India’s decision to put a ban on exports of Remdesivir and its active pharmaceutical ingredients following a continued surge in Covid-19 cases in the country and, consequently, the demand for the antiviral drug at home, should not be much of concern in Nepal, officials and experts say.

Experts have ruled out any immediate impact in Nepal but said the concern should rather be about a possible ban on essential drugs required for patients in intensive care units and other raw materials in light of the rising number of cases in India as well as Nepal.

“Remdesivir itself is not a magic bullet and studies carried out in several countries have shown mixed results,” Dr Anup Bastola, who is also involved in efficacy trial of Remdesivir in Nepal, told the Post. “It can help patients to get cured, if given in the initial days.”

Bastola, who is also the spokesperson for the Sukraraj Tropical and Infectious Disease Hospital, said Nepal imports antiviral medicines from Bangladesh as well.

After witnessing a dramatic decline in the number of new cases, India has started seeing a massive surge of infections, leaving the Indian government to scramble and pull out all the stops to control the virus spread.

India’s decision to impose a ban on Remidisvir follows its move to put on hold exports of the Oxford-AstraZeneca vaccine, which is manufactured by the Serum Institute of India under the brand name Covishield.

"The Government of India has prohibited the exports of injection Remdesivir and Remdesivir Active Pharmaceutical Ingredients (API) till the situation improves," reads a statement issued by India’s Press Information Bureau on Sunday.

“India is witnessing a recent surge in Covid cases. As on April 4, there are 11.08 lakh active Covid-19 cases and they are steadily increasing. This has led to a sudden spike in demand for injection Remdesivir used in the treatment of Covid-19 patients.”

According to the Indian government, there is a potential for further increase in the demand for the antiviral drug in the coming days.

Daily cases have set record highs six times this week, according to data from India’s federal health ministry.

On Sunday, India recorded 152,879 new Covid-19 infections and the country is battling to control the second wave of cases by pushing for faster vaccination.

India’s tally of more than 13.35 million cases is the third-highest globally, behind only Brazil and the United States.

According to a Reuters tally, India leads the world in the daily average number of new infections reported, accounting for one in every six infections recorded globally each day. Deaths have also surged, with the federal health ministry reporting 839 fatalities on Sunday—the highest in over five months—as hospitals and crematoriums in some parts of the country grappled with the worsening situation.

The World Health Organisation in November issued a conditional recommendation against the use of Remdesivir in hospitalised patients, regardless of disease severity, saying there was no evidence that the drug improved survival and other outcomes in these patients.

The UN health agency, which had carried out Solidarity, one of the largest international randomised trials for Covid-19, said in its interim report that remdisivir has little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in patients.

The study was performed in 12,000 patients admitted to 500 hospital sites of over 30 countries.

Seven Indian companies have licensed the drug from Gilead Sciences, with an installed capacity of about 3.9 million units per month.

According to the Channel News Asia, India's drug regulator and some state governments have in recent days raised concerns over hoarding and black marketing of Remdesivir, which in some instances is being sold at more than 10 times the maximum retail price.

Remdesivir has been used in Nepal as well with unconfirmed reports suggesting the possibility of being sold at much higher prices.

With India officially putting a ban on exports of the antiviral drug and reports suggesting its blackmarketing, officials and experts say the possibility of Remdesivir being sold at higher prices could not be ruled out.

Dr Samir Kumar Adhikari, joint spokesperson for Nepal’s Health Ministry, however, said Remdisivir is not a widely used drug in Nepal.

“And we have imported the drug from Bangladesh as well,” said Adhikari.

Concerns have grown in Nepal about the rapid spread of coronavirus as the country lately is witnessing a steady rise in the number of infections, and government officials say the United Kingdom variant, known as B.1.1.7, is responsible.

According to the Health Ministry, 303 people tested positive for the coronavirus and one person died from Covid-19 related complications in the last 24 hours. Besides, 64 people tested positive in antigen tests performed at health desks set up at the border points with India. The number of active cases stands at 2,961.

So far, 280,028 people have tested positive throughout the country since it first reported its Covid-19 case in January last year. Data provided by the Health Ministry shows 3,040 people have died so far due to coronavirus infections.

The government has urged all to strictly follow safety measures, including wearing masks, washing hands with soap and water, using sanitisers, maintaining physical distance and avoiding crowded places. The Health Ministry has also recommended closure of schools. But no decision has been taken yet.

Nepal has currently suspended its vaccination drive for the lack of supplies from India.

Nepal so far has used the Serum Institute of India’s Covishiled and China’s Sinopharm vaccine to immunise its population.

A little over 1.8 million people were vaccinated in the first and second phases of the drive using Covishiled. China has given 800,000 doses of Sinopharm vaccine under a grant assistance.

According to Adhikari, the immediate concern is not that India has put a ban on exports of Remdesivir.

“What could really impact us is if other essential drugs are also restricted,” Adhikari told the Post. “The government will then have to request the Indian government not to restrict raw materials and some specific medicines which are not manufactured in Nepal.”