Coronavirus pandemic | Hydroxychloroquine: Here's all you need to know about the emerging antidote

As coronavirus continues to go on a rampage, infecting people and taking lives across the globe, a warrior drug –hydroxychloroquine – which is being used to cure symptoms, has garnered global interest.

Earlier this week, US President Donal Trump warned of “retaliation” if India did not heed to his request for the drug. On the other hand, Brazilian President Jair Bolsonaro thanked Prime Minister Narendra Modi for supplying raw materials so that the Latin American country can continue to manufacture the drug.

Here’s all you need to know about the emerging antidote:

What is hydroxychloroquine?

Hydroxychloroquine is a drug which is used in the treatment of malaria. Doctors also prescribe hydroxychloroquine for the treatment of rheumatoid arthritis (inflammation of joints) and lupus (an inflammatory disease when the immune system attacks its own tissues).

Where is hydroxychloroquine manufactured in India?

82 percent of India's hydroxychloroquine is manufactured by Ipca Laboratories in Mumbai; 8 percent by Zydus Cadila Healthcare in Ahmedabad; and the remaining by Wallace Pharmaceuticals, Torrent Pharmaceuticals and Oversees Healthcare Pvt Ltd.

Several countries source the drug from India. About 80 percent of the volume manufactured by Ipca Laboratories is exported.

How did hydroxychloroquine come into the picture?

A study published in the International Journal of Antimicrobial Agents (IJAA) pointed out, “Azithromycin (an antibiotic) added to hydroxychloroquine was significantly more efficient in virus elimination.”

However, the study was flagged for lack of explanation on the scope and inclusion criteria to draw a definite conclusion. Last week, the International Society of Antimicrobial Chemotherapy, which owns IJAA, said the study “did not meet the society’s expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety”.

But, by March 21, Trump had started rooting for the drug, even calling it a “game changer”. This had led to panic buying in the US, and consequent shortage of the drug, affecting patients of rheumatoid arthritis and lupus.

What is India’s stance on the drug?

The Indian Council of Medical Research (ICMR) has recommended the use of hydroxychloroquine for health care workers treating COVID-19 patients, and has allowed doctors to prescribe it for household contacts of people who have tested positive for coronavirus.

However, the Union Health Ministry has reiterated that the drug should be used for the treatment of COVID-19 only on the prescription of a doctor. It is not an over-the-counter drug and cannot be sold without prescription. Health Ministry Joint Secetary Lav Agarwal had strongly advised against use of the drug for prevention purposes, and had even warned of side effects as it is still under trial.

How much HCQ does India manufacture?

According to a report in The Indian Express, hydroxychloroquine had a market size of Rs 152.80 crore in the 12 months ended February 2020.

According to Pharmaceutical Export Promotion Council, India exported $36.41 million worth of HCQS in April-February 2019-20.

According to government data, India is capable of producing 40 metric tonnes of HCQ every month, which is approximately 20 crore 200 mg tablets. The government has said that current stocks are adequate to service domestic demand and export commitments, but it is monitoring the sale of the drug, CNBC-TV18 reported.

The government has also placed an initial order of 10 crore tablets with Ipca Laboratories and Zydus Cadila. Drug Pricing Authority NPPA chairman has said that manufacturers have started meeting government orders. If clinical trials of HCQ prove that it can treat patients successfully, production of the drug can be scaled up.

Does India have enough hydroxychloroquine for it to export?

On April 4, India had decided to ban the export of the drug. But, four days later, the Centre decided to ease the ban.

The US, which has reported one of the maximum number of cases, has been looking to procure the drug from India for emergency use.

Besides, the Union Health Ministry, in a press conference on April 9, told media persons that India has sufficient volume of the drug and that it is being exported only after keeping future projections in mind.

Domestic manufacturers have reportedly ramped up production to meet the demand.

Is hydroxychloroquine actually effective?

The jury is still not out on the effectiveness of the drug, as it is still under clinical trial. The WHO is conducting a trial, of which India too is a part, where doctors are to follow a common protocol to treat COVID-19 patients with hydroxychloroquine.

Another trial –the chloroquine accelerator trial – is being funded by the Bill and Melinda Gates Foundation and the Wellcome Trust.