According to the World Health Organisation, the Covid-19 pandemic that ravaged the planet for almost three years infected more than 750 million people, resulting in more than 6.8 million deaths. This unprecedented public health crisis exposed humongous systemic failures in the global health architecture, deficient government responses and government actions that exacerbated social inequities and violated a slew of human rights.

The response of the so called ‘enlightened’ West was decidedly selfish; even before any Covid-19 vaccine was approved by WHO, the Western world had negotiated opaque deals with vaccine makers, and bought up almost all vaccines, even those that were yet to be developed. Many of these same rich governments blocked a proposal by India and South Africa at the World Trade Organisation (WTO) to waive intellectual property rules for Covid-19 tests, treatments and vaccines.

A comprehensive waiver could have helped to expand and diversify manufacturing of lifesaving medicines and other health products for poorer countries that they needed to stem the Covid-19 pandemic. Pharmaceutical companies developed lifesaving Covid-19 vaccines, and associated health products, with massive amounts of public money, but refused to share their knowledge and technology with the world, putting profits over human lives. Ill thought out policies, like nation-wide lockouts worsened existing inequalities, hitting low-income people especially hard.

Stagnating industrial production and disruptions to global trade, caused by the pandemic, resulted in world-wide galloping inflation, which was worsened by the Russia-Ukraine war. According to World Food Programme (WFP) estimates, the spike in food and fuel prices resulted in 345 million people experiencing food insecurity this year ~ more than double the pre-pandemic number. Also, according to Oxfam, the richest one per cent have captured two-thirds of all new wealth created since 2020.

Sadly, the added economic strain from the pandemic has forced cash-strapped governments to cut spending on public welfare and public services, like health and education. The disadvantaged bore the brunt of the Covid-19 pandemic; almost 40 per cent of Covid deaths in the US were reported from residential institutions, housing the old and disabled.

The pandemic also led to a spike in anti-Asian, particularly anti-Chinese, hate crimes around the world. Sometimes, such hate spilled over to other minorities. The pandemic also saw an increase in domestic violence. Finally, many children lost precious years of their childhood as they could neither study or play normally during the Covid years.

However, the pandemic was God’s own gift for certain categories of corporates; pharmaceutical companies that manufactured vaccines and related products for Covid-19; technology giants profiting by the working-from-home trend; and online retailers offering lockdown necessities. Peoples’ Vaccine Alliance estimated that the companies behind two of the most successful Covid-19 vaccines ~ Pfizer, BioNTech and Moderna ~ made combined profits of $65,000 every minute in 2021.

Vaccine companies made windfall US$90 billion in profits (Pfizer $35 billion, BioNTech and Moderna $20 billion each, and Sinovac $15 billion) on their Covid-19 vaccines and medicines in 2021 and 2022; such profits arose largely due to decades of research funded by public investment, billions in grants for development and production and about US$90 billon in Advanced Purchase Agreements (APAs) with governments.

Sadly, these supernormal profits came at a dreadful cost for the poor nations of Asia and Africa, since these companies sold the majority of vaccine doses to rich countries, leaving out low-income countries; Pfizer and BioNTech delivered less than one per cent of their total vaccine supply to low-income countries, while Moderna delivered just 0.2 per cent, at a time when 98 percent of people in low-income countries had not been fully vaccinated.

That the abnormally large profits of the pharma industry were solely based on Covid-19 revenues is borne out from the fact that pharma industry profits retreated to pre-pandemic levels in 2023. As leaders ordered lockdowns the world over, product delivery companies like Amazon became a lifeline for citizens. Amazon’s stock rose to an alltime high, and the company added a record US$401 billion to its market cap.

With up to 75 million people using the Microsoft Teams communication app in a single day, and an unprecedented demand for its other products, Microsoft added almost US$270 billion to its market cap. Apple (US$220 billion), Tesla (US$108 billion), Tencent (US$93 billion) and Facebook (US$86 billion) also recorded unprecedented revenues.

