India's uncontrolled and corrupt medical supply chain comes to bite back just in time for a pandemic

There is a strong yearning among many Indians, myself included, for our nation to reach the upper echelons, to considered as having arrived, and to be recognized as a developed nation. Sadly, political and societal will is lacking. This is not to be considered a negative post railing against India. I just want to state through at least one more recent story (linked below, Indian sites can drain your GPU through glaring graphics, so buyer beware), that I know adds to a large volume of anecdotes and press articles about the corruption that persists doggedly, at many levels of society, and alas, also in the medical supply chain. 

The Story

Recently, my father shared a story about Remdesivir being sold at approximately 4 times the regulated price in Tamil Nadu, India, our home state. You can say, a curiosity about healthcare runs in the family, so he does keep an eye out on local stories. As the story goes, even as supplies are sufficient, unscrupulous pharmaceutical "agents" are hogging supplies and then reselling them to desperate people at very high prices. There has of course been a complaint from the Medical Association to the local Government and as with all things, nothing tangible is happening.

Why? 

Simply put, the Indian government, while heavy-handed, has a very poor sense of direction or priorities.

They claim that Western companies engage in price gouging, so enforce really odd and incredible controls on the sale of drugs and devices originating from elsewhere (most Allopathic medicine in India originates elsewhere anyway). Despite innovations such as the Jaipur leg, this sort of regulation and control has done nothing to promote innovation at large scales from within India.

Yes, there are some really innovative solutions that come up, and there will be more as Indians realize their potential, but it is not owing to the really bizarre and ultimately useless regulatory environment set up. Why do I keep saying bizarre? Well, if you are an Abbott or a Medtronic for example, if you don't like the government's own price gouging, er, control, you have to apply even to withdraw a product from the market. I have blogged about this in the past. This is at the core of the problem. The real problem. 

The Real Problem

Yes, a significant portion of India still lives in poverty. Yet, list prices are not the problem. This is a

solvable issue. Even in a fair market, India could easily subsidize prices for customers who access public care, and of course, regulate ceiling prices. Instead, they control the prices and have done nothing to battle systemic corruption in every aspect of the healthcare chain. Therefore, hoarding and price gouging has just been transferred to criminals at large. This is now a systemic problem and affects every aspect of healthcare delivery like it has for decades, and the general public suffers. 

The Solution

I am not a free-market buff. I think a healthy dose of regulation is not a bad idea. However, the Indian

Government needs to federate pricing and manage this with maturity. Random, piecemeal pricing controls are not the solution, either. As I have written on this blog before, it destroys competitiveness and companies will shy away from introducing drugs and devices in India, medical tourism, or not. Protectionism can go both ways and really risk innovative products from India finding customers elsewhere in the future. The more urgent solution needs to be immediate control of the supply chain within India. Here are a few thoughts:

1. Prices for important drugs and devices, such as branded stents, or Remdesivir should be on a national database, available publicly, with a ceiling price clearly stated. 

2. If there is price gouging, there should be a separate hotline, that is then responded to when called upon, with swift punishments, which should include jail time. 

3. Modern tracking methods such as RFIDs and others should be used to track lots and quantities and where within the country shipments land. 

4. Suprise secret shoppers should visit online and brick-and-mortar stores and check out what is going on. I mean, it can be that simple, and the government has barely scratched the surface on such possibilities. 

Conclusion

It is clear that the Indian Government lacks the maturity to focus on the correct problems and the right solutions. I believe this transcends political parties as well. The medical profession and the public at large must insist on appropriate solutions that prevent injustices which will really push down the country's progress. India's pride and place in the world are at risk otherwise, as the coronavirus pandemic has shown. 

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References:

1. The Times of India Story (please be aware of the graphic-intensive nature of the web page): https://timesofindia.indiatimes.com/city/chennai/rs-3000/vial-remdesivir-sold-for-rs-12000-in-tn/articleshow/77271533.cms

2. An archival post I authored about the medical device market in India: https://chaaraka.blogspot.com/2017/04/indias-bizarre-medical-device-market.html

3. An archival post I authored about the status of Foreign Direct Investments (FDI) in India: https://chaaraka.blogspot.com/2012/08/indias-pharma-fdi-mess.html

Credits: 

1. Cover Image, courtesy Darshak Pandya via Pexels: https://www.pexels.com/photo/architecture-daylight-hand-india-574324/

2. Image of open book with glasses, courtesy Ugurlu via Pexels: https://www.pexels.com/photo/close-up-of-eyeglasses-on-book-336407/

3. Image of question mark, courtesy Pixabay via Pexels: https://www.pexels.com/photo/ask-blackboard-chalk-board-chalkboard-356079/

4. Image of lady with hands on her face, courtesy Kat Jayne via Pexels: https://www.pexels.com/photo/adult-alone-anxious-black-and-white-568027/