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Exclusive: COVID-19 Drug Remdesivir In Short Supply, Prices Go Up By 6x In Black Market

While Cipla's drug is yet to be available in the market, Hetero's initial supply of 20,000 vials is nearly exhausted.

Jul 6, 2020 / 05:06 PM IST

Rajeev*, 38, was tested COVID-19 positive last week.  He complained of breathlessness on July 4, and his family members rushed him to a leading private hospital in Navi Mumbai.

He was immediately put on oxygen support, and doctors prescribed him antiviral drug Remdesivir.

He needs to take Remdesivir for five days, 200 mg IV (intravenous) on day one followed by 100 mg IV daily for four days.

To the dismay of his family members, the hospital informed that it has run out of Remdesivir stock, and they need to get the drug from outside for administration.

The ordeal for the family has begun. The family members have reached out to other hospitals and distributors but the answer was either no stock available or wait for 4-5 days.

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A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

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There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

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Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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In the black market, Remdesvir was being quoted at Rs 30,000 per 100 mg vial; that's almost six times the retail price of the drug manufactured by Hetero. After using some influential contacts and making calls to the company directly, they were able to secure two doses, which were enough for the next two days. But not many are as lucky as Rajeev's family to have the right connections to get access to the drug.

In Delhi too, there are reports of Remdesivir shortage.

Recently, the India Express reported that with the exception of Seven Hills Hospital in Mumbai, other Bombay Municipal Corporation (BMC) hospitals such as KEM Hospital, Sion Hospital and Nair Hospital, which are treating a large number of COVID-19 patients, are yet to begin the use of the investigational anti-viral drug. But BMC hospitals would be soon getting the drug as the corporation has placed an order with Hetero.

Sources in Max Hospitals told Moneycontrol that they have sufficient stock of Remdesivir for their in-patients.

Fortis said, "There is shortage to some extent, since the drug is now approved as a first line treatment for moderate to severe COVID-19 disease and demand has increased. At Fortis, we are currently managing through inter-unit transfer of available stocks within the hospitals based on requirements. We have received support and assurance of fresh supplies soon from the manufacturer. We understand that other manufacturers are also entering the market shortly, and hopefully that will ease out the supply shortage to some extent. We are not aware of any black marketing of Remdesivir."

Max and Fortis have the largest bed capacity dedicated to COVID-19 in the private sector in Delhi and Mumbai.

"While there is a genuine shortage of Remdesivir, a certain portion of supplies is getting diverted to the black market, where they are sold at a huge premium," said a person who is aware of the matter on condition of anonymity.

There are close to 7 lakh reported coronavirus cases in India, of which 2.5 lakh are active cases. While four-fifths of those cases are asymptomatic and mild, the remaining 20 percent are moderate, requiring oxygen support. Remdesivir has been approved by the Indian drug regulator for treating such moderate cases on oxygen support.

Shortages continue

Though it's been almost two weeks since the approval of Cipla and Hetero generic versions of Remdesivir by the Drug Controller General of Inda (DCGI), the patients are struggling to get access to the drug, even as the companies scramble to ensure supplies.

Cipla's drug is yet to be available in the market and Hetero's initial supply of 20,000 vials is nearly exhausted.

Hetero has orders from BMC (15,000 vials) and the Tamil Nadu government (42,000 vials) to supply the drug. The company says it directly supplies to private hospitals in Delhi and Mumbai.

A Cipla spokesperson told Moneycontrol that its Remdesivir is on track, and should be launched in the next 2-3 days. According to sources, Cipla's partner has the manufacturing capacity to supply up to 50,000-80,000 vials per month.

Cipla has priced the drug at Rs 4,000 per 100 mg vial, compared to Hetero's Rs 5,400. For bulk orders like the BMC, Hetero is supplying at Rs 4,144 per vial.

"Hospitals are approaching us for supplies, we are ramping up production. The manufacturing is currently going on, from July 7 onwards new supplies will come into the market," a Hetero spokesperson told Moneycontrol.

"Manufacturing of Remdesivir is a complex process; adding to that, it is an injectable drug. That's the reason why it's taking some time," the spokesperson added.

Hetero has set a target to produce one lakh vials of the drug by mid-July.

The DCGI, meanwhile, has also approved Mylan's version of Remdesivir. Along with Cipla, Hetero, and Mylan, Gilead has licensing deals with Jubilant Life Sciences, Dr Reddy's , Zydus Cadila and Syngene to manufacture and distribute Remdesivir in India and 126 other countries.

(*Name changed to protect identity)
Viswanath Pilla is a business journalist with 14 years of reporting experience. Based in Mumbai, Pilla covers pharma, healthcare and infrastructure sectors for Moneycontrol.
first published: Jul 6, 2020 05:06 pm
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