 Hello and welcome to NewsClick. Today we're going to be talking about the situation with respect to the COVID-19 drug remtissivit. After the US announced it has purchased most of the stocks that are currently being manufactured and going to be manufactured by the company Gilead Pharmaceuticals. We have with us Praveen Prakash. I'm going to talk about this. Praveen, thank you for joining us. So the US announcement is something, the possibility of this announcement is something we've been talking about at iPhone NewsClick for many months. How will the US respond to Gilead Pharmaceuticals once their drug reaches some amount of stability and we've seen what's happened? Many countries are extremely worried. So how do you, this was in some senses expected, but how do you see this playing out? Well, we've been talking about it, you're right, about the vaccine war, the drug war, essentially that unless other countries are able to manufacture drugs and vaccines, it's quite possible that the US will privilege itself in the first in the queue and others will have to wait till the US crisis is over. And at the rate the US is going, that crisis is not going to be over for a long time. So effectively it does mean that the rest of the world does not know now what to do in spite of the fact this warnings have been there for quite some time. And in the World Health Assembly, this issue had come up that what about the patents being put in a common pool, which would be accessible by to many countries. And the US had said no, that this is against intellectual property rights, which the companies have, therefore they will not support it. And they have taken the first step by saying, well, you know, all of Gilead's medicines are ours first, and then we will see what happens to the rest of the world. Now, this in a certain sense is really straightforward, because we've got this battle over AIDS epidemic earlier, when the medicines were not available from the Global South. And they were not also available because of a very high price which is being asked, the concession price at that stage was $4,000 against $12,000 to $15,000 or $10,000 to $15,000 at which they are available in supposedly the home market. So even those prices were very high, but at $4,000 it was a death sentence for us to the world. Remdesivir is a particularly egregious case, because you know, it's a small molecule. The cost of this molecule is probably not more than $10 for a full five day course. This is not what I'm saying. This is what there has been institutions which have been working on it have worked out the detailed costing, and they have come to the figure that about $10 is the total cost of production. Now Remdesivir is also being charged to even the US customers at $3,000 for the insurance for those who are going to the hospitals were not insured. It's $2,000, but that is 200 times the cost or 300 times the cost of the production of the medicine production cost of the medicine. So already you are seeing profiteering on a very high scale, even in the US and not done that what it has capturing the total stock, the issue of actually licensing Remdesivir compulsorily would have been there. And this is what we have been arguing for some time. We hadn't flagged the issue that US might capture most of the stock of medicine. We had raised this, but our also concern was the price which we are going to get. In India, the prices we talked of is about roughly about $400 25 to 30,000 to 350 to $400 is the price that is being talked of told that that price is completely out of the question for large sections of the Indian people. So the question of profiteering is they're very much there with the gillian and also with the United States now saying you devil take the hind most we take the bulk of the medicine that is there. Now this, as I said, because it's a small molecule, it can be produced by any country in the world, which has a reasonable degree of chemical infrastructure for getting a reasonable degree of chemical infrastructure. Because it is the earlier patented version, which Gilead claims to have tweaked and improved has been found effective in cat viruses cat has cats get affected by another coronavirus. And this was found effective against cat coronavirus. So this is being sold in the black market by people who run essentially garage operations and some of them run it out of China. And it's available as mail order. So it effectively can be produced any body with the modicum of chemical knowledge, because it's essentially a small molecule is on a biological drug, which really requires a much bigger set of equipment. Knowledge, et cetera, et cetera, to handle this can be done by any any country in the world with a small or reasonable chemical production infrastructure. So in this particular case, to use patents to deny any other country, this medicine, and then take over the entire production of it, which is what the two steps the United States has done. One vetoing, not vetoing, but saying they don't agree with the basically the patent fool idea. And the second now capturing all the production for itself. I think makes it the case for compulsory licensing of remdesivir is much stronger than it was when it was just simply a price question, which could be negotiated. But now it's no longer that