India's malaria drug powers global coronavirus war

An ever-rising global demand for anti-malarial drug Hydroxychloroquine or HCQ to treat Coronavirus patients has turned the spotlight on India. The country meets 80-85% of the medicine's requirement worldwide and has agreed to export it to the US and Brazil, among other nations, after requests from their Presidents.

As India said that it would help countries that need HCQ, US President Trump tweeted: "Extraordinary times require even closer cooperation between friends. Thank you India and the Indian people for the decision on HCQ. Will not be forgotten! Thank you Prime Minister Modi for your strong leadership in helping not just India, but humanity, in this fight!"

Modi had a quick response. "Fully agree with you President Donald Trump. Times like these bring friends closer. The India-US partnership is stronger than ever. India shall do everything possible to help humanity's fight against COVID-19. We shall win this together," the Prime Minister wrote on Twitter.

Brazilian President Jair Bolsonaro was equally thankful. "We have more good news. As an outcome of my direct conversation with Prime Minister of India, we will receive, by Saturday, raw materials to continue our production of Hydroxychloroquine so that we can treat patients of COVID-19 as well as of Lupus, Malaria, and Arthritis. I thank Prime Minister Narendra Modi and the people of India for such timely help to the people of Brazil," he said in an address to his nation.

In a letter to Modi seeking HCQ, Bolsonaro also invoked ancient Indian epic Ramayana, mentioning the story of how Lord Hanuman brought a holy medicine (sanjeevni booti) from the Himalayas to save the life of Lakshman.

DO WE HAVE ENOUGH?

But with cases spiking in India, the question remains if we produce enough to meet exports, without compromising on domestic needs.

To begin with, India currently produces 10 metric tonnes (MT) that is estimated to be increased to 40 MT by the end of the month. Indian pharmaceutical companies are raising production capacity further to meet the demand for Hydroxychloroquine. By next month, the production is set to rise to 70 MT.

When producing at its peak capacity, India would be able to produce 35 crore of Hydroxychloroquine tablets of 200 mg every month.

However, India's total demand is unlikely to exceed 10 crore tablets, for which the government has already placed orders with manufacturers. Industry experts believe that 10 crore tablets can treat 7 crore people.

The remaining 25 crore tablets in April and the entire 35 crore tablets in May can be exported to other countries. As of now the US, Spain, Italy, France, Germany and some of India's neighbouring countries are seeking Hydroxychloroquine.

"1 crore Hydroxychloroquine tablets India needs, while 3.28 crore tablets are available," said the Union health ministry on Friday.

THE INDIAN FIRMS

Zydus Cadila and Ipca Laboratories are the biggest Hydroxychloroquine manufacturers in India. Intas Pharmaceuticals, McW Healthcare of Indore, Macleods Pharmaceuticals, Cipla and Lupin are the other manufacturers who can produce the drug. But only Zydus and Ipca have backward integrated production capacity that allows them to convert key raw materials to intermediates and then finally to APIs that subsequently lead to the final formulations. The entire process is some 12-15-step-long. And both have stocks that could last 6 months of production.

The others will have to bank on API suppliers. Abbott India, Rusan Pharma, Mangalam Drugs, Unichem Remedies, Laurus Labs, Vijayasri Organics are the API suppliers of the drug. However, as China slowly moves towards normalcy, procuring the raw materials would not be difficult.

WHY HYDROXYCHLOROQUINE

While the effectiveness of Hydroxychloroquine is still being tested, it has shown the ability to curb the spread of virus by preventing it from replicating.

A report in China stated that the drug helped more than 100 patients with various degrees of illness across 10 hospitals. They were treated with various doses.

Other researchers stated that cough, pneumonia and fever were treated faster in 31 patients who were given Hydroxychloroquine over 31 who were not given the drug.

However, not everyone is onboard with this theory. And moreover, these results are yet to be reviewed.

Hydroxychloroquine is an anti-malarial drug and is also used for the treatment of immunological diseases like lupus and rheumatoid arthritis. Most global pharmaceutical manufacturers had stopped producing this drug as the demand for it was very low.