Shortage of anti-fungal drug in India after pent up demand as black fungus cases spike

The country-wide shortage of a life-saving drug has led to its black marketing and inflated prices

Cremation workers carry the body of Covid-19 victim for the funeral during mass cremation ground (EPA)

Covid-19 patients in India are facing a new set of challenges as pharmacies run out of an anti-fungal drug used to treat a deadly black fungus cases.

The exponential rise in cases of black fungus infection, known as mucormycosis, has led to pent up demand to treat the “aggressive” secondary infection which is believed to have as high as 50 per cent mortality rate in patients.

After desperate pleas for hospital beds, oxygen, and drugs to treat Covid-19, social media is flooded with requests for Amphotericin B injections that are used to treat the fungal infection.

A tearful plea by a woman named Kalyani, requesting for urgent help, recently went viral.

"Please help us. We have no money. Without him, we have no life. They said one eye is infected and will have to be removed. Now he is getting pain in the other eye too," she is seen breaking down in the video as her husband sat with folded hands and a swollen eye behind her.

Her husband Anji Babu, a driver in West Godavari, Andhra Pradesh, was suffering from mucormycosis after recovering from Covid.

Indian states are reporting hundreds of cases of mucormycosis as they struggle to emerge from a deadly Covid-19 second wave. Highest number of mucormycosis cases were reported in the worst Covid-hit state of Maharashtra which has an estimate of 2000 cases. Gujarat reported 1,163 cases and 40 deaths so far and Madhya Pradesh has 281 cases and 27 deaths. Several cases have been reported in the states of Uttar Pradesh, Rajasthan and Telangana as well.

In absence of cumulative data from all the states, top health official Dr VK Paul said, “some states are reporting 400 to 500 cases; we do not know the burden of the disease yet.”

“This is an emerging problem and ICMR (Indian Council of Medical Research) has started collecting data. We have also asked states to keep an eye on it,” he said.

The fungal infection is caused by a group of moulds called “mucormycetes” that are present in the air and cause complications in those with acute illnesses such as severe Covid. It can also be triggered in severely immunocompromised individuals or acquired in hospitals through ventilation systems in ICUs.

Doctors believe mucormycosis can be induced in Covid patients by the overuse of steroids, used generally to treat those who are critically ill.

Funeral pyres for COVID-19 victims burn during a mass cremation (EPA)

In Delhi, which has at least 150 reported cases of black fungus, most of the pharmacies are running out of the injection. Hospitals have run out of stock as well.

According to pharma experts, due to low demand of the drug in normal scenario the companies were manufacturing the drug only in limited quantities. But due to a sudden increase in demand, production has been ramped up. The new production is expected to hit the market in at least 15-30 days.

Speaking to The Independent, JS Shinde, Chairman of All Indian Origin Chemists and Druggist (AIOCD), an association of more than 950,000 members of retail and wholesale chemist, said all the major markets of Delhi, Kolkata, Tamil Nadu, Kerala, Gujarat and Maharashtra have reported shortage of the drug.

“There is a heavy shortage of this vaccine in India currently. Only 5-6 companies manufacture it here and Bharat Serum was the major producer. They have the capacity to manufacture 15000 vials in a week. Until now the medicine was not in demand,” Mr Shinde said.

“It will take another 10-15 days for the supply to hit the market,” he added. He said raw material for the medicine is exported from other countries, therefore it will again become difficult for the pharma companies to boost production in short time.

According to an order by the Ministry of Chemicals and Fertilizers, the Department of Pharmaceuticals will manage the supply of the drug among states as an interim measure and is engaging with manufacturers to ramp up the production.

“It has been noted that at present the demand exceeds the supply available from the domestic manufacturers and importers,” it added.

Mansukh Mandaviya, Minister of State for Chemicals and Fertilisers, on 18 May said the government has chalked out a strategy for import as well as production of the drug after reviewing the requirement and supply position of Amphotericin B.

The shortage has led to hoarding and black marketing of the drug. Prices of vials have been inflated10 times the maximum retail price.

The supply chain of the drug will be managed by the central government as happened in the case of Remdesivir injections which were sold through government-identified retailers.

A minimum of 100 injections are required by one patient for the treatment spanning 21 days. The treatment costs about Rs 300,000 ($4100), according to a conservative estimate.

India has reported 4,529 Covid-19 deaths in the past 24 hours, including 267,334 new infections. However, experts say both infections and deaths are being hugely underreported.