Sarah Thebarge, a 41-year-old medical assistant living in San Francisco, takes a pill every day to treat her lupus, a chronic condition that causes unbearable joint pain, fatigue and fainting.
The medication she takes is hydroxychloroquine or HCQ.
But in March, HCQ, which is also used to treat malaria, suddenly became more difficult to obtain after U.S. President Donald Trump introduced the drug as a possible treatment for Covid-19.
As people began to accumulate it, India - which would account for 70% of the global supply of HCQ - quickly stopped exports to guarantee its own supplies.
"When hoarding started, my 30-day inventory was overdue," said Thebarge. "The scenario really scared me, what would happen if I couldn't get HCQ?"
The U.S. Food and Drug Administration (FDA) did not approve HCQ as a treatment for Covid-19, but the episode did show how dependent the U.S. is on India for drugs - namely generic drugs, which are copies of brand name pharmaceuticals that have the same effects but cost less.
In the United States, 90% of all prescriptions are filled with generic drugs, and one in three pills consumed is produced by an Indian generic manufacturer, according to an April 2020 study by the Confederation of Indian Industry (CII) and from KPMG.
While the United States appears to dominate with its ally India to obtain the finished product, there is a bigger problem earlier in the supply chain.
India obtains about 68% of its raw materials - known as active pharmaceutical ingredients (API) - from China. Any disruption in this supply chain can create a major problem, especially during a pandemic.
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