Nepal Struggling to Find Affordable Black Fungus Drug After India Banned Exports

An Indian company that had entered the bid after India had banned the drug’s export is now unable to promise supply.

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New Delhi: The Nepal government is facing “a roadblock” in procuring at a cost-effective rate a drug to treat rising cases of black fungus infections in the country because an Indian company that had entered the bid after India had banned the drug’s export is now unable to promise supply.

The Nepal government has thus far not disclosed the name of the company.

According to a Kathmandu Post report, the unnamed company won the opportunity to supply 10,000 vials of liposomal amphotericin B, the primary drug to treat mucormycosis infections.

Mucormycosis is an opportunistic infection in which fungal spores infect a body that has been ‘distracted’ by another infection or disease, especially diabetes. The number of mucormycosis recently sky-rocketed in India after doctors treated COVID-19 patients – both diabetic and non-diabetic – with steroids, which suppress the immune system.

Officials at Nepal’s department of health services told Kathmandu Post that three foreign companies – one each from India, China and Bangladesh – had submitted bids to supply the drug in response to a June 15 tender.

But, according to the news report, the Nepal government is in a bind now as it is unable to award the contract to the Indian company even though it bid the lowest amount. This is because, “despite participating in the bid,” the company hasn’t been able to “assure the supply of the medicine citing the ban on export of the medicine by the Indian government”.

The Government of India had banned exports of amphotericin B on June 1 – two weeks before the Nepal government issued the tender and a week before parties could bid.

“The Indian company says that it will supply the medicine as soon as India lifts the ban,” an unnamed official from the health services department told the newspaper. “But how long should we wait for the Indian government to lift the ban?”

Although the Chinese company was reportedly the second-lowest bidder, its rate is more than double the one the Indian company quoted – around Rs 11,000 per vial.

“As per the law, we have to award the contract to the lowest bidder. So we will ask the Indian company if it can supply the medicine within a few days,” Bhim Sing Tinkari, director of management at the department of health services, told the Kathmandu Post. “If it cannot supply the medicine as per our requirement, we may scrap the current bids and issue a fresh order.”

Tinkari added the department is not willing to pick the Chinese company as its price was very high. He also said it was considering asking “hospitals to procure the drugs themselves”.

Curiously, Krishna Prasad Paudel, the spokesperson for Nepal’s health ministry, had also recently said that the government had received some doses of the drug and that they were being distributed to government-run hospitals in the mountainous country.

Following a spike in mucormycosis cases across India, the directorate general of foreign trade, under India’s commerce ministry, restricted exports of amphotericin B on June 1, with immediate effect.

According to news reports, over 45,000 people in India have reported contracting the infection and over 4,300 people have died of it. Mucormycosis infections have to be treated early because they progress and deteriorate rapidly.

In late May, the Indian government had instructed Indian missions across the world to shore up on supplies of amphotericin B.

In early June, an India Today report had also said that, thanks to the demand, “unauthorised vendors” were selling the drug at “outrageous prices”.

As the number of COVID-19 cases surged in Nepal, the number of mucormycosis cases have shot up as well. The Kathmandu Post reported that in response, the Nepal government issued the tender for liposomal amphotericin B on June 15, to purchase the drug under exceptional circumstances, under procedures specified in the Public Procurement Act and Regulations.

“Despite  the seriousness of the case, neither the government currently has any significant stock of liposomal amphotericin B nor is it available in the domestic market, ever since India banned its export,” the report said on August 6.