CHENNAI: At Government Tiruvannamalai Hospital, in Covid-19 wards choking with suffering, an insidious business was afoot. Helming it was Ramesh*, a hospital helper, tasked with administering Remdesivir injection to Covid-19 patients. Ramesh, however, was not oblivious of the black-market price of the drug.
So, when a doctor tells him to administer Remdesivir to a patient, he would make his own ‘observation’ to check whether the patient would live or not. If his ‘prognosis’ was negative, which they often were, Ramesh kept the vial for himself, and lied to the doctor that the injection had been given.
This ugly business, however, came undone when Mohammed Imran Khan, a 25-year-old Tambaram doctor who had purchased the vials from Ramesh for sale in the black market, was busted. Superintendent of Police (Civil Supplies CID) S Santhi, whose team arrested the suspects, said Ramesh had stolen vials after vials this way and sold them to Khan.
Blinded by greed
What you just read is one of the many ways money is made out of the an unjustifiable demand for Remdesivir and Tocilizumab in the State. Like the virus, the black market for these drugs has had a morbid mutation in the second wave of the pandemic. Greed, it seems, has become as infectious as the virus itself, with even doctors, hospitals, and hospitals staff jumping on the bandwagon to swindle and exploit helpless patients and their desperate kin. This Sunday, Express tells you how these crimes work in the State. Apart from the modus operandi of Ramesh, four more methods have been identified.
Stealing remaining vials
On April 29, 46-year-old Saambasivam, a compounder at a private hospital in Purasawalkam in Chennai, was arrested by the Vepery police for allegedly stealing Remdesivir vials procured for patients. An investigating officer told Express: “When a patient needs Remdesivir, they will get four or six vials. But, if a patient dies or recovers after one injection, Saambasivam would steal the remaining ones and sells them.” In private hospitals, patients’ kin are often told to procure the drug from Kilpauk Medical College and Hospital (KMC) in Chennai. Six vials are given to each patient on production of a copy of the Aadhaar card, the a doctor’s prescription.
Making a deal with an agent
On May 1, SP (Civil Supplies CID) S Santhi and her team laid a trap for two doctors based on anonymous tip-off that they were selling the drug illegally. They arrested G Deepan and John Kingsley - both doctors. Kingsley had finished his medicine in Russia and is a drug agent. “During interrogation, he confessed that he sourced Remdesivir from a dealer with connections at a manufacturing unit,” an officer said. As for G Deepan, the police claimed he was colluding with a pharmacy staff, one Narendran. Deepan used fake medical prescriptions to get the vials from Narendran. He would then sell them for Rs 22,000 a vial.
Fake Covid-19 patients list
On April 29, the ICF (Integral Coach Factory) police arrested two persons--a doctor, T Karthikeyan, and a hospital assistant, G Jaspher Jano. “During interrogation, we found that the duo took the details of discharged patients and created a fake Covid-19 patient list. Karthikeyan would then prescribe Remdesivir for the patients and Jaspher would go the to KMC in Chennai with fabricated documents to purchase the vials,” said a senior police officer. Each vial would fetch them anywhere between Rs 9,000 and Rs 18,000.
Stealing vials from stock
On April 3, the Chennai city police arrested a doctor and a storekeeper from the King’s Institute in Guindy, and seized 24 Remdesivir vials from them. The suspects, P Ramasundaram, a doctor, and N Karthik, an assistant pharmacist, together stole a few batches of vials that had arrived at the institute. Karthik made false records and stole the vials and Ramasundaram sold them in the black market. For every vial sold, Karthik would get Rs 5,000. In less than a week, over eight incidents were recorded in the city and police seized over 70 Remdesivir vials from suspects. Most of the arrested were doctors or staff associated with hospitals.
A ‘useless’ drug?
Dr CN Raja, National Vice President of Indian Medical Association (IMA), said: “We suspect that some unscrupulous elements are creating an artificial demand for Remdesivir. We had given clear guidelines to hospitals that it should be used only in mild and moderate cases and that it is not effective if used after 10 days of the onset of symptoms. It does not prevent death due to the disease.” According to Dr Raja, despite appeals and clarifications on the use of the drug by WHO, IMA, and the State Health Department, demand for the drug is still soaring.
Demand for the drug is so high that when doctors refuse to administer it to patients, attendants demand they do. “When I refused to prescribe the drug to a patient as I knew it would not help the patient’s recovery, the patient’s attendant took a vial from a bag and told me to administer it,” said Dr Vara Prasad of Omandurar Government Medical College Hospital. Dr Prasad has treated hundreds of patients since the first wave of the pandemic. “I call it a useless drug. It works only when administered in the first three to five days. After that, it was not effective in the cases I treated. And many patients come to the hospital after three to five days. So, it’s useless,” said Dr Prasad.
An opportunity well used
Amid this cloud of suffering, some have seen a silver lining. According to sources, some private hospitals in Salem insist that patients’ relatives get the drug from the open market. A relative of a Covid-19 patient told Express that his uncle was admitted to a private hospital in Salem city. The doctors there told him that the uncle must to be shifted to a ventilator and that Remdesivir was needed to save his life. “They wanted six vials and we bought a vial for Rs 15,000 from black market. Suspecting something was amiss, we later approached a friend in the health department.
The department asked us to send the CT scan report of the patient. On checking the scan report, the health officials said my uncle needs neither Remdesivir nor oxygen support and that he could be treated on an normal bed.” “According to government norms, private hospitals are supposed to procure the drug themselves and administer it to patients. Distributors are not allowed to sell the drug. But, since some of these hospitals are not able to procure the drug themselves, they are putting the onus on to the patient,” said a health department official in Tiruchy.
