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Editorial

How Remdesivir Became A Matter of Life And Death

A group of angry people picketed a chemist at a big hospital in Pune when he said that the injection Remdesivir was out of stock. 6 individuals in Chandigarh,2 in Pune, and probably hundreds of such individuals all across India were arrested by the police after they were caught selling Remdesivir in the black market. There are reports of a single vial of Remdesivir selling for 10x the MRP. So what is this magical drug? Why is there a shortage? Why is there a black market thriving around it? And What is the government doing to solve its shortage? Let’s find out.

About Remdesivir

Remdesivir is an anti-viral medication currently being used to treat the COVID-19. It is originally created and developed by Gilead Sciences. Remdesivir was developed in 2009, to treat hepatitis C and respiratory syncytial virus(RSV) but failed to treat these diseases. In 2015, it was later found effective against Ebola and Marburg Viruses. The drug has currently been given an Emergency Use Authorization(EUA) by the United States Food and Drug Administration(US FDA) as well as Central Drugs Standard Control Organization in India.

The drug is quite expensive and is currently facing a shortage in India. This has caused a vicious cycle of panic-buying, hoarding, and black marketing where people are having to pay more than ten times the MRP for the medication. After the first wave of COVID-19 subsided in India pharma companies cut down on production. After the number of reported cases started to decline in September 2020, the demand for Remdesivir slumped. Companies that were left with excess stockpiles were forced to destroy them. The volume of infections and the severity in the second wave was unprecedented and the demand for the drug went up.  The already expensive Remdesivir was now being hoarded and people had to resort to the black market to buy it. 

The Economics Behind Remdesivir

  • Remdesivir currently is manufactured by 7 major pharmaceutical companies apart from other smaller ones. The companies being Mylan, Hetero, Jubilant Life Sciences, Cipla, Dr. Reddy’s, Zydus Cadila, and Sun Pharma. Hetero is the largest manufacturer of Remdesivir by numbers. India currently has a production capacity of ~38-40 lakh vials per month.
  • According to a statement by Mansukh Manadaviya, the Minister of State for Chemical and Fertilizers,  Hetero produces 10.50 lakh vials a month, Cipla makes 6.20 lakh vials, 5 lakh vials are produced by Zydus Cadila and Mylan produces 4 lakh vials. The remaining drugmakers produce vials in the range of 1 lakh and 2.5 lakh a month. He also stated that the production will be increased to around 78 lakh vials per month soon.  

  • There was a recent ‘voluntary’ reduction in price for the drug by major pharma companies. Since the distribution of Remdesivir is a haywire affair where there is uneven distribution, black marketing, and shortage of the drug, certain state governments have restricted its sale ONLY to hospitals. This move is aimed to reduce the black market of the drug where people end up paying ten times more for the drug. The government has also banned its export and cut down all import duties on the drug.
  • In the past month, the stir around the drug has definitely benefitted the share price of pharma companies. Cadila’s share price has been up by 28% in the past 1 month, CIPLA has been up by 24%, Dr. Reddy’s Laboratories has been up by 19%.
  • There is also a shortage of another drug Tocilizumab. In India, the drug is manufactured only by Cipla in partnership with Swiss-pharma company Roche Holdings AG. Similar to the case of Remdesivir, an excess demand for the drug might positively impact Cipla’s share price and revenue. 
  • While Jubilant Pharmova has been up 16%, its share price surged 8% when it announced that it had developed an oral form of Remdesivir apart from the regular injection administered. Jubilant Pharmova’s share gained special attention a month ago when ace-investors Rakesh Jhunjhunwala and his wife Rekha Jhunjhunwala increased their stake in the company.

