When money talks, don’t listen

Trump asked India to supply hydroxychloroquine. Modi should consider doing so, with two conditions

Last week, American President Donald Trump called Prime Minister Narendra Modi asking for the release of the antimalarial drug hydroxychloroquine so that the US could avail of them. The Modi government has banned its export, given that India itself might need the drug as the coronavirus pandemic spreads through the country. Let’s note right away that while Trump has been talking up the efficacy of hydroxychloroquine for treating COVID-19, his own medical advisers have said that there is no evidence that it is effective. Some national medical research institutions have said that the drug might be of help to doctors and frontline health workers who are severely exposed to COVID-19 patients, but not to the general population.

Nonetheless, given America’s desperate situation – it has the largest number of COVID-19 cases now, with over 400,000 infected and over 9,000 dead -- Modi should consider granting Trump’s request, but based on two non-negotiable conditions:

1. The US should immediately release the 3M masks destined for Germany (that it had hijacked in Bangkok, as reported in major papers across the globe, including the NY Times, Washington Post and the UK-based Independent). Likewise, with masks destined for France. The global goodwill that India would generate from such action will be, in my opinion, substantial.

2. The drug should be sold in the US at the same price as the maximum retail price (MRP) in India. This is very important since there is an unconscionable amount of profiteering by ‘Big Pharma’ here in the US on India-made drugs, even in the absence of any pandemic. To give you a specific example, a 1.7 ml tube of ‘Ilevro’ eye drops used in post-cataract surgery retails for $358 in the US, whereas the same costs $5.50 in India. Surprise, surprise! The Ilevro sold in the US is actually manufactured in Aurangabad.

One shudders to think what US drug companies and hospitals would charge for antimalarial drugs such as hydroxychloroquine, antibiotics such as azithromycin and the anti-tuberculosis BCG vaccine (still made in India, and perhaps only in India) should they prove effective in combating COVID-19.

Faced with a global coronavirus pandemic whose epicentre has moved to the US, in a news conference last week, Trump advocated the use of the drug hydroxychloroquine that he claimed could help tackle the outbreak. He also claimed that the use of the drug in combination with azithromycin, an antibiotic, could be “one of the biggest game changers in the history of medicine”. This has resulted in a sudden shortage of hydroxychloroquine, because of hoarding, and there has been a concomitant increase in price. The drug is normally used for treating lupus and rheumatoid arthritis but now people with these diseases have to contend with either the non-availability of the drug or having to pay exorbitant prices.

Medical experts are of the opinion that the efficacy of hydroxychloroquine combating the coronavirus pandemic has not yet been established. To quote Dr Anthony Fauci, the leading expert in the US on infectious diseases, “It’s a dangerous message for someone without a medical licence to get up there and tell people to try it. You need to listen to physicians, people who understand science, before you go willy-nilly into the medicine cabinet.”

Likewise, the French health minister, Olivier Veran, warned against the use of hydroxychloroquine for COVID-19, saying that it shouldn’t be used by anyone with the exception of “serious forms of hospitalization and on the collegial decision of doctors and under strict medical supervision”.

According to an article in the Guardian newspaper in the UK, the scramble for face masks has created a “madhouse” atmosphere among Chinese manufacturers since they have been deluged with inquiries from US states, national governments, cities, hospitals, distributors and private companies seeking to protect their employees. Producers of masks and respirators are demanding to be paid in full before the products leave their factories and are supplying whoever can pay the most and pay fastest.

There has been an intense state-by-state competition in the US for ventilators and personal protective equipment such as masks, gloves and ventilators and there are no anti-gouging laws that can be invoked when states procure their supplies from private companies, either through competitive bids or from single sources. Add to this the very important dimension of medical supply chain issues that have been created by US companies outsourcing their manufacturing operations to places such as China and India which have much cheaper labour and material costs.

Let me cite specific examples. The State of Massachusetts was able to purchase and transport, via a private plane, 1.2 million N95 masks (made for 3M, a US company) from Chinese manufacturers just four days ago. Various newspapers in Germany have reported that similar masks ordered and paid for by the Berlin police were diverted to the US while they were in transit at Bangkok airport. French government officials were outbid by private US entities in the US when they were in the process of procuring masks as well. Ventilators/respirators have seen their prices jump from $20,000 (about Rs 15 lakh) to $80,000 (about Rs 60 lakh). How much do ventilators cost in India? Lastly, about a month ago, there were reports in the press about Trump offering $2 billion to a German company, currently testing a vaccine against coronavirus, for exclusive use in the US.

Money trumps all? It shouldn’t.

(The writer is a US-based computer scientist)