COVID-19: The Elusive Remdesivir and a Catastrophe in Maharashtra
India exported close to 11 lakh Remdesivir injections in the past 6 months, with very little oversight on domestic production but a clear focus on exports. It was probably a part of the grand scheme of accruing international goodwill for our venerable Prime Minister. Domestic production of the drug is at around 3.9 million units a month and recently, when the Central Government banned its exports, the media gave off the impression that we will suddenly have around over seven million units available for the local market. Sadly however, that is far from the truth.
The export units are presently hoarding their stocks because the Centre hasn’t negotiated any prices with them. Local retail prices are capped in most states, (it is between Rs 1100 and Rs1400 in Mumbai), but these prices are not acceptable to the exporters. The Centre should have stepped in and made good the difference, but like all true masterstrokes of the Modi Government, this export ban was also just to manage headlines; they could not be bothered with the fine print that would lead to actual availability.
Sadly, based on opinions voiced by reputed doctors and even statements given by officials from the World Health Organisation, Remdesivir may not even be a cure for COVID-19 – it is effective only in certain cases of lung involvement. Yet in Mumbai, as is the case throughout India, doctors prescribe it in the first instance, probably to hedge their risks.
The current rules say that it cannot be sold in retail. Hospitals are supposed to procure it through the FDA (Food and Drug Administration). The FDA in Mumbai has supposedly worked out a formula to issue the drug to COVID hospitals based on hospital strength and drug availability. The hospital has to requisition the Zonal Drug Inspectors who then allots them the quantity as per their formula.
What is really happening in Mumbai is that the BMC and some of the bigger private hospitals had the foresight and funds to procure stock beforehand, but most private hospitals didn’t. In fact the BMC Commissioner faced flak for buying Remdesivir at a higher price, but his timely act actually may have saved a lot of lives. The catch is how to get admitted to a BMC facility.
The ideal process is that the moment you test positive one of 240 BMC ground teams is supposed to visit, assess and admit you. That does not happen at all. People just run pillar to post when their condition becomes serious and desperately knock on doors till they get admitted. On April 20, a patient whose oxygen saturation percentage was fluctuating between 73 to 80 was turned away twice from BKC Jumbo Covid Centre and was finally admitted only when the issue was escalated. Also, the BMC cannot legally share its stock with any private hospitals or citizen, not even with any other municipal body; so yes, while the BMC has a large stock Remdesivir, patients who need it just cannot get it.
The private hospitals who don’t have stocks of Remdesivir are at the mercy of the FDA Drug Inspectors who are largely unresponsive. So, the hospital tells the patient's relatives to produce Remdesivir, often giving one or two doses and then asking them to get the balance, causing extreme anxiety to famililes who are under pressure to get the next dose within 24 hours or face the possibility of treatment coming to a halt. Often hospital staff themselves approach patient’s relatives and offer them the vials at usurious rates from black markets.
The government, in an attempt to show the citizens that it would act against hospitals who abdicate their responsibility, started an FDA Helpline for Maharashtra on 1800222365. No one answers this helpline. Period. A list of Zonal Drug Inspectors was made public but 80% of these inspectors did not answer our calls at all, ever. So our team visited the FDA office in Bandra East. We saw an empty call centre on the second floor for the so-called helpline and when we questioned them they said the calls were being answered at the reception. There were precisely two desks at the reception with just two lines for all of Maharashtra! No wonder calls went unanswered.
We tried to meet Commissioner Abhimanyu Kale who made us wait for an hour but did not meet us. Later that day he was shunted out from his job, either due to incompetence or more likely, for tipping off BJP leaders to stocks of Remdesivir before it could reach hospitals. Then we met Mr. Tirpude who is in charge of management of Remdesivir across Mumbai. The gentleman sat in his chair but did not even allow us to be seated. He told us he had zero responsibility on behavior in hospitals or on complaints of citizens. His only job was to inform hospitals on how much supply was available based on their formula, and with which distributor. The FDA has clearly abdicated its responsibilities and their sleepy office shows how unconcerned they are about the pandemic and the suffering of Mumbaikars.
The state government should ideally be policing these hospitals but there is close to no action from them. Ever since the Bruck Pharma and Devendra Fadnavis fiasco the state police is raiding likely hoarders, but policing is now required at the hospital level. The state Health Ministry needs to swing into action – a hospital should prescribe Remdesivir if it is really needed and only if the hospital has the stock. Any hospital prescribing drugs which they do not have, should stand to lose their license. This is not the time to be sluggish, or forgiving, the city is at breaking point and swift action is the need of the hour.
The writer is a spokesperson for the Aam Aadmi Party. The views are personal.
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