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SARS: India's drugs in
demand
By Jayanthi Iyengar
NEW DELHI - It was the anthrax scare in the
United States in 2001 that highlighted a problem
familiar to people in developing countries - the denial
of access to affordable drugs because of tough patent
laws. The deadly severe acute respiratory syndrome
(SARS), which has reportedly killed over 103 people and
infected upwards of 2,600 worldwide, has brought to the
fore another fallout: the economic upside of a killer
disease.
As per reports trickling into the
Indian capital, the mysterious virus has increased
demand for macrolides, resulting in severely affected
countries like China approaching the Indian
pharmaceutical companies for additional supplies.
Macrolides are a family of antibiotics that treat a wide
range of bacterial infections. While doctors are still
battling with the exact cure for the "killer pneumonia",
macrolides, commonly used for treating lower respiratory
tract infections, seems to have emerged as a preferred
drug in treating SARS.
Indian pharmaceutical
companies, particularly those in the Hyderabad area,
have reported that order inquiries have gone up by four
to five times from China and Southeast Asia, the
epicenter of the epidemic. "There is a sudden spurt in
inquiries over the last two days, particularly from
China," said Sirish Kumar, vice president, API
marketing. Compared to the order sizes of between 100
kilograms to 200 kilograms normally, inquiries from the
region have increased to between three to four tons, he
added.
The companies approached manufacture
antibiotics used for treating pneumonia in India.
Alembic and Max Pharma are two of the largest
manufacturers of the full range of macrolides in India,
while a few other companies also manufacture some class
of macrolides.
China is turning to India at this
juncture as it traditionally meets some of its macrolide
requirements. The demand for macrolides in China under
normal circumstances is about 14 tons to 15 tons a
month. Of this, Alembic supplies up to four tons to the
country.
While medical practitioners are still
struggling to find the cure for the killer disease, the
macrolides, widely used for treating pneumonia, are the
favored drug prescribed by medical practitioners at
present. Macrolides include drugs such as erythromycin,
azithromycin, clarithromycin and roxithromycin. They are
particularly useful in the treatment of lower
respiratory track infections.
Given the speed
with which the disease is spreading and its mysterious
nature, predictions have varied as to whether the
infection has plateaued out or whether it is on the
rise. The World Health Organization (WHO) warned over
the weekend that more casualties can be expected, which
is bad news for the public but good news for the drug
companies.
The US Center for Disease Control and
Prevention informed that early manifestations in
stricken patients included influenza-like symptoms such
as fever, headache, sore throat, dry cough, shortness of
breath or difficulty in breathing. In some cases, these
symptoms are followed by hypoxia, pneumonia and
ultimately acute respiratory distress requiring
mechanical ventilation and death.
It may be
recalled that during the anthrax scare, a similar
escalation in demand gave rise to the realization that
legal exceptions to patent provisions would have to be
provided for to tackle such emergency situations. The
SARS parallel does not go that far, since the
perfect-fit drug for the epidemic is not known, but the
additional demand for drugs from the affected countries
is beginning to throw up the frightening specter of a
drug shortfall, along with the escalation in demand it
will make on the hospitals and existing medical systems.
At the time of the anthrax alarm in the US, the
German company Bayer AG held the patent until December
2003 on the anthrax antibiotic, ciprofloxacin, known by
the brand name Cipro, but it had limited stocks. In
India, the country's largest pharmaceuticals company,
Ranbaxy Laboratories Ltd, would have been able to supply
a cheaper, generic form of Cipro, but it was prevented
by patent laws from doing so.
The WHO has
already confessed that the development of a diagnostic
test, which is being pursued around the clock by the
WHO-collaborating network of 11 laboratories, had proved
to be more problematic than hoped. "Three diagnostic
tests are now available and all have limitations as
tools for bringing the SARS outbreak quickly under
control," it said.
The three diagnostic tests
include ELISA, immunofluorescence assay (IFA) and the
PCR molecular test. ELISA detects antibodies reliably,
but only from about day 20 after the onset of clinical
symptoms. It therefore cannot be used to detect cases at
an early stage before they have a chance to spread the
infection to others.
The second test, an IFA
detected antibodies reliably as of day 10 of infection,
but was a demanding and comparatively slow test that
required the growth of virus in cell culture. The more
widely used PCR molecular test for detection of SARS
virus genetic material was useful in the early stages of
infection. However, it produced many false negatives,
meaning that many persons who actually carry the virus
may not be detected - creating a dangerous sense of
false security for a virus that is known to spread
easily in close person-to-person contact, the WHO said.
(©2003 Asia Times Online Co, Ltd. All rights
reserved. Please contact content@atimes.com
for information on our sales and syndication
policies.)
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