Black fungus treating drug in the black market

Covid-19 Health India National Top Story

While the centre has ramped up production of Amphotericin-B, it is still not reaching the states where it is needed.

Bengaluru: Dhananjay, a resident of South Bangalore, ran around the city for three days. He connected with as many chemists as possible, in hopes to find the drug that could treat his mother, who was infected with mucormycosis or black fungus, only to find out that no one had stocks. When he did find the medicine, to his dismay the seller only had two vials and was selling it for triple the price.

“The hospitals have left the responsibility of procuring the injection to the patient’s family,” said Dhananjay. “I was able to get the first two vials of injection out of the 72 that were required on the third day. I had to pay Rs 20,000 per vial, which is three times the price. It’s the fifth day, and we haven’t been able to get access to the remaining vials”

Pharmacies across Bangalore confirmed that the drug wasn’t available with them. There is an acute shortage of Amphotericin-B vials across the states as the black fungus cases are on a surge. The Food and Drug Administration (FDA) estimates show that Maharashtra requires at least 10,000 injections per day. Bharat Serum, BDR Pharmaceuticals, Cipla and Mylan are major manufacturers of Amphotericin- B injection.

There are three types available: plain powder, liquid form and lyophilised. Powder form, which costs Rs 300 per injection, is the cheapest and takes eight to 10 days to manufacture, but can affect the kidney and is not advised to all patients. The liquid form costs Rs 1,000 per vial and takes 10 to 15 days in production. Lyophilised (freeze-dried) takes 28 days in production, costs Rs 6,000 to Rs 8,000 for 50 mg and is in most demand. 

While these are most in-demand, the shortage of supply is increasing the price of the drug.

Hundreds of people like Dhananjay continue to struggle as the dearth of drugs that could save their loved ones life is illegally being sold at a very high price.

Dr. K. Sudhakar, Karnataka Health and Family Welfare and Medical Education Minister said that the (Karnataka) government won’t tolerate any kind of black marketing or misuse of drugs. “The Covid War Karnataka website has an option to report to the government if the medicine is denied even after allocation. We will implement the same to black fungus drugs also,” he added.

The centre has allocated 23,680 vials of Amphotericin-B across the country as of May 21. The surge in cases has been seen across the country. Around 5,424 cases of black fungus were reported in 18 states as of May 24, 2021. Dr. Harsh Vardhan, Minister of State for Health and Family Welfare tweeted on Monday that over nine lakh vials of Amphotericin-B are being imported to ensure the drug’s adequate supply for treating mucormycosis patients in the country.

The black fungus is an infection from the mucormycetes group of fungi that damages the nose, sinuses, eyes and sometimes the brain. It is found in natural environments, especially in soil. While the infection is rare, it has been around for decades and has only affected those with either health conditions or a significantly weakened immune system, explained Dr. Neha Mishra, an infectious disease doctor at Manipal Hospital, Bengaluru.

She further explained that the primary drug that is required to treat black fungus, either orally or via injection, are generally given to a patient for six weeks and more, depending on the weight of the patient and the severity of the infection. In India, each of these anti-fungal infections can cost around Rs 7, 000, and a patient needs up to nine of these a day. This a minimum three-week course could cost as much as Rs. 13 lakhs.

While the Government of India has ramped up the production of the drug and have placed an order of 3,15,000 vials which will be imported in June 2021, the states have not yet received the drug to treat the existing patients.

Maharashtra and Gujarat, are the top states with the maximum number of mucormycosis cases. Nineteen states have declared mucormycosis as a notifiable disease under the Epidemic Diseases Act. Harsh Vardhan, in the group of ministers (GoM) meeting on Monday, said that Gujarat reported 2,165 cases, Maharashtra 1,188, Uttar Pradesh 663, Madhya Pradesh 590, Haryana 339 and Andhra Pradesh 248 cases of black fungus.

Patients are facing a shortage of amphotericin-B vials across all these states. Dhananjay’s mother being one of them.

Karnataka chief minister on May 21, announced that the government hospitals will “treat mucormycosis patients for free,” stating that not all can afford the high treatment cost.

“All citizens can avail treatment for mucormycosis in the government hospitals. We have added 100 beds each in Victoria Hospital and Bowring Hospitals to facilitate treatment of black fungus as well,” said Dr Sudhakar “The Centre has allocated 1,030 vials of Amphotericin B drug to Karnataka and we have requested the Government of India to increase our allocation to 20,000 vials. The Union Government is making every effort to ramp up the production of Amphotericin B. In addition to the existing six companies, five more pharma companies have got approval for producing the drug.  Once the production is ramped up we will soon get more supply,” he added.

Dr. Sudhakar said, “No hospital or medical establishment having the capacity to provide treatment should deny admission of patients.” He added, “Apart from treatment we are also focusing on prevention of infection. We have formed an expert committee to study the source of infection which has already submitted a preliminary report. We are taking measures to ensure that there is no contamination of medical oxygen during refilling, transportation and storage. Hospitals have been instructed to maintain hygiene and ensure proper sterilisation of medical equipment.” 

With inputs from Anusha Ramesh, Aditi Mathur and Baranjot Kaur.