir shortens the time to recovery and reduces the risk of progression. This clinically important endpoint is cost-effective in some health-care settings.

Under these circumstances, Pune district administration has taken the commendable decision that will counter the black-marketing of drug and prevent its sale above the MRP.

On Saturday, Pune district collector Rajesh Deshmukh issued an order preventing over-the-counter sale of Remdesivir. The order allows hospitals to provide the injection to patients and not ask family or relatives to buy the drug.

The hospitals, according to the order, can place an order of Remdesivir with a supplier keeping in mind the requirement for patients undergoing treatment.

Suppliers will have to provide a daily sale report of the drug, including hospital name, associated chemist’s name, bills, and total sale to the Pune Food and Drug Administration (FDA).

For a change, the controlled sale of the drug can stop people standing in long queues and yet returning empty handed without the drugs.

It can also prevent the indiscriminate use of drug, currently being prescribed to anyone and everyone.

Thank you for subscribing to our daily newsletter.