Millions of Indians have to pop pills daily to keep their blood pressure intact, glucose under control, fight infections, keep check on growth of their cancer cells and importantly, carry on with their lives.
To get a pill from lab to medicine cabinet, is a complex operation even in normal times. The measures deployed to contain the COVID-19 pandemic over last one month, has threatened to undermine the entire pharma supply chain, starting from sourcing raw materials to manufacturing, logistics and supply chain.
Yugal Sikri, Managing Director, RPG Life Sciences narrated the unprecedented chaos and disruption his company has to go through to bring a life-saving medication Azathioprine to patients in India.
To be sure this could may well be the story of many other pharma companies who were trying to ensure patients get their medicines. The government extended lockdown up to May 3, but will be relaxing some restrictions in areas with no new cases from April 20 onwards.
Azathioprine sold in India by RPG Life Sciences under brand name Azaron is also its flagship product having a dominant share in the market.
Azathioprine is decades old immunosuppresant drug, that's given to patients who have undergone organ transplant. The drug prevents the body from rejecting the transplanted organ, and has to be taken by the patient for months. Azathioprine is also prescribed to patients suffering from autoimmune diseases like such as rheumatoid arthritis.
Follow our LIVE Updates on the coronavirus pandemic here
Raw material sourcing problem
Like most other Indian drug makers, RPG Life Sciences too depends on China for its raw materials. In this case the intermediate of Azathioprine comes from suppliers based in Hubei province - where the epicentre of the novel Coronavirus outbreak, Wuhan city, is located.
Indian companies typically stock-up on raw materials before the Chinese Lunar New Year. The Lunar New Year is a major holiday season in China, when factory workers return to homes. The holiday season typically begins on January 25 and will last to February 8, for about 15 days in total. This time due to COVID-19 outbreak and subsequent countrywide lockdown, several provinces in China extended holiday season and workers did not return to the factories. Hubei, which is also a major hub for pharmaceutical manufacturing, was the worst hit.
Back in India, with every passing day, the inventories of Azathioprine were dwindling. With Hubei province seeing no signs of coming to back to normalcy - the senior executives at RPG started to worry.
This is when India started reporting cases. Italy, Iran and South Korea were firefighting rising coronavirus infections. Indian government on March 24 declared nationwide lockdown to contain the pandemic.
Sikri recollects the first thing that the company's management did was to call a series of virtual townhall meetings of its 1,100 odd employees and contractors who supply labour and other services to factories.
"We told our employees that we are not like any another company, we are a pharmaceutical company. We are essential part of healthcare services and staying home isn't an option. We are dealing with organ transplant medicines and these patients are also vulnerable to COVID-19 infections. Our duty is to ensure medicines we are manufacturing should reach patients," Sikri said about the broad message they were trying to drill in their employees in those townhalls.
"We explained our employees about social distancing and personal hygiene measures, and assured that the organisation will take care of their safety," Sikri added.
Sikri told that the pep talk did help employees to lift their morale and made them feel that they are part of a larger healthcare ecosystem.
Soon Sikri and his crack team rolled up their sleeves and jumped into action.
While RPG had some raw materials, packaging material in hand, but it was clearly short of key materials needed to make the drug.
"We got in touch with raw material suppliers in China, we apprised them about the situation. They put us on priority list. When Hubei province began to ease restrictions, we were the first to get the intermediates," Sikri said.
There were issues at ports, but we managed to get shipment of our raw materials to India. Lockdown in Hubei province was eased on March 24.
RPG Life Sciences has two manufacturing units. One in Navi Mumbai that makes Azathioprine active pharmaceutical ingredient (API) and the other is a formulation plant that makes finished dosages in Ankleshwar, Gujarat. Both the factories are little over 200 miles apart.
"The biggest problem we faced was getting workers to the factory. Some workers were stopped and a few were beaten up by police. This was happening despite government allowing pharmaceutical factories to function. Some workers stopped coming fearing police action," Sikri explained.
He added, "We took necessary permissions from authorities, arranged transport, gave employees copies of government notification exempting pharma operations from lockout to show it to police. We devised shifts in a way that, an employee works two shifts continously, and takes a full day off. This cut the number of times that the employee had to commute to work place. We spoke to contractors, and ensured that contract workers stayed at the factory. They were provided accommodation and food," Sikri explained.
The company finally managed to produce the APIs. Then the crucial step is to get the API batches tested for quality.
To test the API batches, RPG Life Sciences relied on outside pharmaceutical services provider. But that company wasn't functioning due to lockdown. "We managed to get that company open, and got the quality personnel with great difficulty. Finally the batches were cleared," says Sikri.
Now the API had to be shipped to Ankleshwar plant. Transporters were unwilling to move the material. "We pleaded transporters to help us. They agreed but were charging three to five times more than the original transportation cost," Sikri said.
The API material started its journey to Ankleshwar plant. Here again getting workers was an issue.
Anlkeshwar plant is located in a rural area. This time the problem was with gram panchayats. They were not letting people in their villages to step out for work, fearing infections.
"Our managers reached out to panchayats, showed them the videos of our factory and the social distancing and safety measures we took. Finally they relented. There was a problem with availability of packing materials like cartons, strips because those manufacturers were also not functioning. We managed with whatever inventory we had," Sikri said.
Finally the Azathioprine API was converted into tablets and ready for consumption.
Distribution in haywire
Here comes the most important phase - distribution. The finished product now had to be distributed across the country.
There are about 20carry and forwarding( C&F) agents across India. But a few of the C&F agents were located in the containment zones. A containment zone is a specific geographical area where positive cases of COVID-19 are found. Strict movement restrictions were imposed in such zones to prevent further spread of the virus. "It was like siege," said Sikri.
From C&F agents - the medicines had to move to stockists.
"We deal with 1,300-1,400 stockists across length and breadth of India. We need to ensure the goods need to reach stockists, if they have to reach the last mile retailer. Again transport was a big issue, but we were able to deliver medicines to stockists," Sikri said.
After medicine reached stockist, the responsibility falls on company's field force to take orders from retailers and pass it on to the stockist. It was a challenge for the management to motivate them to go on field to take orders.
"The regular pep talks by senior management helped. Some went out on their motorcycles to take orders, some booked order over telephone. But there were instances where the stockists were not able to deliver orders, because their employees were unable to reach the warehouses due to restrictions of lockdown," Sikri said.
Reaching out to patients directly
Meanwhile RPG Life Sciences started seeing surge in enquiries from patients, who were concerned whether they would be getting their medicines or not. Some started calling, some reached out through their website.
The company collected contact numbers and addresses of patients, and passed it on to the concerned field force person.
"I told my guys now here's the opportunity to prove that we really care for our patients, we made sure that the medicine is hand delivered at the patient's doorstep," Sikri said.
Sikri said as token of appreciation, we created a nice template with a photograph of the employee who delivered the medicine and circulated instantly across our whatsapp groups.
"We faced hundreds of hurdles in the journey, but what makes me really proud that every single person who wrote to us got his medicine," Sikri said.Follow our full COVID-19 coverage here