Over the past few weeks, as countries have become more desperate to fight the incessant onslaught of the COVID-19 outbreak, hydroxychloroquine (HCQ) has emerged and been advertised as a beacon of hope. Noting its potential, Indian authorities banned the export of the drug. However, in response to requests by several countries, and threats by the USA, India rescinded the ban. Various political leaders applauded this India’s decision to resume exporting HCQ, instilling hope in the efficacy of the drug in fighting COVID-19.
The celebration of HCQ’s use in treating COVID-19 patients raised eyebrows in medical communities across the world. With several arguments and anecdotal evidence on both sides of the argument, the world watches on in anticipation, awaiting any possible solution to contain the outbreak. Despite no conclusive evidence in favour of HCQ, leaders continue to laud the drug as a saviour. During this period of uncertainty surrounding the efficacy of HCQ, India is quickly emerging as the sole beneficiary of the hype surrounding the drug.
India is irrefutably one of the key players in the international pharmaceutical market. It exports 30% of its pharmaceutical exports to North America, 16% to Europe and 17% to Africa. Moreover, according to the Indian Pharmaceutical Alliance, India accounts for 70% of the global manufacture of HCQ.
Amidst the uncertainty surrounding the outbreak, the Indian government is undeniably benefitting from HCQ being touted as a treatment for COVID-19. Following the temporary ban on the export of the drug, several countries requested Indian authorities to rethink the decision, citing humanitarian needs. This showed the asymmetry of power in the trade of HCQ in the international market by indicating an overdependence on Indian pharmaceutical companies. Consequently, India emerged as an important stakeholder in the fight against the coronavirus pandemic.
Once the ban was lifted, India guaranteed exports on humanitarian grounds to neighbouring countries and to those severely affected by the pandemic. Currently, the Indian government is fulfilling world demand in two ways–through donations and the commercial sale of HCQ. India is donating HCQ to countries from Africa, Latin America, and SAARC, and selling it to European countries and the US.
For India, both donating and selling HCQ constitute a win-win situation. Whether or not HCQ emerges as a confirmed treatment for COVID-19, India is emerging as a key player in the fight against the pandemic, generating goodwill and potentially fortifying post-coronavirus trade relations. Through this “medical diplomacy”, India can prospectively avoid unnecessary retaliation and trade bans by other countries on medical equipment needed for domestic needs. Furthermore, the large-scale demand for the commercial sale of a locally produced drug will ease the burden on India’s finances during these trying times.
Several political leaders applauded the decision to lift the ban on Indian exports and viewed it as a sign of a strengthening friendship with India. For instance, Donald Trump tweeted, “Extraordinary times require even closer cooperation between friends. Thank you India and the Indian people for the decision on HCQ. Will not be forgotten! Thank you Prime Minister @NarendraModi for your strong leadership in helping not just India but humanity, in this fight!” Brazilian President Jair Bolsonaro and Israeli Prime Minister Benjamin Netanyahu, too, thanked Indian authorities for providing HCQ. The provision of HCQ also caused a turnaround in India’s previously soured relations with Malaysia, with an Indian source claiming that “there will be a new alignment of relationships”.
While medical experts repeatedly deny any conclusive backing to the claims of the positive impact of HCQ on COVID-19 patients, political leaders across the globe–whether implicitly or explicitly–are celebrating the drug as a ray of hope. American President Donald Trump is the loudest advocate of prescribing HCQ for COVID-19 patients. He called the drug “very effective” and the “biggest game-changer in the history of medicine”. Similarly, Bolsonaro posted a video, which was eventually taken down by Facebook and Twitter, claiming that HCQ is 100% effective in treating COVID-19 patient.
However, the excitement surrounding the procurement of the drug may be misplaced, with experts worrying that the drug may do more harm than good. The celebration of HCQ as a cure is repeatedly scorned by medical experts who warn of the dangers of over-reliance on HCQ as a prospective treatment for COVID-19 patients. Proponents of HCQ rely on two separate studies–one conducted in France and the other in China–that show positive results. While the French study reversed their position, saying that the article does not meet “the society’s expected standard”, the Chinese trials only showed success in treating moderately ill patients. Simultaneously, both the studies are being criticised for not including control groups to compare treated patients from untreated patients. Dr. Zhang Dingyu, the head of Wuhan’s Jinyintan hospital, expressed concern about the dosage after local health authorities warned that an overdose of the drug could be fatal.
The over-emphasis on the drug by political leaders led to several physicians using HCQ as first-line therapy, causing concern about the impact of the side-effects on the patients, especially those with underlying conditions. Despite the known harms, various physicians face pressures from patients, who, citing the medical advice of their political leaders, wish to be prescribed HCQ as a treatment for COVID-19. On April 7, it was reported that, since March 27, 43 cases of heart-related side-effects were reported following the prescription of HCQ to COVID-19 patients. According to Swedish media reports, several incidents of severe side-effects caused Swedish hospitals to stop prescribing HCQ altogether. Apart from its impact on COVID-19 patients, the hype surround HCQ is predicted to cause a shortage for its traditional uses–curing malaria, lupus, and arthritis.
Without any conclusive tests on the efficacy of the drug, the obsession with HCQ may be construed as a carefully-crafted distraction from the more alarming issues that have emerged from the COVID-19 outbreak. The pandemic has caused healthcare systems of even the more prosperous and developed countries to crash, thereby raising concerns about the preparedness of medical systems across the world for such public health emergencies.
As leaders rush to provide hope to their anxious and fearful populations, HCQ may represent a false dawn and a smokescreen in the fight against COVID-19. Leaders like Trump are arguably using the unproven drug to urge calm and engender confidence in their leadership and their ability to contain the virus at a time where, by his own admission, the virus is “not under control for any place in the world”. As the world’s largest producer of HCQ, India holds considerable bargaining power in the present scenario and stands to gain both economically and diplomatically from this instability and panic, both in the short-term and the long-term.
However, regardless of India’s gains, a question that remains unanswered is: amidst a global shortage in PPE and ventilators, which are being demanded by medical communities across the world, why are world leaders focussing on HCQ rather than investing in medical supplies known to assist in the recovery of COVID-19 patients?
Image Source: India Legal Live
The Uncertainty Surrounding Hydroxychloroquine: An Unexpected Win for India?
April 16, 2020
