India’s Drug Diplomacy: Decoding the HCQ Export Decision

Dr. Obja Borah Hazarika
April 19, 2020


Why did India export the hydroxychloroquine (HCQ) drug or raw material to generate HCQ, a drug used to treat malaria, arthritis, and lupus, to countries such as the US, Israel, and Brazil? This question arises because India had only recently (4 April 2020 to be precise) banned the export of this drug as it was touted as being effective in the treatment of COVID-19 patients, cases of which have been steadily rising in India despite a nationwide lockdown initiated on 25 March 2020. This decision was revoked (two days after the banning) very quickly on the heels of a statement wherein the President of the US, Donald Trump spoke of “retaliation” in case India did not release the drug. It is essential to keep in mind that the topic of retaliation was brought up by an interviewer who asked the US President if he was worried about retaliation to his decision to ban the export of medical goods from the US. In answering this question, which did not touch upon the US retaliation per se, Mr. Trump mentioned that in case India did not export HCQ, “that would be okay” but added that “but, of coursethere may be retaliation, why wouldn’t there be?.” However, concluding that the US would have gone ahead with its threat if India did not acquiesce to its demands should not be understood so simplistically, and needs further exploration to understand India’s decision in contextual depth.

One of the reasons for this step taken by India could be that India produces more than a whopping 70 percent of the world’s HCQs given that the drug is used in treating diseases such as malaria, which is a widespread threat to the health security of the country owing to its tropical location. Such diseases are not common in the countries of the West, such as the US, due to geographic factors and environmental conditions, which also means that they do not produce this drug domestically. 

It is also a major soft power victory for India as this move shows that it is stepping up in times of a global crisis and putting the interests of the globe at par with those of the nation as required in the times of a pandemic, which does not observe state boundaries. A pandemic is, by definition, global in character, but the steps taken for countering it has been national in nature, which has been futile as far as effectiveness is concerned. Given the nature of the virus and current character of the challenge to humanity as a whole, a rethink on questions of cooperation and governance at the multinational and global level is called for in a Covid-19 and post-Covid-19 world. 

Steps such as exporting HCQ to countries impacted by COVID-19 are examples of transcending national barriers and treating every person in need of medication, regardless of nationality, as global citizens. The move to lift the ban can be read as a display of solidarity and cooperation by India on the question of essential services and pharmaceuticals while facing the global fight against COVID-19. As many as thirty countries have requested India for the drug, and there are reports that on humanitarian grounds, HCQ would be released to countries where the demand for the drug is mounting owing to a surge in cases. India is also dependent on other countries to fight the pandemic. Export of HCQ to such countries could thus help India at a later stage in case it requires other essentials (test kits, masks, ventilators) which these countries could provide.

The demand surge for this drug from across the world during this pandemic implies that India is advantageously positioned to leverage its supply to extract favorable concessions from nations on other policies and industries. For instance, reassurances from the US on removing its reservations regarding India’s export subsidies to its producers of steel products, pharmaceuticals, chemicals, etc. which was challenged by the US at the WTO as being detrimental to American workers and manufacturers, could have been a clinching factor prompting India’s current drug diplomacy. As quid pro quo of the drug export at this crucial time, India could also be eyeing a relaxation of the US’s backing of the Non-Violations Complaints which it intends to bring into force in the TRIPS agreement that would permit a member to raise disputes against a fellow member’s policies regardless of a violation of the WTO agreement.

Additionally, in return for the export of the drug, India could try to get the US to relax its demands on Indian pharmaceutical companies and drug producers to abide by US rules in intellectual property. Several Indian pharmaceutical companies and drug producers have been manufacturing through reverse engineering variants of patented life-saving drugs at a cheaper cost under the “compulsory licensing” clause of the Indian Patents Act in order to ensure that drugs reach those who cannot afford the costlier patented version. This has been a constant source of tension between the US and India. The current drug diplomacy could help India extract concessions from the US regarding the production of such life-saving medications at an affordable price. 

The threat of retaliation from the US President, though unspecified, could be coincidental and may not have triggered the near-immediate withdrawal on the drug export moratorium. President Trump is known for his instant comments without weighing his words. As such, any retaliation/sanction on the trade front would have led to severe consequences for the economies of both the countries, which are already precarious due to the global slowdown caused by the pandemic.

The demand for HCQ arose when President Trump called it an effective treatment for those suffering from COVID-19, and in India, the ICMR approved the usage of this drug as prophylaxis for the disease by some people. Such decisions meant that there was a sudden large scale demand for the drug both domestically and internationally. Measures were taken in India to prevent hoarding of the drug, which is also used by those suffering from rheumatoid arthritis and other problems. 

Each month, India can produce 200 million HCQ tablets of 200 mg strength. Three leading pharmaceutical companies (Ipca Laboratories Ltd., Zydus Cadila, and Wallace Pharmaceuticals Ltd.) produce HCQ in India. They are confident that the current rate of production can meet the present demand of the drug, and production can be scaled up if more HCQ is needed. It is also to be noted that there is still research needed for HCQ to be established as effective in curing those suffering from COVID -19. Dr. Anthony Fauci, Head of the National Institute of Allergy and Infectious Diseases, US, has said that the data on the HCQ as a treatment for those with COVID-19 was only “suggestive” and therefore has not been proven to be a cure. More clinical trials have been suggested to ensure that HCQ is effective and safe in treating COVID-19 patients.

*** The author is currently teaching as an Assistant Professor in Dibrugarh University, Assam since 2013. Her research interests include international relations and riparian relations. ***