India can further consolidate its stature as the “pharmacy of the world,” despite the jury still being out on HCQ’s effectiveness.
As the novel coronavirus continues to dictate the workings of different nations, India’s medical diplomacy is gaining momentum across countries. After lifting the initial two-week ban on its export, India exported Hydroxychloroquine (HCQ) — the anti-malarial drug touted as being effective against COVID-19 — to 55 countries. The decision followed after US President Donald Trump threatened retaliatory action against India if it did not export the medicine to meet its rising demand in the US. Apart from countries such as South Africa, Russia, the United Kingdom and the neighbouring Bangladesh, Afghanistan and Bhutan, New Delhi even dispatched the medicine — either on a commercial basis or as grants, to African nations such as Zambia, Mali, Congo and Egypt.
HCQ has been green-signaled by the US Food and Drug Administration (FDA) and the Indian Council of Medical Research (ICMR) as a potential cure for COVID-19, although the latter has stated that the use of the medicine should be stopped immediately if patients begin to show side-effects. Some of these side-effects, as detailed by ICMR, include cardiomyopathy and heart-rate disorders. HCQ use in India came after an observational prospective study at the All India Institute of Medical Sciences (AIIMS), New Delhi, which found that 248 of 334 healthcare workers who took HCQ had a lower incidence of getting the coronavirus infection. As per the ICMR, the medicine however, can only be given to asymptomatic healthcare workers, healthcare workers in non-COVID hospitals, and frontline workers.
Owing to numerous studies across the world, the record on the effectiveness of HCQ is mixed. For instance, a study in China found that those patients with mild-to-moderate COVID-19 who were given Hydroxychloroquine did not recover faster than those who received standard care. According to another study published in the New England Journal of Medicine, researchers found that HCQ does not prevent the disease if the patient has already been exposed. It was the first study on the drug, which was double-blind randomised and placebo-controlled. The study found that HCQ did not prevent COVID-19 in patients with high-risk or moderate-risk exposure to the disease.
The World Health Organisation (WHO) itself, in a press conference in May, cautioned countries from using the medicine against COVID-19. Michael Ryan, a WHO official, said in May: “At this stage hydroxychloroquine nor chloroquine have been as yet found to be effective in the treatment of COVID-19 or in the prophylaxis against coming down with the disease. In fact, ... warnings have been issued by many authorities regarding the potential side effects of the drug.”
In India as well, after the ICMR’s initial recommendation on the potentialities of Hydroxychloroquine, medical experts had raised concerns over its use. Following which, the ICMR cautioned in some of its statements that the use of HCQ should not give a sense of “false security.” Medical experts, however, believe that the ambiguous green-signal given by ICMR and other medical bodies around the world will do just that.
Moreover, with COVID-19 having persisted in many countries for past several months, citizens are now getting impatient for a cure. With ICMR and other recognised medical organisations allowing its use, people are beginning to believe that it is an appropriate cure for COVID-19.
Despite warnings by the FDA that it should not be taken before clinical trials or outside a hospital, Trump has stated that he has himself taken the medicine continuously for a few weeks “because it’s good.” On multiple occasions, the US President has openly touted the medicine — meant for curing malaria and lupus — as a treatment against COVID-19 and even termed it as a “game-changer.” White House Press Secretary Kayleigh McEnaney, while responding to questions about Trump’s confidence in the potential of the medicine and his health, said that numerous doctors and researchers are coming out in support of the controversial medicine.
Whereas, Dr. Anthony Fauci (Director of the National Institute of Allergy and Infectious Diseases at the US-based National Institutes of Health (NIH)), who is part of Trump’s COVID-19 taskforce, has had a very different view. According to him, current studies of HCQ only show “anecdotal evidence” of curing patients infected by the coronavirus and more testing of the medicine is needed to scientifically prove it as a treatment for the disease. As per reports, this divergent view also resulted in a heated argument between Dr. Fauci and Trump’s trade advisor, Peter Navarro. Dr. Fauci has been the most prominent critic of HCQ’s efficacy in Trump’s near orbit, even as the president has continually touted its effectiveness.
This divergence in views has also played out on live television. During a press briefing in April, after Trump spent a large part of the briefing pushing Hydroxychloroquine as a cure for COVID-19, a CNN reporter asked Fauci to comment on the “medical evidence” of the controversial drug. Before Fauci could answer, Trump cut in: “Do you know how many times he’s answered that question? Maybe 15.” After the reporter interjected that the question was actually for Fauci, Trump cut him short, stating, “You don’t have to ask the question.”
As the confusion over its efficacy continues, some may begin to question India’s responsibility in exporting an unproven medicine (Hydroxychloroquine), especially since many Indian medical bodies have come out in disagreement with the ICMR’s review.
However, India’s prominent role as a key exporter of HCQ, despite its unproven ability to cure COVID-19, is not going unnoticed. India is donating the medicine based on two categories — “humanitarian aid” and “commercial basis.” It is being donated to SAARC, several African countries and is being sold chiefly to the US and Germany.
Many political leaders are lauding India’s decision to not only lift its ban on the export of HCQ and other medicines, but to also donate it in the form of humanitarian aid. Maldives’ Foreign Minister, Abdullah Shahid, called HCQ a “game-changer,” thanked Indian Prime Minister Narendra Modi for recognising Maldives’ demand for the medicine, and praised India (saying, “a friend in need is a friend indeed”). Brazil’s Prime Minister Jair Bolsonaro actually equated India’s gesture to the “holy medicine from the Himalayas” episode from Indian epic Ramayana. Praise also came in from Trump, and several other global leaders.
Despite the global debate regarding Hydroxychloroquine’s effectiveness in treating COVID-19, it has also become a tool for India to cement its position not only as a responsible stakeholder amidst the coronavirus, but also consolidate its standing as a leading producer of medicines in the world. For instance, India is trying to implement ways in which it reduces its dependence on China for active pharmaceutical ingredients (APIs) by producing it locally. With the fillip accorded by its recent medical diplomacy, the government of India has planned to introduce an incentive scheme worth around INR 10,000 billion ($1.3 billion) to help the pharma sector boost domestic production of medicinal raw materials.
Hence, despite the jury still being out on HCQ’s effectiveness, the export of the anti-malarial drug can help India consolidate its stature as the “pharmacy of the world”.
The author is a research intern at ORF Mumbai.
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