As anti-viral remdesivir flew off the shelves across several states, an India Today investigation found several touts and pharmaceutical vendors black-marketing the drug six times its official price.
The injectable drug has been repurposed for Covid-19 treatment and was cleared by the country's top drug regulator for restricted emergency use in June 2020 on patients with severe complications.
As the cases peaked from the new surge, several states complained about shortages of remdesivir.
Following tips, an India Today investigation found sharks in the pharma supply chains exploiting the grim situation, selling the medication by obscene amounts, with no real guarantees about the genuineness of the drug.
On April 17, the central government capped the price of remdesivir currently manufactured by seven companies in India.
A 100-mg vial of the drug manufactured by Cadila now has a maximum retail price of Rs 899, Syngene's Rs 2,450, Dr. Reddy's Rs 2,700, Cipla's Rs 3,000, Mylan's Rs 3,400, Jubilant's Rs 3,400, and Hetero's Rs 3,490.
THE REMDESIVIR SHARKS
A drug tout India Today TV investigated at Gurugram offered remdesivir, purportedly manufactured by Hetero, for Rs 20,000 a vial, almost six times its new MRP.
"You need four [vials], right? It will cost Rs 80,000," Sam Yadav told India Today TV's reporter. "That's how the rates are, brother. Till yesterday, it was available at Rs 17,000. Today it's not. It's Rs 20,000 a vial today."
Sam Yadav demanded immediate payment in cash, without a bill. "The payment has to be made right here. Only then will I give you the injection."
At Delhi's Yusuf Sarai market, vendor Ravindra at the Helpline Medical Store agreed to supply remdesivir for around Rs 14,000 a vial. He claimed the product would be smuggled out of a hospital.
"You will get remdesivir. You'll get two doses. It will be smuggled out of a hospital. The MRP would be erased," Ravindra said. "Two doses will cost around Rs 28,000-29,000. If you confirm now and make an advance payment, I'll get the two doses for you in half-hour."
A DEBATABLE DRUG
Remedisivir is a prescription drug. In India, six doses are usually recommended for the sickest hospitalised patients for over five days.
Earlier this month, the government banned exports of remdesivir injections and its active pharmaceutical ingredients in order to meet rising demands at home.
The effectiveness of the drug in Covid treatment is debatable though.
WHO THUMBS DOWN REMDESIVIR IN COVID CARE
In October, the World Health Organization (WHO) found the medication has little or no effect on preventing deaths from the new coronavirus.
"The evidence suggested no important effect on mortality, need for mechanical ventilation, time to clinical improvement, and other patient-important outcomes," a WHO recommendation on remdesivir said in November.
International health experts wonder why the drug is still being prescribed so widely in India.
"UK guidelines, Stanford US guidelines, or even WHO guidelines have clearly said that there is no clear evidence (of remdesivir) which has any impact on patient mortality, patient need for mechanical ventilation, or any other important outcome factors for patients," Dr Aviral Vatsa of NHS Scotland said.
He cautioned that the drug can be tried only in specific situations, and that also in a tiny minority of critical patients, which account for five to ten per cent of the total Covid cases.
"If at all there's any weak recommendation in UK and US guidelines, it is in very specific patients, which for example, are hospitalized. No home-isolating patients need remdesivir. They should not be given that. Even in hospitalized patients, which would be five to ten per cent of the whole positive patient population - only five to ten per cent - even in that the very minority of them on which remdesivir can be tried in specific situations," Dr Vatsa noted.
He emphasized that central drug authorities should update their guidelines about remdesivir based on the evidence of its efficacy in Covid treatment.
"That why clinicians are prescribing [remdesivir] in India beats me. Why is it happening? But one thing I can think of is that they don't have time to analyze data, they don't have time to go and look at what evidence is there although it is six months now that the WHO provided that. But still, it is the duty of the centralized body to continuously analyze, update evidence and then update the guidelines."
With the swelling caseload fuelling demands for the drug, the central government, however, announced plans to boost remdesivir production in the country.
— Mansukh Mandaviya (@mansukhmandviya) April 18, 2021
"The current total installed capacity of the seven manufacturers of remdesivir is 38.80 lakh vials per month," said a recent government statement. "Fast-track approval has been given for seven additional sites having the production capacity of 10 lakh vials/month to six manufacturers. Another 30 lakh vials/month production is lined up. This would ramp up the production capacity for manufacturing to around 78 lakh vials/month."
MAKING THE HAY WHILE DEMANDS SOAR
For now though, the black-marketeers are found to be making hay while the demands sour.
A vendor at Starmax Medical store in Delhi's Saket, Mohit, offered a 100 mg Hetero vial five times the MRP.
"You'll get them. We'll give them to you for 18,000 [Rs a vial]. It will be Rs 36,000 for two," he said. "We'll give you the injection outside [the store], not inside."