The Hidden Picture

So far there hasn’t been a strong clinical trial report that supports the use of Remdesivir. What remains unknown is the sudden spike in usage of this one particular drug. World Health Organisation(WHO) had approved the drug for emergency usage only in the case of patients with high symptoms. For patients with mild symptoms, other drugs were prescribed. Dexamethasone is another recommended drug that costs just about Rs 6- Rs 12 in the retail market as against the few thousands paid for Remdesivir. There are other drugs prescribed for patients with mild to moderate symptoms that are cheaper than Remdesivir. 

In November 2020, WHO advised AGAINST the use of Remdesivir for treatment of COVID-19 patients. Excess use of Remdesvir can lead to a severe immunogenic reaction called the Cytokine Storm which can be fatal. The body starts to attack its own cells and tissues instead of just the virus. Even the European Union decided not to go ahead with authorizing Remdesivir after it had stockpiled the drug. Despite the global negative outlook, Indian doctors have continued to prescribe the relatively expensive drug. There might be a false demand being created over here since patients with mild symptoms are prescribed other drugs like Fabiflu, Hydroxychloroquine, Favipiravir. Treating COVID-19 might not be an expensive case after all. 

The director of AIIMS Delhi, Dr. Randeep Guleria has said that Remdesivir isn’t a magic bullet. He also said that ”Giving treatment when it is not required, you may be doing more harm than good”.

Drug Regulators, Health ministers, and agencies have advised doctors to judiciously prescribe Remdesivir, that too only for patients with severe symptoms. While pharma companies struggle to meet demand, they are facing flack from government bodies. Major Remdesivir manufacturers have companies of political pressure, calls from local corporators MLAs, and MPs. 

Pharma companies need to assess ramping up production of these vials as they face the risk of a glut/overproduction. The second wave of the deadly coronavirus has hit with an unprecedented magnitude. Individually, states have started to impose lockdowns. One can expect an increased production of Remdesivir by respective pharma companies. It won’t be before one month that we get a clearer picture of the second wave of COVID-19. Until then, Stay Home, Stay Safe!

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Market News Top 10 News

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Editorial

Vaccine Wars: Can India Come Out on Top?

The world is now searching all over for COVID-19 vaccines. Vaccines have become a diplomatic tool for countries to expand their domain and improve ties with other countries. Countries like India, China, Russia, UK have been ahead in the race for vaccine production and have now started using their vaccines as a tool for diplomacy. The European Union(EU) and the UK have locked horns with each other, India and China are competing fiercely in what is being termed as a ‘Vaccine War.’ What is the whole ‘Vaccine War’ all about? Let’s find out. 

EU vs Britain: Bad Blood on Brexit Still On?

The UK and European Union haven’t been on good terms since they parted ways, and the UK stopped being a part of the European Union. In the COVID-19 situation, European Union and the UK depend on the same source for their vaccine, the British-Swedish Pharma company AstraZeneca. AstraZeneca is manufactured in the UK and the Netherlands. The UK, apart from domestic production, also ‘imports’ vaccines from Europe. AstraZeneca had earlier promised 12 crore vaccines to the European Union. It could not meet its commitment to Europe and reduced the pledge to 3 crore vaccines in the first quarter.

European Union says that the UK had imported vaccines from Europe and had reciprocated by exporting them. This had led to a shortage of vaccines in Europe. So much so that some countries like Hungary inoculated Russia’s Sputnik-V vaccine, even when the European Union had stated that it had no intention of doing so.

The EU has said that if the vaccine shortage continues and the UK does not reciprocate by exporting vaccines, there might be a ban on the export of vaccines from the EU. The UK is leading the way in Europe in terms of the number of people vaccinated. Likewise, countries in the European Union are way behind in the race. 

India and China’s Vaccine Wars

India has come up with two vaccines so far – COVAXIN by Bharat Biotech, COVISHIELD manufactured by Serum Institute of India. On the other hand, China has three vaccines – CoronaVac, CanSino, and BBIBP-CorV. India has the upper hand in vaccine production since, even before the COVID-19 pandemic, India manufacture 60% of all vaccines across the world. India is using this as a tool for diplomacy. Seeing this, Chinese Manufacturers like Sinopharm, Sinovac, and many other vaccine producers have started ‘ramping up’ their annual production capacity. 

