The Ebola effect
The fear of the Ebola Virus Disease (EVD) being imported into India is worrying our Parliamentarians but besides relying on Indians returning from the affected areas to voluntarily report to immigration and also alert health authorities if they observe any of the symptoms of the disease, there is nothing much that the Government can do except hope for the best. With an estimate of around 45,000 Indians at risk in the four affected countries (Guinea, Liberia, Sierra Leone and Nigeria) the risk is quite substantial.
We have once again been caught unawares by a zoonotic disease, where the disease causing agent, here the Ebola virus, is carried by animals (fruit bats infect chimpanzees, gorillas, monkeys, forest antelopes) but enters the human population (in this case through consumption of their meat). After the first species jump from animal to human, it doesn’t take long for the infection to assume epidemic proportions, as more humans get infected through animals or humans when they come in close contact with infected body fluids or body secretions.
The 2002 outbreak of the SARS virus and the various flu epidemics (bird/swine/horse) as well as bovine spongiform encephalopathy (BSE), commonly known as Mad Cow Disease are all examples of such zoonoses. Public health experts note that each year sees a new such infection emerge, run its course and fade out, but not before taking a death toll. According to a WHO report, as of August 6, 2014, the cumulative number of cases attributed to EVD in the affected four countries stood at 1779, including 961 deaths.
As far as cures go, in most cases, we have very few options and since these are not common disease conditions, not too many pharma companies are willing to invest in such drugs or vaccines. For example, for the current EVD, two experimental treatments have been cleared by the US FDA to treat people showing symptoms of the disease but stocks have already run low.
What can be done to encourage more companies to research cures for such disease outbreaks? Clearly, drug and vaccine research is an expensive proposition and medicines for ‘poor man’ diseases like neglected tropical diseases will never be blockbusters. But as such zoonotic outbreaks prove, with increasing international travel, such diseases have no boundaries. Indeed, India too could see some cases once citizens in affected zones start returning.
Industry observers point out how the Government in India is bringing more medicines under price control as well as making rules for clinical trials more stringent. The intention is to make medicines more affordable and safer for patients. Minister of State for Chemicals & Fertilisers, Nihal Chand informed the Rajya Sabha that NPPA’s decision to cap the MRP of 108 non-scheduled formulations relating to diabetes and cardiovascular treatments led to price reduction of these drugs ranging from less than one per cent to over 79 per cent and this no doubt earned the regulator a patient-friendly aura.
But a few companies are already feeling the heat. There are moves to sell off brands to tide over the cash crunch while other companies are looking at reducing or abandoning manufacturing in India in favour of more accommodating countries in South East Asia. (See story ‘Counting on research’, pages 22-23 in the Lab Special section). This unfortunately will serve neither the interest of the patient, the Government or the industry.
The previous Government’s venture to make low cost medicines available to the public, through the setting up of generic drug stores or Jan Aushadhi stores (JAS), has also been proved futile. Over one-third of these stores are lying defunct, even considering that though the government had planned to open 626 such outlets between 2008 and 2012, only 154 could be opened till March 2013. Clearly, these options are not viable without the cooperation and inputs from a larger section of industry. It is high time that Government give a serious non-judgemental hearing to industry associations and all stakeholders work out a compromise.
Viveka Roychowdhury
Editor
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