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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 38  |  Issue : 3  |  Page : 307-308

Panic buying of repurposed drugs for COVID-19 in India: Challenges and the way forward


1 Department of Psychiatry, BKL Walalwalkar Rural Medical College, Ratnagiri, Maharashtra, India
2 Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission24-May-2021
Date of Decision09-Jun-2021
Date of Acceptance27-Jun-2021
Date of Web Publication28-Jul-2022

Correspondence Address:
Dr. Ramdas Ransing
Department of Psychiatry, BKL Walalwalkar Rural Medical College, Ratnagiri - 415 606, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_137_21

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How to cite this article:
Ransing R, Kar SK, Menon V. Panic buying of repurposed drugs for COVID-19 in India: Challenges and the way forward. Indian J Soc Psychiatry 2022;38:307-8

How to cite this URL:
Ransing R, Kar SK, Menon V. Panic buying of repurposed drugs for COVID-19 in India: Challenges and the way forward. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Oct 3];38:307-8. Available from: https://www.indjsp.org/text.asp?2022/38/3/307/352510



Dear Editor,

Since the outbreak of COVID-19, many countries have repurposed some drugs for the prevention and treatment of COVID-19 infection. Drug repurposing involves the process of identification of new indications of existing drugs and is often considered an efficient and cost-effective strategy.[1] In addition, the repurposed drugs have known pharmacological profiles and therefore can directly enter Phase III or IV clinical trial.[1] Considering the relative advantages of repurposed drugs, the World Health Organization and research agencies across the world have evaluated many repurposed drugs (e.g., remdesivir, hydroxychloroquine [HCQ]) or alternative medicine (e.g., ayurvedic products) for the prevention and treatment of COVID-19 infection.[2],[3] Unfortunately, these drugs were found to have little or no effects in clinical settings.[2] Currently, there is no specific treatment available for the treatment of COVID-19 infection.[2] However, the panic buying (PB) of these repurposed drugs or products has been observed in many parts of India.[4] Here, we aimed to discuss the potential underlying factors, their consequences, and control measures that can reduce the PB of repurposed drugs in the future.


  Potential Factors Top


  • Health and research literacy: Low health and research literacy (i.e., poor knowledge about the process involved in the approval of repurposed drugs) among the general population, media, and fake news circulating on social media could be the main reasons for PB
  • Poor control on pharmaceutical services: In India, many drugs are often dispensed as over-the-counter medicine and without any prescription, self-prescription, old prescription, or fake prescription.[5] There is no established mechanism to identify the authentic prescription (such as verification of medical practitioners who issued the prescription)
  • Media and social media: Media have endorsed the repurposed drugs through their portals as potential remedies, which may be the reason for the overuse of these medicines without appropriate indications and leading to scarcity of these medicines. Medical protocols prepared for health professionals were circulated on media and social media which endorsed the people's belief that these drugs are approved remedies
  • Healthcare system: Healthcare services in India are primarily delivered by the private sector and by medical practitioners of alternative medicines in rural areas. Unfortunately, these drugs were perceived as approved standard care for COVID-19; this may be due to inadequate training in the research and drug approval process
  • Political and pharmaceutical support: Despite little or no evidence of the effectiveness of these drugs, politicians and the Indian government has supported these repurposed drugs, encouraged the pharmaceutical production and distribution of these drugs to gain the sympathy of people in ongoing preelection rallies[6]
  • Perceived scarcity of essential drugs: Scarcity of essential medications, availability of hospital beds, lockdown measures, oxygen, and other life-saving equipment are being constantly discussed among the public, social media, as well as news media, which evokes panic among people, compelling them to indulge in PB of medicine in the anticipation of future need. In addition, the hoarding of medicines might be giving a sense of security and control.



  Consequences Top


PB has created anxiety, fear, panic, and agitation among the general population. This phenomenon has raised the price of repurposed drugs, and overcrowding to purchase these medicines may have increased the risk of the spread of infection in most affected states. Events of suicides were also reported among those who failed to procure the repurposed drugs.[7] On the other hand, some drugs (e.g., HCQ) are used for the treatment of chronic conditions (e.g., rheumatoid arthritis). Unregulated PB has affected drug compliance among these patients. Furthermore, the purchase of these medicines at higher prices has put a financial burden on poor and unaffordable people. The scarcity of these products due to heavy purchases by the consumers resulted in the introduction of various fake medicines, which have serious health hazards.


