COVID-19: International Trade on Medicines

International Trade on Medicines

Priyanshi Agrawal 1933360

Christ (Deemed to be University)

                                                                       

The article discusses about the disruption caused by health crisis of COVID-19 in health sector and imbalances in global supply chain of medicines. It aims to state the measures taken by different nations and pharmaceutical companies for medicine for international trade of medicine. Further, it outlines the carelessness of international organizations in controlling the worldwide health crisis.

Keywords:  globalization, COVID-19, pharmaceutical companies, drugs.

 The process of globalization which began in late 15th century has brought connectivity in terms of business, technology and culture among different parts of the world. Many countries have benefited from comparative advantage of other nations and vice versa. This process began from trading of raw materials and at present more or less all types of goods including finished goods are globally traded. Though many countries have benefited from globalization, this process has led to disruption in many countries during the times of pandemic, financial crisis and natural disaster.

Over past eight months, havoc created by the pandemic COVID-19 or Coronavirus Disease 2019 has affected nearly every corner of the world and almost all sectors of the economy. COVID-19 is a disease caused by newly discovered SARS-COV2 which causes respiratory illness. Its effects can be ranged from mild to severe symptoms with old people and people with co-morbidities being affected the most (WHO). This Communicable Disease’s R naught value is very high resulting in high number of affected populations. It has affected almost 1.78 crore people and more than 6.84 lakh deaths worldwide. The pandemic has completely disrupted social and economic environment. Though governments of many countries are trying to control its spread by lockdown, increased tracing and testing, number of cases worldwide are rising at an alarming rate. Many countries which were infected at beginning of the pandemic, were remarkably successful to control the disease spread, but the disease has not completely vanished in those nations. Moreover, lately infected countries at present have reached their peak in recording the number of active cases and death. Moreover, it is noticed that developed countries which are more globalized recorded higher number of cases than less globalized economy. 

As the pandemic is expanding at a progressive rate, its impact is clearly visible on international trade of various goods, mainly on pharmaceutical gods and medical products like instruments, medicines, diagnostic apparatus. Sudden outbreak of the pandemic has led to shortage of medical products, affecting its global supply chain. It has forced many countries to adapt the policy of protectionism wherein countries banned export of medical products to fulfill the domestic medical demand in their home country. This reduced supply of medical products has increased its price due to levying of tariffs and customs duties.

 

Source: self created from MS-Word.

The supply shock in COVID-19 crisis has surged the hazard posed by international trade of fake medicinal products.  Large amount of fake pharmaceutical products due to shortage of COVID-19 drug, is occupying medical trade in developing nations which have poor research and development and medical infrastructure. Unhygienic environment at PPE production sites, imitated hand sanitizers, absence of API in medicines and false coronavirus tests has further worsened the situation. Since the outbreak first originated in China, the country became the largest export of medical supplies. However, fake quality PPE kits sent abroad by China were reported by many nations and later it had to alter its production technique.

            Enforcement of lockdown, physical and social distancing and proper hygiene is observed as the best possible way to contain the outbreak. This worldwide lockdown has halted many economic activities though sectors for production of essential commodities are given full freedom. Millions of people lost their jobs due to declining profits of the companies which also disrupted global supply chain in the lockdown period. On 23rd April, 2020 nearly 80 countries had put export ban on foodstuffs, medical equipment, PPE kits, medical supplies and medicines.  These nations have violated the WTO 2012 decision of Agreement on Trade Facilitation on any new export restrictions. Only 39 out of 80 countries has notified WTO for restrictions (Tirkey, 2020). This shows the inability and poor strategy of WTO and WHO to control the outbreak and poor management of these organizations to maintain healthy trade relations between nations.

            Pharma companies have integrated technology with medical science for formulating effective drugs to overcome the outbreak and analyzing the potential of existing pharmaceuticals. For instance, many drug companies have chosen online platforms like 1mg, Pharmeasy.com, Netmeds.com, Amazon Web Services to transform manufacturing and supply chains for smooth delivery of the drugs to remote areas. The drug companies have gained deep biotechnological knowledge from decades of major viral outbreaks like, Nipah virus, Ebola virus, MERS virus, HIV virus, influenza virus H1N1 and many more. Government has also incentivized medicine and vaccine development by providing financial to pharmaceutical companies. For instance, US government will pay $2.1 billion to Sanofi and GlaxoSmithKline and $1.95 billion to Pfizer and BioNTech for vaccine development for around 200 million doses collectively.