it's the that what is called the API in the bubble drug, what is called the active pharmaceutical ingredient, which is there, which comes from guillir at the moment, even to India. At least this plans to come to India and come to SIPLA. I think SIPLA and Hetero are the two companies which have got the agreement with guillir to sell it in the Indian market. Now they will not just get the active pharmaceutical ingredient either. So given all of this, I think the case for compulsory licensing has just increased enormously. And I think this is an US overreach that has taken place. Of course, the question is, will Mr Modi, in this case, the Prime Minister take on Trump, Donald Trump. Earlier yet, you know, if you remember, we had stopped hydrochloroquine export from India and Trump's under Trump's threat, we agree. Now, of course, hydrochloroquine did not become very useful. So that's a different issue. But now that we know that this medicine is useful, it does reduce the time of infection by about 20, 20%, 15 to 20%. We also know it doesn't work on people who are seriously ill. There we have the dexamethasone and heparin, which are basically blood thinner and one is a corticosteroid. Dexamethasone is a corticosteroid that relieves the inflammation. So seriously, in patients, remdesivir really has no effect. So, but it does have effect in cutting down the infectious period, therefore slowing down the transmission of the disease also. So therefore, it still has some value for us that in this particular case, instead of looking at the common good of humanity, the US should be talking about intellectual property and monopoly over the drug at the moment. This seems to fly in the face of what the world needs and also shows, shall we say, the kind of exceptionalism that the US believes in, that it has, the world's good doesn't matter to it. It has only respect for its own good. And in this particular case, the good of Gilead, because it's also getting a fact price for the drug. And of course, that the American people will get this drug at least available through their insurance cover. And that is what is in store for the rest of the world, that unless we break patents, we manufacture it ourselves, remdesivir is not going to a medicine which is accessible to the rest of the world. In this context, two questions. One, Gilead does claim that it has arrangements with companies in various other parts of the world, and that this will continue, although the modalities of it are still very uncertain as of now, it's still a process, still a bit of a trial. But more importantly, is there right now the global mechanism to actually confront the United States on this issue and make sure that it cannot go ahead with these kind of actions? I think that that's not the role we should take, how to confront the US. The question is what, how quickly can we break Gilead patent and ratchet up our production. If we accept that they have the right to monopolize the intellectual property, more than production itself are really raising the issue of intellectual property, then we have given the game away. So I think the basic issue is can you break that monopoly of patent? And answer is yes. Most countries have compulsory licensing under its kitty, in their kitty, and so does the world. In fact, WTO itself in 2001, the Doha declaration had accepted that yes, countries can break the patent and can license companies within their country and also outside. This can import this from anywhere. This is under conditions where there is a health emergency, out there is an epidemic, and in this case it's both, COVID-19 is really both. The countries have the right to do so. So we have a right to do so. When we have a right, why should we beg, confront, fight? We should exercise the right. And sure, US has the right to say it's company within the shorts, it will take over all the production. That's the right it has. So we have the right to manufacture it in India. So we should. Now the question is why is it that when Gilead says that they're making other arrangements, why don't I trust it? Because Gilead for the last six months has been trying to buy up all the possible ingredients that go into the manufacture of this particular drug. And therefore they have stockpiled a large amount of base chemicals which are required for the production of this particular drug. I do not know enough chemistry to say how it can be done alternatively. That's something that we really need to explore and we should have explored by this time. It would have been very foolish if Government of India did not instruct the CSI laboratories who have made process engineering one of their strengths. That's how the whole genetic industry in India came about. I would be very surprised if they have not taken steps to also know how remdesivir equivalents can be manufactured and what are the base chemicals you require for it and some stockpile of the same. So I think that is the road down which we have to go. Confronting the US is playing to its strength. That doesn't really work because no country can say, No, your company has to give me Gilead, you know, Mani medicine. So you're really asking the US to ask Gilead to give you medicine when by right you can produce it in your own country. So I think that's the route to take. How