Covid-19: Bangladesh sees acute shortage of Actemra injection 

Throughout Friday, relatives of the eminent journalist Hassan Shahriar and doctors treating him were looking to get their hands on an Actemra injection. The drug was one of their last hopes to save his life. He was battling Covid-19 in the intensive care unit (ICU) of a private hospital in the capital. The drug was not found. Shahriar breathed his last on Saturday. 

Many more critical Covid-19 patients like Shahriar who doctors say could have had a better chance of surviving with an Actemra injection have died recently amid a massive shortage of the drug in the country.  

However, the importer of the injection in the country, Radiant Pharmaceuticals Ltd, said the next consignment of the injection will arrive within the next two or three days and will reduce the crisis.

Dr Nirupam Das, chief administrator of the Bangladesh Doctors Foundation, who also tried to get the drug for Shahriar, told The Business Standard, "I have searched at all the Radiant booths from Friday afternoon but the injection was not found anywhere. This injection produces good results among patients in the ICU. There is a huge demand for it, but Radiant is importing it in very low numbers."

Actemra is a drug used mainly for the treatment of rheumatoid arthritis and systemic juvenile idiopathic arthritis. Health workers have been using it to treat critical Covid-19 patients. Demand for the drug has recently sky-rocketed across the country amid the second wave of the Covid-19 pandemic, creating a massive shortage in its supply.
 
According to health officials, the Actemra injection is producing positive results among critical patients in the ICU. 

Dr Shoman Aniruddha, an anesthesiologist at the ICU of Mugda General Hospital, told the Business Standard, "Although there has been no specific publication (research) about it, we have seen that the injection creates a positive response in 10-20% of critical Covid-19 patients, especially among those who require a high level of oxygen. But now the supply of the injection in demand ratio has turned very low."

Dr Shoman said the drug is not supplied by any hospital. Relatives of patients are asked to purchase it and provide it to health officials to be used for patients' treatment. 

The injection was first used in a limited range in treating critical Covid-19 patients during the first wave of the infection in the country. At the time, a patient's relatives would be able to get the medicine just by contacting Radiant's booth.  But now, one has to submit a prescription, patient's name, hospital's name to Radiant in order to get the medicine, Dr Shoman added.

Meanwhile, Nasser Shahrear Zahedee, chairman, Radiant Pharmaceuticals, told The Business Standard the drug shortage will end soon.  

He said, "The arthritis medicine is very effective in reducing lung inflammation in Covid-19 patients. It has been out of our stock for the last few days. The stock of the drug became empty within two days of import. The next consignment will come on Tuesday."

"We import the injection from Roche of Switzerland. But the problem is that they cannot provide us with our desired amount as the global demand for it has increased. We are not getting the drug in line with the demands we are making," he added.
 
There are complaints that Radiant has been selling more injections to the corporate hospitals.

Asked about allegation, Zahedee denied it. As he put it, "We did not separately provide the injection to any hospital. If a hospital asks for it, it is given a maximum of five to ten doses after reviewing its patients' list.

"After confirming about the patients, the drug is handed to their attendants. We are trying to provide the medicine in as much rational a way as possible," he added.

Actemra injection is available in vials of 80, 160, 200 and 400 milligrams. Depending on the vials, it costs Tk15,000 to 45,000. In Bangladesh, 400ml vials are commonly used to treat Covid-19 patients, which costs around Tk43,000 to 45,000.