Calcutta Notebook

Health Sovereignty

Bharat Jhunjhunwala

The Multinational Companies (MNCs) had two-thirds of the domestic drug market of India in 1970. Then the Government annulled the "Product Patents". The Government allowed Indian companies to manufacture drugs that had been patented by MNCs by alternate processes. This resulted in a fast increase in domestic drug manufacturing and not only Indian, but the world drug market got to be dominated by Indian companies. The dominance of Indian companies in the drug market, known as "formulations",  is maintained as of date. The trajectory of the "active pharmaceutical ingredients" or APIs that are the raw materials for the manufacture of the drugs followed a different course. Only one percent APIs were imported in 1991 and 99 percent were made within the country. This has increased steadily after the opening of the economy in 1991 and today 70 percent of the APIs are imported-mostly from China. The unavailability of formulations required to treat Covid-19 patients in India can be traced to the unavailability of the imported APIs.

The present dominance of Indian companies in the formulations market is also under threat. According to Shaktivel Selvaraj of Public Health Foundation of India, China may enter the formulations market of India in the next 5-6 years and oust Indian companies just as they have done in the APIs.

The Government has announced that Rs 6,940 crore will be spent in the next six years to strengthen medical manufacturing infrastructure in the country. Further, 19 medical devices have been earmarked for purchase from domestic manufacturers. These steps are in the right direction but too feeble given the emergency people are facing today. As said above, Chinese formulations are likely to take over the Indian market by the time the Government builds this infrastructure. More is needed. Especially because the Chinese are able to produce APIs at a lower cost despite the wages being five times more.

The first step to be taken is regarding import duties generally, of which the APIs are a part. India's negative "trade balance", that is, the excess of imports over exports was (–) 1.91 percent of GDP in 1999. It reduced marginally to (–) 1.79 percent in 2004 during the reign of the Vajpayee Government. Then, it increased dramatically to (–) 2.99 percent in 2014 during the reign of Manmohan Singh. It has reduced marginally to (–) 2.72 percent in 2019 during the first stint of the Modi Government. Once again, this reduction is feeble given that the trade balance was only (–) 1.79 percent in 2004 at the end of the Vajpayee Government. The negative trade balance means that the cost of manufacturing of goods in India is more than the imported goods hence businesspersons prefer to import- rather than manufacture them. The immediate step to be taken to jumpstart manufacturing in the country is to increase the import duties so that imports become expensive and domestic manufacturing is given a fillip. That has been elusive though. Coming to the medical sector, Rajiv Nath of the Association of Indian Medical Device Industry has said that he is disappointed with the Budget for 2021-22  for  not  having increased the import duties on medical devices. Therefore, one needs to increase import duties and bear the burden of high cost of domestic manufacturing for a while, at least, if India has to manufacture the APIs and medical devices like ventilators and oxygen concentrators in the country.

The second step is that of investment in frontline medical technologies. The strength of Indian companies today lies in the manufacture of generic medicines that are outside the writ of the Patents Act. The inventions are made by MNCs. They earn huge monies for the first 20 years during which Patents protection is available to them-just as AstraZeneca is charging 50 percent of the sale price of Covishield vaccine that Serum Institute is manufacturing in India under their license. One needs to invest huge monies in the invention of new drugs. Reportedly, Pfizer and AstraZeneca have received huge monies that helped them invent the Covid vaccines while India's Bharat Biotech got a measly Rs 65 crore. Thus Himanshu Baid of Poly Medicare has said that the Budget of 2021-22 does not   provide any encouragement in this direction. Similarly, according to Satish Reddy of Indian Pharmaceutical Alliance the Government needs to give grants to companies for the innovation of new molecules, automation and digital technologies.

The third step is to invest in the infrastructure needed for jumpstarting manufacturing in the health sector in India. The Government has announced in this March of 2021 that Rs 6,940 crore will be spent in the next six years to build this infrastructure. But, as said above, Chinese formulations may take over the Indian market by that time. Again, Himanshu Baid of Poly Medicare says this investment should have been frontloaded and done in the next three years.

The fourth step is to make available capital for investment. The cost of borrowing for capital investment in China is about 5 percent against about 12 percent in India. Further, countries are providing huge assistance to build their health sovereignty. For example, the United States Government has provided an assistance of US dollars 765 million or Rs 5700 crore repayable in 25 years to Eastman Kodak to build API manufacturing capacity in the United States. It is to be noted that this assistance has been provided under the Defense Production Act. In other words, the US Government believes that domestic manufacture of APIs is necessary to defend the country.

[Formerly Professor of Economics at IIM Bengaluru]

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Vol. 54, No. 5, Aug 1 - 7, 2021