Shortage of key coronavirus drug remdesivir fuels illegal market in India
New Delhi — Dinesh's 70-year-old father was admitted to a hospital in Mumbai, India's financial capital, earlier this month after testing positive for coronavirus. When his condition worsened, doctors prescribed remdesivir, a broad spectrum antiviral medicine cleared for restricted emergency use by several countries, including India.
But the hospital had run out of the drug, so doctors asked Dinesh (not his real name, as he wished to remain anonymous) to find his own supply.
"I am glad I could get it on the black market, otherwise I may have lost my father," he told CBS News. But finding the drug, one of just a few proven to help COVID-19 patients, wasn't easy.
He said he "ran between drug stores" and made "hundreds of phone calls" before finally securing a course of the medicine — at 10-times the market price. He paid 40,000 Indian rupees ($533) for just one 100 mg dose of the drug, which normally costs only about $66. He bought six of those vials, the dose an adult patient is supposed to receive, forking out a total of 240,000 rupees or about $3,200.
That's a price that only a small percentage of people in India could hope to afford.
Demand, but little supply
Remdesivir, an anti-viral drug that has been used for years to treat Ebola, has been shown to speed the recovery time for coronavirus patients in a U.S. clinical trial. It works by attacking an enzyme that a virus needs to replicate inside human cells.
But that success has seen demand surge, and the medicine is in short supply in India, which currently has the world's third-worst COVID-19 epidemic with almost 1.2 million cases and over 28,000 deaths.
The demand has created a thriving illegal trade in the drug.
"We had no option but to pay the higher price," Delhi resident Pankaj (who also asked that his real name not be used), told CBS News.
Three of his family members were hospitalized with COVID-19. One of them, his 52-year-old uncle who has an underlying disease, became severely ill. Doctors put him on remdesivir injections, but after two days the Delhi hospital ran out.
"We first tried buying it from the market but it wasn't available," said Kumar. "But we managed to make contact with a person who arranged it for us at a price of 40,000 Indian rupees (USD 533)." That's about eight times the official price.
"We didn't even think about the inflated price at that moment… all that was on our mind was to save the life of our patient," Kumar told CBS News. His uncle is still in the hospital, but feeling better after the remdesivir injections.
Crackdown
Indian authorities have started cracking down on the people behind the illicit market in remdesivir.
Last week, police in Mumbai and Hyderabad said they had broken up a ring involving nurses, hospital staff, pharmacy staff and dealers, arresting 14 people in all for selling the drug illegally, at about six times the market price. Police said they also recovered 23 vials of the medicine from those taken into custody.
CBS News made contact with several individuals who had helped supply other coronavirus patients or their families with illegally sourced remdesivir. When asked if the drug was available, one of the middlemen said we would have to, "wait for a couple of weeks, as the police are very active and conducting raids."
The Mumbai arrests involved police posing as customers looking to buy remdesivir, which appeared to be making people in the black market supply chain more cautious.
Another source, who works in the pharmacy industry in India, told CBS News that hospital staff had a "big role to play" in the illegal sales of the drug. "They siphon off the supplies to drug stores, who sell them to desperate patients."
Why the shortage?
The patent on remdesivir is held by the original manufacturer, California-based pharmaceutical giant Gilead Sciences. In June, the Trump administration struck a deal with Gilead to secure its next three months' worth of remdesivir production (500,000 doses) for U.S. hospitals. The controversial purchase came as the U.S. saw coronavirus cases soar into the millions. America has the worst epidemic on the planet right now, with more than 145,000 deaths confirmed.
But the block order left negligible stocks of the life-saving drug for the rest of the world.
"The U.S. is the worst affected country by coronavirus, but that does not give them the right to buy the entire world stock of the drug," Dr. Andrew Hill, a senior visiting research fellow at the University of Liverpool's pharmacology department, told CBS News.
Even before the U.S. secured virtually all of Gilead's remdesivir stocks, the pharmaceutical company signed licensing agreements in May with nine companies in India, Pakistan, and Egypt to manufacture and distribute generic versions of the drug in 127 countries, "nearly all low-income and lower-middle income countries, as well as several upper-middle- and high-income countries," according to a Gilead statement.
But while the deal was signed in May, only three of the nine companies have actually started production of their own versions of the drug. The delay has been due, in large part, to the companies waiting for approvals from respective authorities in their own countries.
Fixing the "supply gap"
The three companies now making their own versions of remdesivir are all in India. Cipla, Hetero Labs, and Mylan all started production after the Drug Controller General of India (DGCI) approved their drugs for restricted emergency use in COVID-19 patients. A fourth Indian company, Jubilant Life Sciences, has also received approval and is set to begin production soon.
Cipla has been selling its remdesivir drug, under the brand name CIPREMI, in India since July 8. One dose sells for a fair 4,000 Indian rupees.
"Given the unprecedented demand for the drug, we have ramped up our capacity and that of our partner network. We aim to supply over 80,000 vials within the first month itself, and expect the demand-supply gap to normalize in the next few weeks," Cipla told CBS News.
Hetero Labs has launched its drug under the brand name COVIFOR, priced at 5,400 Indian rupees per dose, while Mylan launched its version on Monday, branded as Desrem and priced at 4,800 rupees.
It's not clear yet how many doses can be produced by the nine companies in India, Pakistan and Egypt over the next three months. But Hill, of the University of Liverpool, said it will be "nowhere near enough."
"There is not enough remdesivir in the world at the moment… and it's a difficult drug to make — it takes time," he told CBS News. "I would say countries should prioritize the use of much cheaper and as effective drug, dexamethasone," he said.
Given the limited production thus far, all the three companies in India are distributing their products directly to hospitals in a bid to prevent illegal sales.
They have also launched phone helplines for information on the drug's availability.
Until there is enough supply to meet the demand, however, many will keep looking to illegal suppliers.
"I understand the black marketing should stop, but at the same time the government should ensure enough stocks are available," said Dinesh in Mumbai, whose father is also still recovering in a hospital.
