Narayan B. Chhettri

The COVID-19 that first broke out in Wuhan city of China in December last year has now become an invisible enemy of the entire humankind, causing enormous socio-economic impacts on both developed and poor countries alike. The virus has been highly contagious spreading from human to human with a capacity to develop a rapid mutation. The biggest pandemic of century has spread to most of the nations and killed over 398, 496 people as of Saturday, with over 6,862,700 cases.

Anti-retroviral drugs
The race is now on to develop a vaccine to cure the COVID-19 disease. However, this is a huge task which is estimated to take at least 6 to12 months. Designing a therapeutic such as a commercialised form of RNA interference (RNAi) will promise faster delivery to market. Yet, efforts may be hampered by the fact that the virus now is believed to have evolved into two separate strains. At this desperate situation, alternative and supportive approaches include the evaluation of various anti-retroviral drugs for their efficacy to combat the infection. Furthermore, drugs used for the treatment of rheumatoid arthritis, anti-malaria, some retroviral and antibiotics have been administered to cure patients with serious lung damage resulting from the uncontrolled immune response. Many multinational and Indian pharmaceuticals are putting their efforts to develop COVID-19 vaccines.
Owing to the worldwide interdependency of pharmaceutical manufacturing, the ongoing corona crisis has disrupted the global supply chain of diagnostic kits, active pharmaceutical ingredient (API) and finished dosage form therapeutics, medical goods and equipment. China is a key player in the global pharmaceutical industry. It contributes to the production of APIs and finished dose forms, as well as providing many essential intermediates and raw materials. Understanding China’s dominance in the market is, therefore, vital when it comes to establishing and de-risking pharmaceutical supply chains. China is the world’s largest exporter of generic medicines, accounting for approximately 70 per cent, which form essential intermediate chemical for the global API manufacturers. The corona crisis has increased the price of most of the raw materials and allied chemicals.
India is the second-largest exporter of generic finished formulation but Indian API manufacturing companies largely depend on China for their production. It has made concerted efforts and strategic initiatives to shift manufacturing activities to its own land to attain self-sufficiency in pharmaceuticals for the past few years.
The COVID-19 emergency is likely to force some governments to ban the export of key materials such as pharmaceutical APIs and chemicals due to their possible shortage in their own market. In early March, India declared that it would restrict the export of 26 APIs and finished formulation, fearing that it might face their shortage in future. But many Indian pharma companies under the Indian Pharmaceutical Alliance (IPA) and the Indian Drug Manufacturers’ Association (IDMA) took initiatives to relax the restriction. However, they are yet to ease the supply of most essential drug such as Paracetamol and Hydroxychloroquine. It is quite understandable that every country gives priority to the health of its own citizens and acts to ensure their sufficient stock to meet domestic demand.
The COVID-19 crisis has provided an important lesson to every nation that self-reliance is the only way to survive and sustain during the global calamities and make the national economy stronger. However, it is always very difficult to remain completely isolated from one another in the inter-connected world. But, the developing countries should certainly identify their key areas of strength for self-sustainability and move ahead to achieve it.
Sufficient investment in Nepali pharmaceutical industries and the available installed capacity can achieve more than 80 per cent self-reliance in pharmaceutical products in the next two years if the government protect, support and promote them. Self-reliance is a priority of every citizen and the government. It is has been observed that every politician and top bureaucrats have committed to taking positive action plans to achieve self-reliance in the pharmaceutical sector but it has not seen any tangible outcome.

Promoting domestic products
In order to attain self-reliance in medicines, I would like to recommend following ideas: 1. All should promote a feeling of nationalism by using 'Made in Nepal’ products. 2. Every citizen including doctors, chemists and patients should promote and use domestically manufactured medicines. 3. The government should stop importing identified molecules which are already sufficiently manufactured inside the country. 4. We should discourage the use of external products and impose various non-tariff barriers to imported items. 5. The country has to promote pharmaceutical industries by establishing special economic zone (Pharma hub).
Finally, the pandemic has forced every country to rethink about reducing dependency on imports and develop local sustainability and identify those areas or products which can help attain self-reliance in pharmaceuticals which Nepal can achieve in next few years.

(Chhettri is the Rtn General and president of Association of Pharmaceuticals Producers of Nepal)