New Delhi: India, popularly known as the pharmacy to the world, is on everyone’s radar for its supply of hydroxychloroquine (HCQ).
The anti-malaria drug is believed to be a possible cure for the Covid-19 pandemic, which has infected over 1.35 million people and killed more than 75,290 world over. After spreading from Wuhan in China, the epicentre of the outbreak moved to Europe and North America. Currently, the US has the most number of cases (over 3.67 lakh) while Italy has recorded the most number of deaths (over 16,500).
The US, Spain, Italy and Germany make up for more than 7 lakh of the total cases in the world.
India, which at present has over 4,400 cases, can produce over 20 crore tablets of 200 mg of HCQ every month. But manufacturers say this capacity can be scaled up to about 30-35 crore tablets every month.
Before the outbreak, the domestic requirement for HCQ was around 20 lakh tablets per month.
While a few clinical trials have shown limited success of the drug, scientists have warned against a widespread use of HCQ to battle Covid-19, which has no known cure, treatment or vaccine as of now. So, why has HCQ emerged as the front-runner?
Also read: Hoarding chloroquine won’t cure coronavirus
Hydroxychloroquine & its uses
The popular anti-parasitic medication has been around since the 1940s. It’s been used to treat malaria.
HCQ is a derivative of chloroquine, and has fewer side-effects.
Chloroquine works by increasing the levels of haem or heme — a substance toxic to the malarial parasite — in the blood. This kills the parasite and stops the infection from spreading.
According to some Chinese studies, “chloroquine has strong anti-viral effects on SARS-CoV infection of primate cells”. SARS-CoV-2 is the novel coronavirus causing the Covid-19 infection.
One study showed that chloroquine interferes with “terminal glycosylation of the cellular receptor, angiotensin-converting enzyme 2”. What this means is that it negatively influences the virus-receptor binding, which ultimately terminates the infection.
Tech entrepreneur Elon Musk also tweeted that chloroquine was “maybe worth considering” as a potential treatment.
Maybe worth considering chloroquine for C19 https://t.co/LEYob7Jofr
— Elon Musk (@elonmusk) March 16, 2020
Earlier used for treatment of rheumatoid arthritis, India has been using the drug to treat Covid-19 patients along with the antibiotic, azithromycin.
Further, the government ordered 10 crore pills of HCQ after the apex medical research body, the Indian Council for Medical Research (ICMR), advised the use of HCQ for prevention among high risk categories — healthcare workers and relatives of confirmed patients.
Rise in global demand
Apart from receiving requests for “sizeable” orders from the US, around 30 countries including Brazil and a several SAARC nations, have reached out to India for a supply of HCQ.
Reportedly, Indonesia, Australia and Germany have also reached out to Indian manufacturers of the drug.
As the demand grew while the number of cases climbed, India banned the export of the drug “without any exceptions” and with “immediate effect” on 4 April. Incidentally, on the same day, President Trump said he had spoken to Prime Minister Narendra Modi requesting India to release a US order of the drug.
“I called Prime Minister Modi of India this morning. They make large amounts of Hydroxychloroquine. India is giving it a serious consideration,” Trump said during his daily news conference at the White House.
The government Tuesday decided to partially lift the ban on the export to clear “all existing orders”.
How well stocked is India?
The restrictions on exporting HCQ were put in place to ensure India’s domestic supply wasn’t hit. The Ministry of Health and Family Welfare had last week ordered production of 10 crore tablets of HCQ.
The central government’s affordable medicines scheme, Jan Aushadhi Pariyojana, is additionally ordering 1 crore tablets for its retail outlets.
“The industry has assured us that it will reserve 10 crore tablets before approving any export order,” a government official said last month after taking stock of the drug availability in India.
According to the price and drug availability watchdog, the National Pharmaceuticals Pricing Authority (NPPA), India has a production capacity of 40 metric tonnes, which means 20 crore tablets of 200 mg per month.
India’s capacity for producing the active pharmaceutical ingredient (API), the raw materials needed for making the drug, stands at 38 metric tonnes per month, whereas it is capable of adding 20 metric tonnes more — approximately 30 crore tables per month.
According to the internal estimates of the industry, Ipca Laboratories, Zydus Cadila and Mangalam Pharmaceuticals are the top manufacturers of the API whereas Cipla, Ipca Laboratories, Zydus Cadila and Wallace Pharmaceuticals are top producers of the formulations or finished tablets.