India prioritizes supply of potential coronavirus drug to its own population by banning exports, while other countries, hospitals and even individual doctors join the global crisis for untreated treatment proven hailed by US President Donald Trump as a game changer.
India, the world’s largest exporter of generic drugs, has recommended to healthcare professionals and those at high risk to use hydroxychloroquine, an antimalarial, to help prevent Covid-19 infections.
There has been a sharp increase in global demand for hydroxychloroquine and chloroquine, a similar drug with more significant side effects, despite the lack of solid scientific evidence against the new coronavirus.
India is one of the largest producers of hydroxychloroquine, with drug manufacturers Zydus Cadila and IPCA Laboratories among the largest manufacturers. The country has also banned exports of the drug’s active pharmaceutical ingredient.
“We are currently increasing our production of hydroxychloroquine to meet the requirements at around 150-200 million tablets per month,” said Zydus Cadila.
A first study conducted in France last week suggested that chloroquine could be useful, but it was carried out on a small number of patients and without the rigor of a randomized control trial. Another small trial from China, released on Tuesday, showed that the drug had no impact. Larger trials – including one in New York and a multinational program run by the World Health Organization – are just beginning.
Trump has often touted drugs from the White House podium and in tweets, causing a surge in US hospitals storing drugs for Covid-19 patients and individual physicians procuring supplies for themselves, their friends and their families.
Several states in the United States are now limiting prescriptions to the tens of thousands of people who are already taking the drug, fearing that patients with lupus and rheumatoid arthritis who need it may have trouble filling prescriptions.
Patrice Harris, president of the American Medical Association, chastised the doctors for prescribing panic. “WADA calls for the cessation of all inappropriate prescriptions and orders for drugs, including chloroquine or hydroxychloroquine, and calls on physicians and all health professionals to follow the highest standards of professionalism and ethics “, she said.
There have been reports of overdoses of chloroquine, which may lead to acute poisoning, by people confused by false information about the effectiveness of the drug for Covid-19, including in the United States, Nigeria and Vietnam.
Supply chain experts believe that there are many other sources of active ingredient for hydroxychloroquine beyond India, including Finland, Hungary, China and South Korea.
Manufacturers such as Teva, Mylan and Novartis have promised to increase the supply – and some give the drug for free. Novartis said it had enough active pharmaceutical ingredients for doses of 80m, while Mylan, which manufactures in the United States, said it had enough for 50m. Teva did not respond to a request for comment.
But a person familiar with the matter warned that India’s ban on the export of chloroquine or its active ingredients could pose “a major problem” because it appears to be the sole producer.
New Delhi restrictions heighten fears in Europe about the continent’s dependence on India and China for many generic drugs and active pharmaceutical ingredients.
Adrian van den Hoven, managing director of Medicines for Europe, the generic industry body, said that the supply of hydroxychloroquine and other potential drugs for Covid-19 should be monitored. It was becoming more and more urgent because some doctors were already prescribing coronavirus drugs and they were needed for the trials.
“We have already alerted the [European] Commission the need to take action on this, “he told the Financial Times. “We need to have an insurance plan for Europe to meet the experimental needs – and also to coordinate the doctors.”