As India battles a massive second wave of Covid-19 infections, its drug makers are under pressure to deliver vaccines and medicines.
Called the “pharmacy of the world”, India’s sprawling factories were expected to supply the bulk of Covid-19 vaccines and medicines to the world.
However, a record jump in coronavirus cases in a country of more than 1.3 billion people is putting the sector under strain. India’s health ministry reported 346,786 new infections on Saturday and 224,959 new cases on Sunday.
“The pharmaceutical industry does need to ramp up its infrastructure to facilitate higher production of essential [drugs and vaccines],” says Dr Nikhil Mathur, chief of medical services at the Care Group of Hospitals.
India is the world’s third-largest pharmaceutical market by volume, the largest provider of generic medicines and is the biggest manufacturer of vaccines, with the market projected to reach $130 billion by 2030, according to Invest India.
One of the sector’s major selling points is that its pharmaceutical manufacturing costs are 33 per cent lower than in the US. But as the country struggles to meet its domestic needs, it has been forced to slow its exports of Covid-19 vaccines and medicine and direct them into the local economy to support its struggling health care system, which is buckling under the weight of the pandemic.
“Across cities, there have been reports of shortages of hospital beds, ventilators, oxygen supplies and medications,” says Dr Mathur. “As a result, many patients are not able to receive the necessary care and treatment they should.”
There is also a “major shortage of life-saving drugs”, including Remdesivir and Tocilizumab, he says.
Sumit Goel, the managing partner and practice leader for health care, pharmaceuticals and life sciences at Praxis Global Alliance, says there is an acute demand-supply gap of certain antiviral drugs used in the treatment of Covid-19, due to the sharp increase in number of new infections.
“So, the stress is localised to some drugs and not sector-wide. However, industry and government are taking steps to ramp up the capacity and promote the judicious use of drugs to address this challenge.”
The Indian government this month banned the export of Remdesivir and its active pharmaceutical ingredients to meet local demand for medicine. This will be in place “until the situation improves”, the health ministry said.
However, the ban has resulted in a thriving black market for the drug, which is being sold for several times its retail price, according to local media reports.
India’s pharmaceutical sector could help address Asia’s third-largest economy’s ballooning health crisis but it needs its own shot in the arm, experts say.
“The pharma sector has the capabilities,” says Karnvir Mundrey, director of Bengaluru-based Atharva Lifesciences Consulting. “There are many perspectives to this. It involves logistics, capabilities and government.”
But amid mounting pressure, many believe the sector is well placed to tackle the challenges.
“We have significantly reduced our dependence from China for active pharmaceutical ingredients,” says Rahul Darda, chairman and managing director of Brinton Pharmaceuticals. “In the past few quarters, we have [also] significantly improved our manufacturing and distribution capabilities.”
The government has blamed the current health crisis on people flouting Covid-19 guidelines. However, crowded election rallies, including one addressed by Prime Minister Narendra Modi, and the Kumbh Mela religious pilgrimage that drew thousands to the banks of the Ganges have been contributors to the current surge in infections.
Mr Modi has said he does not want to impose another nationwide lockdown due to the devastating economic impact, although the governments of the worst-hit states of Maharashtra and Delhi have imposed their own movement curbs.
The vaccination drive is a key part of the government’s strategy to battle the pandemic. However, the programme has been slower than expected, with 138 million doses administered, health ministry data reveals.
Doctors say that the drive needs to be ramped up, given the sheer size of India’s population. More vaccines are now needed to meet India’s growing demands. The country has insisted there is no ban on the export of the Covid-19 vaccines it manufactures.
However, figures on the website of the country’s health ministry reveal that exports have slowed, compared with earlier this year when the country was exporting tens of millions of doses. The last shipment was over a week ago to Syria and Albania, the data shows.
India manufactures two Covid-19 jabs. One is the Oxford-AstraZeneca vaccine, which is made locally by the Serum Institute of India in Pune, Maharashtra. The other is a home-grown shot made by Bharat Biotech in Hyderabad.
Even as millions of doses are being produced, some states have reported shortages. Serum Institute chief executive Adar Poonawalla told Indian news channel NDTV this month that he was “very stressed”.
The institute, which operates one of the world’s biggest vaccine factories, already produces more than 60 million Covid-19 doses a month. In reaction to the supply challenges, the government has taken steps to boost production. The finance ministry on April 20 approved $610 million in funds to enable the Serum Institute and Bharat Biotech to to scale up the manufacture of Covid-19 jabs.
The move was welcomed by the manufacturers. This comes as India plans to widen its vaccination drive to include everyone over the age of 18 from May 1. The government will also allow manufacturers to sell half of their supply to state governments and on the open market.
“The promising directives will help to scale up vaccine production and allow the state governments, private hospitals and vaccination centres to procure vaccines directly,” says Mr Poonawalla. “For the next two months, we will address the limited capacity by scaling up the vaccine production.”
But Indian pharmaceutical manufacturers face another challenge: a US ban on the export of raw materials needed to produce Covid-19 vaccines and other medicines.
Amid these hurdles and due to the country’s massive need for jabs, India is also turning to vaccine imports.
The country authorised the emergency use of Russia’s Sputnik V jab, which will also eventually be manufactured locally. It plans to fast-track approvals for other vaccines that have been approved for use in the western world and Japan, paving the way for the shipment of Covid-19 shots produced by Pfizer and Johnson and Johnson.
“Increased production will take care of the future cases while importing jabs will help stabilise the immediate healthcare needs of the country,” says Dr Mathur.
Even though such challenges persist, “the pandemic has definitely reinforced India’s role as a pharmacy to the world”, says Mr Mundrey.
“India has not only been producing the AstraZeneca vaccine but is one of the very few countries to have developed its own vaccine.”
The country also has other jabs under development, including one by Ahmedabad-based Zydus Cadila, which could also soon get the green light.
“India will continue to play a pivotal role in the global pharma sector as we have a strong pool of scientists and world-class manufacturing capabilities and facilities,” says Mr Darda.
For now, though, the pharmaceutical sector needs to deal with the near-term issues.