  Recommendations Top


  • Media and social media: Media has a vital role in preventing and dealing with PB of investigational drugs. The media should avoid the portrayal of the investigational drug as gold standard or magic remedies unless there is evidence. Public health authorities should monitor the publication of news items related to these drugs and social media for fake news for the prevention of PB
  • Regulatory authorities: Drug regulatory authorities should monitor the repurposed drug or new drug (emergency approval) for any potential overuse or misuse by practitioners and PB among the general population. Furthermore, the delivery of these medicines through the registered pharmacists and with valid prescriptions should be encouraged
  • Government authorities: The establishment of helplines to educate the people about repurposed drugs, repeated statements of assurance from the public health authorities about the availability of these drugs along with scientific evidence, prevention of hoarding or black marketing, regular check on the production and sale of fake medicines, and punishment for hoarding are necessary to reduce the perceived fear of scarcity
  • Good clinical practices: General practitioners and practitioners of alternative medicines should be trained in good clinical practices, investigational drugs, the process involved in the approval of repurposed drugs, and the off-label use of drugs. Regular and periodic training should be mandatory for renewing their licenses. This will increase the research literacy among practitioners and prevent the misuse or overuse of investigational drugs
  • Research on repurposed drugs: Repurposed drugs are usually available in the market, and repurposed drugs should be blinded to the general population (e.g., as drug A) till the completion of the research trial. Further, public health authorities should undertake adequate precautions to prevent the circulation of the emergency treatment protocol in social media or media
  • Role of mental health professionals: Sense of losing control, social learning, anxiety, and agitation are often associated with PB. Therefore, group-level psychological interventions could be beneficial. Individual assessment of anxiety, hoarding behavior, and psychopathology of people who indulge in PB may not be a cost-effective approach and may be done when indicated.


To conclude, the PB of repurposed drugs covers multiple disciplines such as behavioral science, marketing, politics, media, supply chain, social science, and economics. Therefore, multi-level and coordinated efforts of different authorities (e.g., media, public health authorities) are warned to prevent it during the COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh TU, Parida S, Lingaraju MC, Kesavan M, Kumar D, Singh RK. Drug repurposing approach to fight COVID-19. Pharmacol Rep 2020;72:1479-508.  Back to cited text no. 1
    
2.
WHO Solidarity Trial Consortium, Pan H, Peto R, Henao-Restrepo AM, Preziosi MP, Sathiyamoorthy V, et al. Repurposed antiviral drugs for covid-19-Interim WHO solidarity trial results. N Engl J Med 2021;384:497-511.  Back to cited text no. 2
    
3.
Batta A, Khirasaria R, Kapoor V, Varshney D. Therapeutic clinical trials to combat COVID-19 pandemic in India: Analysis from trial registry. J Basic Clin Physiol Pharmacol 2020;32:267-78.  Back to cited text no. 3
    
4.
Hindustan Times. What's Behind India's Remdesivir Shortage? Indiscriminate Use, Hoarding and Black Markets. Hindustan Times; 2021. Available from: https://www.hindustantimes.com/india-news/careless-use-hoarding-and-black-markets-behind-india-s-remdesivir-shortage-101618148086724.html. [Last accessed on 2021 Apr 18].  Back to cited text no. 4
    
5.
Soumya R, Devarashetty V, Jayanthi CR, Sushma M. Drug dispensing practices at pharmacies in Bengaluru: A cross-sectional study. Indian J Pharmacol 2016;48:360-4.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
The Indian Express. Under Political Pressure for Supplies: Remdesivir Makers. The Indian Express; 2021. Available from: https://indianexpress.com/article/india/remdesivir-supply-stock-covid-19-7270642/. [Last accessed on 2021 Apr 18].  Back to cited text no. 6
    
7.
Mumbai Mirror. Man dies by Suicide after Failing to Acquire Remdesivir Injection in Solapur. 2021. Available from: https://mumbaimirror.indiatimes.com/coronavirus/news/man-dies-by-suicide-after-failing-to-acquire-remdesivir-injection-in-solapur/articleshow/82088016.cms. [Last accessed on 2021 Apr 18].  Back to cited text no. 7
    




 

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