Colored version of electron microscopy of SARS-COV2. Source: erc.europa.eu

           

            Though there is no solid data to prove efficacy of these drugs, most countries have authorized the drug for “emergency-use” or as an “off-label” drug during the pandemic. The drugs which have been used worldwide are Remdesivir, Lopinavir-Ritonavir, hydroxychloroquine, dexamethasone and plasma therapy (not a drug), has shown improved results. Remdesivir, a broad-spectrum antiviral drug developed by Gilead Sciences has shown effective results for treating viral disease like SARS, MERS, Ebola virus, Hepatitis C has shown favorable results for fighting COVID-19 (NIH, 2020). It has been manufactured by several pharma companies under different brand names and has been approved for its emergency usage in worst-hit regions like US, EU, India, France, Australia. As Remdesivir is a drug patented by Gilead Sciences, the company has been charging highly exploitative prices in other countries for its sale at US$3200 for 6-day treatment against its manufacturing cost of just US$6. Hydroxychloroquine, an anti-malarial drug along with macrolide has shown limited but debated results (Mehra, Desai, Ruschitzka, Patel, 2020). India, the 3rd largest country in the volume of drug production was the 1st country to approve the combined drug treatment for curing the disease. India has exported 285 million tablets of the drug to 40 countries and has gifted $5 million of drugs to import-reliant countries till date. However, the drug was put on ban on export to developed countries so that India has enough availability of drugs to cure its own patients. The country had also put ban on export of 26 pharmaceutical ingredients and formulation for manufacturing generic drugs.  Similarly, lopinavir- ritonavir and dexamethasone which can cure mild and severe symptoms patients have shown recovery. Plasma therapy, most successful in early treatment of the disease has proven to be one of the best methods for treating the disease.

Pharma companies and medicine trade-

§  Boehringer Ingelheim- A German pharmaceutical company, has a growing team of more than 100 scientist from nearly all areas of R&D for finding effective treatment solutions for COVID-19. It has received collaboration call by Innovative Medicines Initiatives (IMI) of the EU and Bill & Melinda Gates Foundation for COVID-19 medicine development. It also supports international development of medicines by its open innovation portal opn.Me.com, where anti-viral compounds and high-quality pharmaceutical tools are offered for free pre-clinical testing of research.

§  Johnson & Johnson-An American multinational conglomerate, is doing research to find new chemical compounds with antiviral response against COVID-19 in collaboration with Rega Institute of Medical Research (Belgium).

§  Novartis- Along with new R&D in medicine for COVID-19, it is speedily testing its existing treatment solutions for checking its efficacy against treating the disease. It aims to volunteer 450 patients at multiple medical countries in France, Germany, UK, US and Spain.

§  AstraZeneca – This company is focusing on SOLIDARITY Trial of WHO to find an effective and universally accessible treatment for COVID-19 by evaluating the treatment of antibody generation. It has also collaborated with AIIMS, Delhi (India) and Sweden for digital, affordable, quality and accessible healthcare to the large chunk of population (ABPI, 2020).

 

            These are some of the pharma companies which are collaborating globally for finding quick treatment for COVID-19 through intense R&D. There are four classification of SARS-COV2 based on the strands, 229E (alpha coronavirus, NL63 (alpha coronavirus), OC43 (beta coronavirus), HKU1 (beta coronavirus), and nearly 2000 genetic sequences of viruses, which are scattered randomly in different parts of the world (CDC, 2020).

            This different classification of virus is further complicating the medicine development to which all the patients can equally access. Since, coronavirus can be infected both symptomatic and asymptomatic with its effect ranging from mild to severe, the specific and proven medicine for curing the disease has further increased complexity for R&D of the medicines. Intensive research, training, adequate fund allocation and government support to the health institutions is the need of the hour. The health crisis has also forced government and public health sector to increase expenditure of GDP to improve health sector in their respective nations. Currently, around 150 countries are in the process of developing vaccines for containing COVID-19 pandemic.  The pandemic has so critical effects that even non-COVID patients like those suffering from NCD like cancer, diabetes, cardiovascular disease are hesitating to visit the hospitals for getting their health treatment and they are not receiving medical service for the same in especially developing countries due to shift of hospital’s focus to COVID-19 treatment. Fear, panic and anxiety are further affecting the mental health of these patients.

 

 

 

 

 

 

 

 

 

References

            The Association of British Pharmaceutical Industry (ABPI)(2020, June 8). What are pharmaceutical companies doing to tackle COVID-19? Retrieved from:https://www.abpi.org.uk/medicine-discovery/covid-19/what-are-pharmaceutical-companies-doing-to-tackle-the-disease/

 

Mehra, M.D., Desai, S.S, Ruschitzka, F, Patel, A.N. (2020, May 22). Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19? The lancet. DOI: https://doi.org/10.1016/S0140-6736(20)31180-6

Centers for Disease Control and Prevention (2020, February 15). National Center for Immunization and Respiratory Disease (NCIRD), Division of Viral Disease. Retrieved from: https://www.cdc.gov/coronavirus/types.html

Tirkey, A (2020, May 23). COVID-19: Export bans, trade rules and international cooperation. orfonline.org. Retrieved from:  https://www.orfonline.org/expert-speak/covid19-export-bans-trade-rules-international-cooperation

National Institute of Health (NIH) (2020, February 25). NIH trial of Remdesivir to treat COVID-19 begins. nih.gov. Retrieved from: https://www.nih.gov/news-events/news-releases/nih-clinical-trial-remdesivir-treat-covid-19-begins

erc.europa.eu (2020, March 15). Retrieved from https://erc.europa.eu/news-events/magazine/coronavirus-what-s-beyond-science-frontier

 

 

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