While bigger private hospitals dealing with a large number of Covid-19 patients are able to procure the drug, smaller ones with 10-20 Covid-19 beds are having a hard time. Most of the requests put out on social media come from patients admitted to these smaller hospitals. Most requests, however, go unanswered as procuring the drug legally is hard. When Express contacted several distributors, some said they had no stock whereas some quoted exorbitant rates. One distributor even quoted Rs 35,000 a vial. Given that one Covid-19 patient normally needs five to six vials, the cost of the medicine can easily run into Rs 2,10,000.
Tocilizumab all the rage now
It’s not just Remdesivir that is high demand among Covid-19 patients and their kin. Scramble for Tocilizumab, an imported immunosuppressive drug reportedly effective against Covid-19 and given to critically ill patients, is also on the rise. When middlemen are involved, the price of the drug (around Rs 40,000) booms to several times its MRP. This is what Priyanka*, a Chennai resident, experienced during the second wave.
When her 80-year-old father contracted Covid-19, she was told only Tocilizumab could save him. She ran from pillar to post in search of it, but in vain. Finally she contacted a dealer. To her shock, however, he demanded a whopping Rs 1,60,000 for a single vial. She had no choice and spent her entire savings to get one. “The dealer told me that one has to go through a network of people to find the drug as it was not available in the city. This was the only option; so I got it,” she said. The kin of many Covid-19 patients said the drug was sold mostly in the black market. Express could not contact the dealer though.
Sharmila Raj from T Nagar said she didn’t buy the drug after the dealer demanded a ‘ridiculously’ high amount. “I was contacted by a dealer who told me to pay him five-times the actual amount of the drug. I cannot believe how people are being exploited in times of despair. Fortunately for us, we could source the drug a week later through a pharmacy at MRP in Chennai,” she said.
Similar was the situation last year. Joel Pinto had to shell out Rs 1 lakh to buy the medicine for his father. “We asked everywhere we could and there was no reply from anyone. The doctors initially told us they would get the medicine within a couple of days. But, they later asked me to get it on my own as they were uncertain when the medicine might be available. I called hundreds of pharmacies and placed requests on social media. But instead of medicine, I found a lot of people like me, searching for the same drugs on the internet in Chennai,” remembers Joel.
What is this drug?
Tocilizumab was earlier used for treating rheumatoid arthritis, including that in children. Its only importer is pharma giant Cipla. The drug continues to be in short supply because the officials had not anticipated this demand, according to sources. Last year, the peak was around 7,000 cases a day, the State is now witnessing more than 25,000 a day, burdening the health system. The Centre recently allocated 200 vials of Tocilizumab to the State. According to the State Drug Control department, these were handed over to TNMSC. Sources from TNMSC, however, said they do not have a stock. When contacted, Cipla distributors told Express that whatever that was allocated to the State would be given to hospitals through the government.
Know the drug to the tee
Remdesivir is a broad-spectrum antiviral medication developed by biopharmaceutical company Gilead Sciences
It was originally developed to treat hepatitis C and was subsequently investigated for Ebola virus disease and Marburg virus infections before being studied as a post-infection treatment for Covid
On 12 May 2020, Gilead announced that it had granted non-exclusive voluntary licenses to five generic drug companies in India and Pakistan to manufacture Remdesivir for distribution to 127 countries
A large-scale analysis by the World Health Organisation’s Solidarity trial consortium stated that Remdesivir “had little or no effect on hospitalised patients with Covid, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay”
In India, Remdesivir is marketed by Cipla, Hetero, Zydus Cadila, Dr Reddy’s, Jubilant Life Sciences and Mylan under license from Gilead
Viral vial
Gilead gifts fts 25,600 vials to India
On Saturday (May 8) Gilead Sciences gifted 25,600 Remdesivir vials to India. “Grateful to @GileadSciences for gift of another 25,600 vials of Remdesivir that arrived in Mumbai this morning,” the Ministry of External Affairs (MEA) spokesperson said in a tweet. Gilead Sciences, the developer of antiviral drug Remdesivir, on Wednesday, had sent more than 1.5 lakh vials to India
Bangladesh provides over 10,000 vials
Bangladesh’s Deputy High Commissioner in Kolkata Toufique Hasan on Thursday (May 6) handed over 10,000 vials of Remdesivir to the representative of the Indian government at the Indian border port of Petrapole. These 10,000 injections manufactured locally were sent as medical assistance on behalf of the people of Bangladesh at the instruction of Prime Minister Sheikh Hasina for the Covid-affected people of India, according to an official statement
United Stattattates, Canada continue to deliver vials
A flight from the United States carrying 1.25 lakh vials of Remdesivir landed in India on Sunday (May 2). On the previous day, the US had provided India 1,000 oxygen cylinders, regulators and other medical equipment. Canada is sending up to 25,000 vials of Remdesivir and up to 350 ventilators from its National Emergency Strategic Stockpile to India
Cheapest generic version
In August last year, Zydus Cadila launched the cheapest generic version of Remdesivir in India to treat Covid following reports of shortages at hospitals. Zydus has priced it at `2,800 per 100mg vial. It is being sold under the brand name Remdac to government and private hospitals. In March this year, the company revised the price to `899 for a 100mg lyophilized injection
*Names changed. With inputs from, Chennai, Coimbatore, Madurai, and Tiruchy bureaus