New Delhi: With black fungus officially an epidemic, Amphotericin B, an antifungal medicine used to treat the infection commonly known as black fungus, is in high demand. States are reeling under a severe shortage and the central government is scrambling to boost imports and domestic manufacturing.
But one state is an exception — Bihar.
The eastern state is well stocked with Amphotericin B. The reason: The drug is also used to treat Kala Azar (black fever), a disease that India has been trying to eliminate, and Bihar is the Kala Azar capital of the country.
Kala Azar is caused by a parasite named Leishmania donovani. Symptoms include fever, enlarged spleen and liver, weight loss, discolouration of the skin of hands and feet (hence the name) and anaemia. The disease spreads through sand flies. One of the exercises undertaken in the national Kala Azar elimination programme is spraying of insecticides to prevent the flies from thriving.
Till April, 332 of the total 447 cases of Kala Azar reported in the country this year were in Bihar, according to data available with the National Vector Borne Disease Control Programme (NVBDCP). In 2020, 72 per cent of the 1,964 Kala Azar cases reported in India — or 1,424 — were in Bihar.
“We have adequate stocks of Amphotericin B because we have a very high burden of Kala Azar and the drug had already been procured for that purpose. Just this morning, we had a meeting to review the situation of Kala Azar, Japanese Encephalitis and Acute Encephalitis Syndrome,” Bihar Chief Secretary Tripurari Sharan told ThePrint.
A 2007 article in the journal Clinical Infectious Diseases by researchers from the Kala Azar Research Centre at the Banaras Hindu University sought to explain how the drug came to be used for the disease: “Amphotericin B deoxycholate has been used in India for treatment of visceral leishmaniasis (kala azar) for >1 decade. Its rediscovery as effective treatment for Leishmania donovani infection was spawned by the development of large-scale resistance to conventional pentavalent antimony therapy in Bihar state.”
Multiple Kala Azar elimination deadlines missed
India has set multiple deadlines to eliminate Kala Azar — including in the Union Budget presented in 2017 — and missed all of them. The latest deadline was 2020. That was reportedly missed because of the Covid-19 pandemic.
The largest number of Kala Azar endemic districts is in Bihar — 33. West Bengal follows with 11 districts, and then come Uttar Pradesh (6) and Jharkhand (4). According to the NVBDCP, approximately 165.4 million, or 16.54 crore, people in these four states are at the risk of the disease. All the three states except Bihar have reported a shortage of the mucormycosis drug — Uttar Pradesh, West Bengal, and Jharkhand.
In a statement issued on 21 May, the Union Ministry of Health acknowledged that there is a shortage of the drug. “There is also a reported shortage of Amphotericin-B, an anti-fungal drug used for treatment of the black fungus disease. The Union Ministry of Health along with the Department of Pharmaceuticals and the Ministry of External Affairs (MEA) are making proactive efforts for significantly ramping up domestic production of Amphotericin-B drug,” it said.
The statement added: “The Union Government has also made effective efforts in supplementing the domestic availability through securing supply from global manufacturers. There are five existing manufacturers of Amphotericin-B in the country and one importer. The production capacity of these companies was extremely limited in the month of April 2021. As a result of the handholding by Government of India, these domestic manufactures will cumulatively produce 1,63,752 vials of Amphotericin-B in May 2021. This will be further ramped up to 2,55,114 vials in the month of June 2021.”
Six more companies have since been given licence to manufacture the drug.
India has so far recorded 11,717 mucormycosis cases. Earlier this month, the central government invoked the Epidemic Diseases Act to make it notifiable, which means states and UTs have to inform the central government every time a black fungus case is reported.
The surge of black fungus cases has come as India battles the second Covid wave. The central government has said a link between the disease and excessive use of steroids in Covid treatment can’t be denied.