India is prioritising the supply of a potential coronavirus drug to its own people by banning exports, as other countries, hospitals and even individual doctors join the global grab for an unproven treatment hailed by US President Donald Trump as a game-changer.
The world’s largest exporter of generic drugs, India has recommended that its healthcare workers and high-risk individuals use the antimalarial drug hydroxychloroquine to try to prevent Covid-19 infections.
There has been a surge in global demand for both hydroxychloroquine and chloroquine, a similar drug with greater side effects, despite a lack of solid scientific evidence that they work against the novel coronavirus.
India is one of the largest producers of hydroxychloroquine, with drugmakers Zydus Cadila and IPCA Laboratories among the biggest manufacturers. The country has also banned exports of the active pharmaceutical ingredient in the drug.
“We are at the moment ramping up our production of hydroxychloroquine to meet the requirements to about 150m to 200m pills a month”, Zydus Cadila said.
An early study from France last week suggested chloroquine could be helpful, but it was carried out on small numbers of patients and without the rigour of a randomised control trial. Another small trial from China, published on Tuesday, showed the drug had no impact. Larger trials — including one in New York and a multinational programme run by the World Health Organization — are just starting.
Mr Trump has touted the drugs frequently from the White House podium and in tweets, sparking a surge in US hospitals stockpiling the drugs for Covid-19 patients and individual doctors procuring supplies for themselves and their friends and families.
In the US, several states are now limiting prescriptions to the tens of thousands who already take the drug, concerned that patients with conditions such as lupus and rheumatoid arthritis who need it may struggle to get their prescriptions filled.
Patrice Harris, president of the American Medical Association, admonished doctors for panic prescribing. “The AMA is calling for a stop to any inappropriate prescribing and ordering of medications, including chloroquine or hydroxychloroquine, and appealing to physicians and all healthcare professionals to follow the highest standards of professionalism and ethics,” she said.
There have been reports in local media of overdoses of chloroquine, which can cause acute poisoning, by people confused by misinformation around the drug’s effectiveness for Covid-19, including in the US, Nigeria and Vietnam.
Supply chain experts believe there are many other sources of the active ingredient for hydroxychloroquine beyond India, including Finland, Hungary, China and South Korea.
Manufacturers such as Teva, Mylan, and Novartis have promised to increase supply — and some are giving the drug away for free. Novartis said it had enough active pharmaceutical ingredients for 80m doses, while Mylan, which manufactures in the US, said it had enough for 50m. Teva did not respond to a request for comment.
But one person familiar with the matter warned that India’s ban on the export of chloroquine, or its active ingredients, could cause “a major issue”, as it appears to be the only producer.
New Delhi’s restrictions play into wider fears in Europe about the continent’s reliance on India and China for many generic drugs and active pharmaceutical ingredients.
Adrian van den Hoven, director-general of Medicines for Europe, the generic drugs industry body, said the supply of hydroxychloroquine and other potential drugs for Covid-19 needed to be monitored. This was becoming more pressing because some doctors were already prescribing the drugs against the coronavirus and they were needed for trials.
“We have already alerted the [European] Commission to the need to take action around this,” he told the Financial Times. “We need to have an assurance plan for Europe to supply experimental needs — and also to co-ordinate physicians.”