India has so far donated eight crore vaccines to developing countries. Developing countries do not have that kind of money to buy these vaccines and vaccinate their citizens extensively. India and China are trying to win the goodwill of these very countries. China has donated vaccines to more than 52 countries globally, mostly middle and low-income in the Asia-Pacific and Carreibian Region.

Both China and India are trying to generate popularity through vaccines. India is doing so through its Vaccine MAITRI program, wherein it donates vaccines to friendly developing nations.

While some countries awaited vaccines from China, India had already delivered the vaccines to them. Sri Lanka was awaiting Chinese vaccines in January when it put the Chinese vaccines on hold and got its first lot of vaccines from India as a part of the Vaccine MAITRI program. At the same time, India has also bagged orders for exporting several million vaccines on a commercial basis.

A question remains, is India compromising on its citizens while making an applaudable humanitarian and political move? While India is facing a surge in COVID-19 cases, it has already exported a few crore vaccines in the form of grants. Delhi High Court has questioned this move. 

“We are not utilizing it fully. We are either donating or selling it to foreign countries and are not vaccinating our own people. So there has to be that sense of responsibility and urgency,” a bench led by Justices Vipin Sanghi and Rekha Palli said.

While developed countries like the USA have managed to vaccinate close to 16% of their population, countries like India and China that have the upper hand in vaccine production barely managed to vaccinate even 2% of their citizens. China has only recently started vaccinating its citizens above the age of 60; before that, the vaccine was available to only critical COVID-19 frontline workers. 

India’s Advantage In Vaccine Diplomacy

India has managed to earn goodwill among countries that could not rely on US or UK-based vaccines, which might be expensive. India’s ‘Neighbourhood First Policy’ has ensured that it provides its neighbours like Bangladesh, Bhutan, Sri Lanka, Seychelles, and Mauritius with the vaccine before delivering it to other countries. Such a move will strengthen India’s geopolitical position with the neighbouring countries. 

India will have an advantage over China in terms of diplomacy. China did offer vaccines to India’s neighbouring countries, but India’s efficiency in producing these vaccines ensured that its vaccine reached them first. 

While the west is dealing with its own political and economic problems, India’s vaccines act as a support system for countries that cannot afford expensive vaccines. India’s Pharmaceutical sector will see a boost.

Since India produces 60% of the world’s vaccines, with increasing demand for the COVID-19 vaccine, even western countries will start importing vaccines from India. India’s vaccines do not have a good brand value in highly developed countries. However, this reputation is changing in the global markets gradually.  If India becomes the global production and supply centre, India’s GDP will benefit from vaccine production.

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Moderna Vaccine Submitted for Approval

Covid-19

Moderna submitted its 95% success rate vaccine for approval from USFDA(United States Food and Drug Administration). The company said that they have enough information on the trials conducted, and they are proceeding with their application. The clinical trials from more than 30,000 volunteers showed the vaccine prevented virtually all symptomatic cases of Covid-19.

Moderna expects that on December 17, the FDA will be ready for a public meeting to discuss this data. They will also seek approval from the European Medicines Agency. Moderna shares price went up by 20% in the US as a reaction to the news. The vaccines may be available for commercial use this month and the supply will also be limited.

To know more about the stocks that could benefit from Covid-19 vaccines, click here.

Moderna received more than $1 billion in U.S federal government funding to develop and produce its vaccine. They have also received $1.5 billion to supply it to the American public as soon as it is available in the market. India is also likely to get Moderna’s vaccine through the COVAX facility, which is a global initiative to bring together governments and manufacturers to ensure and accelerate the development and manufacturing of Covid-19 vaccines. India hasn’t signed any advance purchase agreement for Moderna’s vaccine.

For more details about the approval of Moderna’s vaccine visit here.