Harshlal Tope was amongst the first to arrive at SK Agencies and SK Distributor in central Mumbai at 6.30 am on Thursday after getting to know on WhatsApp groups that the stockist was about to get a consignment of Tocilizumab, a drug that is still in the clinical trial stage for the treatment of Covid-19 patients. He had been looking for it for four days, for a hospitalised family member.
The stock arrived 14 hours later, at 8.30 pm. By then, there were 400 anxious people —some had travelled over 100 km — waiting to buy it, no social distancing, and frequent fights over queue jumping. The police had to be called in at midnight to control the crowd.
After a wait of nearly 17 hours, Tope was able to buy one vial of the drug for Rs 31,500 at 1 am. Two hours later, the stock was finished.
Tope wanted to buy two vials but the distributor was rationing the stock — one per person. Tope reckoned he would have to return when the distributor receives fresh supply. The hospital where his family member is admitted is demanding Rs 60,000 per dose, Tope said.
Tocilizumab and Remdesivir, two drugs that are still undergoing trials as possible treatment for Covid-19, are in huge demand as cases surge and doctors increasingly prescribe it for moderately to severely ill patients even as scientific evidence on their efficacy is awaited. Dr Pradeep Vyas, Health Secretary of Maharashtra, said they are soon going to release a treatment protocol so that the “drug is not unnecessarily prescribed and administered to Covid-19 patients”.
Maharashtra Home Minister Anil Deshmukh said the state government will be purchasing Remdesivir and Tocilizumab soon. After a meeting with FDA Minister Ravindra Shingne, Deshmukh said, “There is high demand for these two drugs across the state. We have started making purchases and soon they will be available across Maharashtra.”
Shah, owner of SK Distributor, informed the Food and Drug Administration (FDA), that he got 702 Tocilizumab injections in 10 days of July. Within hours it got over. “The supply is erratic. The last stock came on July 5. Even then I had a long queue outside my office. I can’t turn away these patients so I am selling directly to them,” he told The Indian Express. Like him another major supplier of Tocilizumab in Mumbai is Byculla Pharmacy and Stores.
Tocilizumab is manufactured by Roche Pharma. The Mumbai-headquartered Cipla has distribution and marketing rights. A company spokesperson declined to comment.
Roche has increased its global capacity for Tocilizumab by 50 per cent. A spokesperson for Roche said, “At Roche India, we are constantly monitoring the evolving situation and coordinating with our global supply chain teams to ensure that the demand requests for Tocilizumab are met. We have already received a few consignments in the last couple of weeks and are expecting more consignments to reach India in the coming weeks. We would like to reiterate that Tocilizumab is currently not approved for treatment of Covid-19.”
In a few cases, doctors have asked patients to stock up the drug even though requirement is not immediate. Yash Gajre, whose parents — father aged 66 and mother 56 — were admitted to a Malad nursing home ICU for the last 10 days and were shifted on Thursday to Seven Hills, was among those in the queue. “Doctor bola drug leke rakho, baad me mile ya nahi. (Doctor said buy the drug, later we may not get it),” said Yash.
S M Padhle of Ghatkopar police station, who arrived at the stockist around midnight after the crowd outside it grew, said, “Every time the stock comes, a crowd gathers here.”
The Brihanmumbai Municipal Corporation (BMC) has written to FDA to ensure Tocilizumab is sold to hospitals directly and not to patients.
“We are noticing an increase in prescription by private doctors. It is not a magical drug. In civic hospitals we have given strict instruction on judicious use of Remdesivir and Tocilizumab. Each use is approved by the hospital dean. Every evening we get details of patients being administered these drugs,” said Suresh Kakani, additional municipal commissioner.
Several treating doctors said as hospitals are not getting stocks, they are forced to ask patients to procure it. A Kalyan resident, whose father-in-law Dinesh Shadida is admitted at Bandra’s Aastha hospital, has been struggling to get five vials of Remdesivir. Last week his wife, also infected by Covid-19, was hospitalised in Sai Criticare hospital, Kalyan. The doctor prescribed Tocilizumab. “I enquired with the hospital chemist, he didn’t have any stock. An hour later I got a call from a middleman who offered the drug for Rs 45,000. How did my number reach him? Hospitals don’t have stock but several agents have it. Government should look into it,” the Kalyan resident said.
On Friday, the state government ordered a crackdown on black marketing of drugs after directives from the Centre. “We have decided that there will be joint action by the police and FDA officials if it comes to light that someone is selling these drugs illegally at high prices,” home minister Deshmukh said.
D R Gahane, joint commissioner (drugs), FDA, said, “We have started touring hospitals. The number of prescriptions for Remdesivir and Tocilizumab have shot up since a week. There are no loopholes in the distribution channels. We have to check whether supply is being diverted from hospitals. We urge citizens to inform us.”
Gilead Sciences, manufacturer of Remdesivir, has signed licensed agreements with five manufacturers to supply the drug in India. Currently Cipla and Hetero Healthcare are major suppliers. A spokesperson of Hetero said they have so far supplied 30,000 Remdesivir vials to hospitals in India, by next week 12,500 vials will be distributed to the public and private hospitals in Maharashtra alone. “We manufacture API in Visakhapatnam and drug manufacturing is in Hyderabad. We are also ramping up our production,” the spokesperson said.
Concerns have been raised by experts over the way investigational drugs like Tocilizumab and Remdesivir are being prescribed. They still lack scientific credibility over their efficacy to cure Covid-19. “A month ago we didn’t have these drugs, but we still managed to save lives. These drugs should not be the only source of hope to treat Covid-19,” said Dr Rahul Pandit, adding that only if used at the correct time and for specific cases can Remdesivir and Tocilizumab improve patient’s condition.
Infectious disease expert Dr Om Srivastava said there is only a small window to administer these drugs. “We need to understand that neither of these drugs are a cure. Remdesivir reduces viral load and Tocilizumab is an immunosuppressant. Both have to be used as per clinician’s discretion,” he said.
Back in Ghatkopar, as the stock quickly dwindled, Nitesh Kale stood worried. It was 1.30 am. He had travelled from Palghar, over 100 km away.
“If the stock gets over before my turn, I don’t know from where I will get this drug. Since a week I am searching for Tocilizumab. Two of my relatives need this.”
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