Food and energy companies joined in the merrymaking, with the top 95 companies in these sectors raking in US$306 billion in profits. Rich individuals also profited; according to Forbes; the Covid-19 pandemic was responsible for the creation of at least 40 billionaires. A significant fall-out of the pandemic was the coming of age of the Indian pharmaceutical industry, which was known only for production of cheap, basic drugs.

At the beginning of the pandemic, in March 2020, the then US President Donald Trump somehow got the idea, against the advice of his medical advisor, Dr Fauci, that Hydroxychloroquine (HCL), an antimalarial drug was a cure for Covid19.

Learning that India was a producer of Hydroxychloroquine, Trump pressurised the Indian Government to supply Hydroxychloroquine to the USA. The positive outcome of this sorry episode was that the world came to know that India had the wherewithal to produce anti-Covid drugs. This belief was reinforced by the successful Covid-19 vaccination programme, which saw indigenously made 220 crore vaccine doses administered in India, and 17 crore vaccine doses exported to 96 countries.

Serum Institute of India emerged as the largest vaccine producer in the world, manufacturing more than 100 crore vaccine doses, at an unbelievably low price of US$3 per dose. Later on, Indiamade versions of anti-viral drugs Molnupiravir, and the combination drug Paxlovid, were in great demand in China. India’s importance in pharmaceuticals can be estimated by the fact that we are the third largest manufacturers of pharmaceutical products, exporting around a lakh crore rupees of pharmaceuticals.

However, this advantage is being frittered away by malpractices committed by some unethical drug manufacturers. Recently, cough syrup originating from India led to hundreds of deaths in countries as diverse as Gambia and Uzbekistan. Again, very recently, a number of people died in India, after consuming an Ayurvedic cough syrup. Two years ago, 632 medicines from Jan Aushadhi Kendras had to be recalled after failed drug quality tests.

In an earlier report, the European Commission found that 75 per cent of the global cases of spurious/ falsely-labelled/falsified/counterfeit (SFFC) medicines originated from India. Obviously, this is not good news for a country which PM Modi dreams of making ‘the pharmacy of the world.’ Lax regulation is the bane of the Indian pharma industry; most drugs hit the market before being properly tested. According to a 2019 report, under the National Good Laboratory Practice programme, India had only 47 drug testing facilities and only six central laboratories, testing in total only 8,000 samples ~ highly inadequate looking to the quantity of drugs produced annually.

An article ‘Inconsistent drug regulation spells danger for India’s global pharma ambitions’ in the British Medical Journal, makes depressing reading, as it lists out the regulatory failures in the Indian pharma industry, like no action being taken against a drug manufacturer whose cough syrup killed 11 children in Jammu in 2020. A similar article ‘Cough syrup deaths expose lax drug regulation in India’ appeared in the Lancet also.

The fault lies with the loose drug regulation architecture and lackadaisical administration. India has more than 10,000 pharmaceutical manufacturing units, which are regulated by the Central Drugs Standard Control Organisation (CDSCO), a sparsely staffed organisation, headed by the Drugs Controller General of India (DCGI), which administers the Drugs and Cosmetics Act, 1940 and Drugs Rules, 1945. Substandard/counterfeit medications can be restricted and better quality control can be ensured only if the antiquated legislation is updated and, technology like block chain based pharma solutions, trackand-trace technologies, mass serialisation with QR codes, is compulsorily adopted by manufacturers.

At a more basic level, providing more staff to CDSCO, and subsuming the 36 regional regulators in it, is required. Also a public database listing past violations, inspection records and failure history of key molecules, brands and manufacturers needs to be maintained. Penalties, including victim compensation, should be stipulated for firms manufacturing spurious drugs. Enhanced penalty should be imposed for export of SFFC drugs.

To comprehend the menace from counterfeit medicines, we should remember the warning of Ronald Noble, SecretaryGeneral, Interpol: “Fake drugs are more deadly than terrorism. Forty years of terrorism has killed 65,000 people globally, compared with 200,000 in one year alone, in China, from counterfeit medicines.”

(The writer is a retired Principal Chief Commissioner of Income-Tax)