quickly can the world augment remdesivir production in different parts of the world? I would be very surprised and it would be criminal on the part of the governments involved if they have not taken steps already because this writing has been on the wall since the day in the World Health Assembly. The US said it does not recognize the concept of a patent pool. Companies has to be compensated for their intellectual property. Therefore they will not accept the World Health Assembly resolution. So this remdesivir battle has been brewing from that time. And that's why we had raised the warning. If you remember in news click on a number of earlier locations that this is a battle which is there. Yes, it's true. The remdesivir is not a life saver. It could have been, but it is not. It's also not true that it will completely cure you. It won't. But it does reduce the infectious period and today I would take any game in this fight against COVID-19 as something that we need to really hold close to us. Because even if I reduce the infectious period by 20%, that means there's a 20% weakening of the transmission of COVID-19. The people who are infected are the ones who transmit. So 20% reduction is also significant in that sense. So I do not think that these are the issues that we should really worry about. That how important it is, whether we should really beg from the United States, whether we should confront the United States. We just should go ahead and start what we need to do to manufacture the remdesivir generic. This is also in some sense a prelude to what is going to happen once vaccines are tested and they are proved to be effective. Well, that's the other part of it, that if this doesn't give the game away, what the US plans to do about vaccines, nothing else will. So it's very clear at the moment that they are funding in their what speed program, they are funding five vaccines globally, out of which couple of them are from the United States, but three of them are not. And their basic argument is that because we are giving you $2 billion and when the Sanofi agreement was being talked about, this was the terms on which money was going to be given, that you have to give us the first dips, that whatever vaccines are produced, the first lot come to the United States and the first lot given to 100, 300 million population. We do not know whether it's going to be three months, six months protection we are going to get from the vaccine. This would be extremely dangerous if we do not proceed alternatively. The good part of it is that at the moment, I think vaccines under phase one, phase two, phase three trials, I think only one or two are in phase three trials. And there may be a couple of more which are not listed by the WHO. But there are also another odd hundred and sixteen hundred and twenty vaccines which are also coming or which are in the pipeline. So the vaccine pipeline is large. The date is not clear. Who will be the first? There are also five Chinese vaccines which are the head start. Some of them are going into also phase three trials like the Moderna vaccine and the Oxford vaccine is likely to do. So given all of this, it would be extremely damaging for the globe, for the world. If one of these vaccines which US is funding becomes successful and nobody else is there, in which case I think we are very, very likely to see the repeat of the Remdesivir case. Because US is looking at all of this to leverage its political power in the international arena. So it's going to be traded okay. You now give me some trade benefits. Maybe I'll give you so many ampoules of vaccine and so many injection files for your people. So this basically what Trump says, I'm an extremely good negotiator, deal maker. So he's going to deal politics in this particular way. And I think the indications are extremely clear. It's not that he's going to use Gilead only for the American people, but also for his deal making. So I think the real issue is intellectual property. And I would suggest that we do the same for vaccine. Once we know the vaccine is successful, a particular vaccine is successful. It is very much possible for countries like India particularly who have a strong science and technology infrastructure to be able to duplicate that vaccine. So we don't really have to do the whole gamut of clinical trials and everything. We're going to duplicate the vaccine. That's a much easier task than trying to research, find out what works and then do the clinical trials. So all of that, if we get the same scenario that it becomes a monopoly of the United States, the same issue will come up and that's the same step we'll have to take. Break the monopoly, break the patent. Do not let that stand in the way. The question again is the political will to do so and can we stand up to the United States? And that is something which will be good for countries to come together on. So we get a club of countries who come together to say we'll collectively break the monopoly of the United States on either remdesivir or the vaccines when it comes. That I think is the way we should go. So it's a kind of global negotiations with each other that we have to do rather than with the United States at this point. Thank you so much Praveen for talking to us. That's all the time for today. Keep watching.