Supply according to demand, yet Remdesivir remains scarce

“Remdesivir and Actemra are the two medicines prescribed to COVID-19 patients that are in shortage in the state at present,” Dinesh Khivasara, Assistant Commissioner, Food and Drug Administration (FDA) Pune said. Around a month after the coronavirus cases began surging in Maharashtra in the second wave, some of the essential medicines, prescribed to several patients, still remain short of supply in most parts of the state. While Remdesivir is an antiviral, Actemra is an anti-inflammatory drug.

As per Khivasara, however, the shortage of Remdesivir is not as acute as it was a month ago, despite the number of hospitalised COVID patients being so high. “Currently, we try to distribute the available stocks of Remdesivir in such a manner, that the hospitals have stocks about 40 percent of the number of Oxygen beds. It would be safe to say that the state has been maintaining 40 percent of the Remdesiver stock in comparison to the number of patients on Oxygen,” he added.

However, Dr Avinash Bhondwe, Maharashtra President of Indian Medical Association (IMA) said that the hospitals are getting hardly 10 percent of their actual requirement of Remdesivir. “The medicine is now not available at medical stores or distributors. The companies provide the vials to the District Collectors. Hospitals have to give a list of patients along with all the necessary details about the condition of those patients to the Collector, and then injections are allocated to the hospitals. If the hospital sends them a list of 50 names, only about 10 injections are received. How are the hospitals supposed to decide who gets the injections?,” Bhondwe questioned, adding that the government failed to estimate and plan the orders of Remdesivir adequately, as per the rise in the number of COVID patients.

In an earlier report, Khivasara had told Indie Journal that one of the main reasons behind the shortage of Remdesivir in Maharashtra was that it was being used more than necessary. Pune District Collector, at the time, had issued a circular asking hospitals to make rational use of the antiviral drug. The State Government had started district-level control rooms to ensure availability and prevent blackmarketing of Remdesivir. At the same time, guidelines were issued asking hospitals to arrange for the medicine themselves, and not send the relatives of COVID patients out to look for the vials.

However, despite all of this, the social media inquiries for the drug and frantic search of the injections by the relatives of COVID patients continue. “The number of companies producing Remdesivir has more than doubled over the last month. However, the shortage continues due to blackmarketing and inequitable distribution,” says a pharmaceutical distributor based in Pune.

Pointing at the excessive use of the drug, he adds, “Doctors have been using the injection more than necessary. Research has shown that it is not to be administered immediately, but after a couple of days of treatment, if the patient does not improve. But hospitals seem to be rushing the use of Remdesivir to send patients home earlier.”

However, strongly opposing this accusation, Bhondwe states that the shortage of Remdesivir is the failure of the administration. But, he added, that the doctors are being made the scapegoats. “Remdesivir is only administered when necessary. Yes, it is prescribed a bit earlier than before, but not if the symptoms of the patients are not serious. And often, by the time the patient receives the injection three-four days later, they have reached a critical stage,” he said.

He also said that if the government feels that Remdesivir is not administered rationally, the officials are welcome to conduct an audit for the same, adding, “When we give them a list of patients, we include all the details like the patient’s CT scan score, other medical conditions, Oxygen level, etc. So the government already has the details enough to ensure that the injection is being prescribed to the right patients.”

Last November, the World Health Organisation (WHO) had said that there is still no evidence to indicate that Remdesivir is beneficial in treating hospitalised coronavirus patients. AIIMS Director Dr Randeep Guleria had stated last month that Remdesivir is not a magic bullet and this is not a drug that reduces mortality. However, Bhondwe says that there is no substitute for Remdesivir yet, and it has proved to work for several COVID patients in India.

Actemra, also known as Tocilizumab, is also in shortage in Maharashtra. “The drug is manufactured in Switzerland. The government there had restricted its exports as the drug was not proven to be useful against COVID-19. That led to its shortage, as it is still prescribed by the doctors here. Now the restriction has been lifted,” Khivasara said.