A watershed moment in the AIDS epidemic was 20 years ago when Indian drug major Cipla started manufacturing and providing a triple cocktail medicine for AIDS at roughly $1 a day, a fraction of the existing treatment price at the time. The company was instrumental in helping control the epidemic, especially in Africa. When Swine Flu broke out, they immediately started manufacturing Antiflu (Oseltamivir) to combat it. Now, in the midst of the coronavirus storm, we caught up with Cipla chairman Y K Hamied to find out how they are preparing to meet this challenge.
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The Prime Minister has announced a 21-day nationwide lockdown; what do you think about the decision? What’s your advice to the Indian population?
The lockdown is absolutely essential, but essential services should not suffer. Isolation is the best thing we can do now. Let us look at it step-wise. First, we have to work on prevention. What are the maximum precautions a person can take? Other than isolation people talk of sanitisation. I accept that. If you are sanitising your hands why aren’t you sanitizing inside your nose and mouth and inside your lungs? In my personal opinion steam inhalation twice a day is advisable, it doesn’t cost anything, in addition to that gargling once a day with Listerine is also good since alcohol kills viruses.
From Cipla’s current arsenal of drugs there are quite a few which can be used to treat Covid-19. There is anecdotal evidence from across the world that HIV, malaria and swine flu medicine are effective to some extent?
Firstly, I want to point out that for 80 per cent of those who get the virus, it’s very mild. Those under 20 hardly get it seriously. Out of the balance 20 per cent, 15 percent would be bad cases. For this 15 per cent I think the drugs that we have such as Antiflu (Oseltamivir), HCQS (Hydroxichloroquine), Azee (Azithromycin), and the AIDS drugs – all of that will certainly help. The balance 5 per cent have pneumonia and serious lung infections, for that we have the Roche drug, Actemra.
Cipla is also currently working with the Indian government on developing another drug to help fight coronavirus. Can you tell us a little more about that?
There’s an anti-viral drug called Favipiravir, which has seen some good results in Japan. We have done developmental work in conjunction with the Indian Institute of Chemical Technology (IICT) in Hyderabad and we hope to make it available in 6 to 8 months time. It’s a difficult synthesis. We have to now scale up the manufacturing, but our factories and offices are right now virtually closed. It’s very difficult to initiate large -scale manufacture. Even though medicines are coming under essential commodities, it’s difficult to get staff to come as trains and buses are not running. The government must clearly identify what is essential.
At a time like this will you divert most resources to the drugs that help fight coronavirus?
Apart from coronavirus there are many chronic ailments. People need drugs all the time for asthma or diabetes. We can’t just do coronavirus drugs and nothing else. There are limited resources. We owe an obligation to thousands, those who are on our inhalers, nebulisers and other medicines – we can’t deprive others who suffer from other diseases.
Besides, Corona is a respiratory disease and some of the anti-asthmatic drugs we make will benefit in coronavirus. It’s up to the doctors to prescribe them. I think corticosteroids can be helpful. You have to do essential drugs for other diseases as well. In America, the salbutamol inhalers have disappeared from the market. Other ailments that are of a chronic nature can’t be ignored.
Currently what is Cipla’s inventory like for Antiflu, Hydroxychloroquine and the HIV drugs that are being used to treat coronavirus?
We have kept Antiflu (Oseltamivir) going and have been supplying that quite a lot. Whoever wants it can get it. For Hydroxychloroquine, we are only making the tablets, the active substances are made by other companies like Cadila. And those active ingredients are in short supply for Cipla.
One can handle a few thousand patients but if the situation becomes like it is in Italy or America, one can’t handle millions. That makes it a precarious situation. It’s hard to predict. Take the swine flu drug Antiflu (Oseltamivir) for example. Swine flu never took off and Cipla was sitting on 53 million dollars of raw material and there was no sale.
If medicines are available today, what the government could do is keep a buffer stock if they can for distribution. For drugs such as Antiflu and Hydroxychloroquine, they can keep it at least in the government hospitals. We are doing our best to distribute but the Government can also keep some stock.
Is Cipla working on repurposing other existing medicines to treat coronavirus? Do you feel the government is being quite proactive in these efforts?
Research is being conducted on repurposing and repositioning existing drugs. Yesterday, the director of Indian labs said they did a test on a drug which is a sweetening agent called Stevia – and they found that stevia helps coronavirus. They also did a test on a TB drug. This is what the government of India is doing today through ICMR (Indian Council of Medical Research), they are running short clinical trials on various drugs. I just got a note that Theobromine (an alkaloid compound slightly similar to Caffeine) and Theophylline (a compound present in small quantities in tea leaves), which are used to treat respiratory diseases, are helpful in treating this virus. We have to conduct our research to see if these can be repurposed. I think the government has been fantastic and Dr Balram Bhargava, Director General of ICMR, is the key person in the government handling the issue. Dr VG Somani, the Drug Controller India, and Dr Chandrashekhar from IICT Hyderabad are also doing a very good job.
What’s your overall outlook? How do you see this situation playing out in India?
Let’s not predict and jump to conclusions. At this juncture whatever best we can do is being done. It’s uncertain. One can’t predict. If you look optimistically with the hot weather coming up we will escape or it may just be very mild.
What’s your final plea to the government?
The steps that the government has taken are most encouraging. I hope the whole nation goes along. This should be an ongoing effort not just three weeks. England has announced there will be restrictions for six months.
However, the government should clearly identify what is essential. In this whole thing of corona we can’t overlook that people suffer from other ailments. There should be no blanket shortage of other medicines.
Availability of food might also be a problem. As there will be limited imports. It’s a very good opportunity for us to look into self-reliance and self sufficiency at this point.
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