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Tocilizumab is nowhere to be found, and no one seems to know of next availability

States like Delhi, Maharashtra, Chandigarh, Kerala and Chhattisgarh have complained of acute shortage of tocilizumab. The drug is used to treat Covid and rheumatoid arthritis.

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New Delhi: A search for tocilizumab sent Ghyas Khan, a 29-year-old based in Mumbai who was looking for the Covid-19 drug for his uncle in Kolkata, to fraudsters and black marketeers in India’s financial capital.

“My uncle is hospitalised in Kolkata. Had I found the medicine I would have taken a flight to West Bengal,” he told ThePrint about his futile search for the injection.

“Since we weren’t able to find the drug, the doctor gave him an alternate medicine. But in the process of searching for the medicine, I came across a fraud who asked for Rs 10,000 in advance per vial. Another man offered one vial of the drug for Rs 2 lakh. This drug is nowhere to be found,” he said.

Delhi-based Jatin Singhal went through a similar ordeal but in his case, the outcome was the death of a relative.

“My aunt was undergoing treatment in a private hospital in Delhi. Her blood oxygen saturation level was below 80 and she was being administered remdesivir regularly. Since her condition was not improving the doctor prescribed tocilizumab for her,” said Singhal, adding that his aunt’s family, including husband and son, had also tested positive for Covid and were undergoing treatment.

Singhal too came across several frauds and black marketeers. “It is so shameful that people are trying to profit off somebody’s suffering. Because we couldn’t find the injection on time, my aunt passed away,” he added.

These are not isolated incidents. According to reports, several states, including Delhi, Maharashtra, Chandigarh, Kerala and Chhattisgarh, have complained of acute shortage of this drug.

Also read: How this Surat govt hospital cut Covid patients’ admission wait to 15 minutes from 5 hours

What tocilizumab is used for and its import in India

Tocilizumab, currently being used to treat critically ill Covid patients, is originally a rheumatoid arthritis drug. It helps to reduce pain and swelling due to rheumatoid arthritis. It is also used to treat giant cell arteritis.

According to the Union Ministry of Health and Family Welfare protocol, tocilizumab anti IL-6 therapy can be considered in Covid patients with moderate disease with progressively increasing oxygen requirements, and in mechanically ventilated patients who are not improving despite use of steroids.

Tocilizumab belongs to a class of drugs known as Interleukin-6 (IL-6) blockers. Interleukins are cytokines or proteins that are involved in immune system cell signalling. The drug works by blocking IL-6, a cytokine produced by the body that plays a key role in transitioning inflammation from acute to chronic.

This immune-suppressing drug is manufactured by Roche, a Swiss pharmaceutical company. It is not manufactured in India. Pharma giant Cipla is the sole importer of the drug in the country.

The cost of a single vial ranges from Rs 40,000-50,000. However, black marketeers are offering a single vial for as much as Rs 2 lakh — nearly four-five times the actual price.

In a statement on 16 April, Cipla had said, “Given the spike in cases and surge in demand, we are facing a shortage and are working closely with our partner in taking necessary steps to ensure availability of the drug. We expect intermittent supplies as the demand outstrips supply with some more receipts at the earliest.”

In a response after the report was published, a Cipla spokesperson said, “As per the latest Central government directive, Tocilizumab will only be supplied to authorised government and private hospitals. We have hosted contact details of relevant State FDA on our website.”

A Roche spokesperson said, “We have observed an unprecedented demand for Tocilizumab (Brand: Actemra) given the significant increase in Covid cases across India in the last few weeks. We are responding to this situation with supplies over this and the coming weeks to meet the immediate emergency demand. However, we are mindful that the current unprecedented demand may far exceed the supplies we can provide at this moment.”

Also read: Tejas aircraft tech comes in aid of oxygen-starved Indian cities. This is how it works

‘Have written to Centre, state but to no avail’

On 25 April, Sandeep Nangia, the president of Delhi’s Retailers and Distributors Chemist Association, circulated a message asking people to “be patient” since the stock of tocilizumab had run out.

Speaking to ThePrint, he said, “Since the second wave started we haven’t had any fresh stocks of tocilizumab come in. This means that since 25 March there have been no new stocks of this medicine, we are daily getting 500-1,000 requests and calls for this medicine but we cannot help them.”

Asked if pharma companies have given any assurance of supply, he said, “For the last one month we have been getting weekly dates where they tell us that the drug will be supplied but to no avail. The next date for fresh supply is tomorrow.”

Another chemist in Delhi said on condition of anonymity, “Up to 50 people are turning up daily requesting this drug. We want to give it to people but there is absolutely no supply, where do we get it from?”

Dr Harjit Bhatti, a doctor in a Delhi government hospital said, “As of now we prescribe tocilizumab only to certain patients who we think might need it. We place an order for the drug with our hospital authorities and we are provided with the medicine. Since we haven’t seen much impact on mortality in patients to whom it is administered, we are only selectively prescribing it.”

Dr P.K. Bhadwaj, a surgeon with Saroj Hospital in Delhi, said, “I want to keep it short and tell you there is no tocilizumab available to hospitals or individuals right now. We have all written to the Centre and state but to no avail.”

This report has been updated to include responses by Cipla and Roche spokespersons.

(Edited by Amit Upadhyaya)

Also read: Countries failed in a global response to prevent India’s ‘tragic’ Covid crisis, Dr Fauci says


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