The US's need for the antimalarials chloroquine and hydroxychloroquine, which are being tested for anti-Covid-19 effects, opens up some extraordinary opportunities for India. US president Donald Trump told the American media that he had requested prime minister Narendra Modi for an urgent supply of hydroxychloroquine, and that India is giving it serious consideration. Given India, as per the Indian Pharmaceutical Alliance, accounts for 70% of the global manufacturing of hydroxychloroquine-the National Pharmaceutical Pricing Authority (NPPA), as per a report in ThePrint, pegs current manufacturing capacity at nearly 20 crore 200 mg pills per month-coming to the US's aid would seem to make strong bilateral relations, and business and humanitarian sense. At the moment, India has banned export of the drug-an April 4 commerce ministry notification amended to this effect a March 25 notification that restricted the export of the drug to only that of "certain shipments on humanitarian grounds". It is not certain if India is going to revisit this in light of Trump's request. However, the government needs to do the maths on domestic demand, and the capacity (after ramping up by companies) India is estimated to have for the manufacture of the drug before it takes a decision.
It is, without doubt, impossible to accurately predict the peak extent of Covid-19 spread in India. But, some models do imagine scenarios where there could be a situation where 5% of the population-or 6.5 crore people-are infected. To be sure, this may not materialise if appropriate testing and isolation of Covid-19 cases is done, even as compulsory social distancing measures such as lockdowns (blanket or targetted) are enforced. But, being over-prepared-especially when the country's healthcare infrastructure simply can't handle the demand for hospitalisation likely to arise in the worst-case scenarios predicted-doesn't hurt. That apart, the Indian Council of Medical Research has advised the use of chloroquine/hydroxychloroquine as a prophylactic for health sector professionals who face a higher risk of infection, while the use of the drugs for malaria and rheumatic arthritis will most certainly continue unabated.
India's ban does place the US-with over 300,000 Covid-19 cases, and nearly 8,000 deaths-in a tight spot. Nearly half the current supply of hydroxychloroquine in the US comes from Indian pharma companies, as per Bloomberg. While the White House says the US has some 2.9 crore pills in its current stockpile, and American drugmakers are likely to restart production of the drug, the fact is that even the APIs for these are routed through India. Indian pharma's dependence on China for APIs is also something that the Centre must keep in mind. While it has launched a scheme to encourage domestic API capacity, the fact is that if the Chinese decide to curtail supply in the near term, or are unable to match both the Indian and the American demands, giving the US the hydroxychloroquine it clearly needs will affect India's sufficiency on the key drug.