HONG KONG – India has lifted some restrictions on the export of its medical supplies in light of the global battle against the COVID-19 novel coronavirus.

Last month, Indian authorities started restricting the export of certain active pharmaceutical ingredients (APIs) and the formulations based on some specific APIs.

On April 4, India’s Directorate General of Foreign Trade (DGFT) also issued a notice restricting the exports of hydroxychloroquine, an anti-malaria drug that has been given emergency use authorization by the U.S. FDA for coronavirus patients.

“The export of hydroxychloroquine and formulations made from hydroxychloroquine, therefore, shall remain prohibited, without any exception,” a DGFT notice read.

Then on April 5, U.S. president Donald Trump spoke with India’s prime minister Narendra Modi on working together to combat the coronavirus pandemic.

“The two leaders agreed to remain in touch on the issue of global supply chains for critical pharmaceuticals and medical supplies and to ensure they continue to function as smoothly as possible during the global health crisis,” said Judd Deere, deputy press secretary for the White House.

On April 6, Trump piled on the pressure in a press briefing by warning of “retaliation” if India did not allow the export of hydroxychloroquine tables.

However, hydroxychloroquine has not been proven to be a cure. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has warned that it has only “anecdotal evidence” for its efficacy.

Nonetheless, India has since reversed some of its previous restrictions.

The DGFT lifted export restrictions on 24 of the 26 APIs and formulations that were restricted in March. Shipments of paracetamol and its formulations still require authority approval.

As of press time, there is no written statement on hydroxychloroquine but Indian officials have spoken about it.

“In view of the humanitarian aspects of the pandemic, it has been decided that India will licence paracetamol and hydroxychloroquine in appropriate quantities to all our neighboring countries who are dependent on our capabilities,” said Anurag Srivastava, the spokesperson for India’s Ministry of External Affairs.

But there are some restrictions that are still in place.

Ventilators, sanitizers and masks were amongst a batch of medical supplies that were banned from being exported in late March. There are reports that some medical supplies, such as personal protective equipment, are running out for India’s health care workers. Another restriction still in place is that on diagnostic kits: “The export of diagnostic kits falling under any Indian Trade Clarification based on Harmonized System Code... is restricted with immediate effect,” said a DGFT notification on April 4.

An employee of Agva Healthcare Ltd., a Noida, Uttar Pradesh-based med-tech firm that produces an economical, toaster-sized ventilator, told BioWorld that the company is keeping its focus on meeting local demand.

“Due to the ongoing pandemic of COVID-19, there has been a surge in ventilator demand all over the world. To serve the growing demand, our production is happening 24 hours a day with an increased production rate of 10,000 units a month,” Agva said on its website.

The Agva employee did not disclose how many of its devices were usually exported overseas prior to the ban, other than exports were on a “based on demand basis.”

“We are currently only producing a single very powerful and cost-effective model that works well on COVID-19 patients. This step is taken in order to save time and resources,” said Agva.

"Agva Healthcare, a local Indian startup, claims that its portable ventilator has a battery back up of three hours and requires no special installation. These features are important considering the power outages and limited infrastructure available in healthcare facilities in small cities and rural areas across India," said Bhaskar Vittal, a medical devices analyst at consulting firm GlobadData.

He believes Agva’s price range of US$2,000 to $3,000 gives it a major advantage in the price-sensitive Indian medical equipment market, where conventional ventilators cost $4,000 to $10,000.

And demand for it will only continue to rise.

“Once the community transmission phase starts, the number of cases is expected to grow significantly in the coming days and weeks. This will result in a huge demand for ventilators in India,” said Vittal. Agva claimed that it had experienced “a countless number” of supply chain disruptions but has since streamlined all its processes. Automobile manufacturer Maruti Suzuki India Ltd. has also stepped in to help Agva meet the demand.

In this, India is in step with a global trend of inter-industry collaboration, which is being promoted as a major step towards meeting ventilator demand.

“In order to meet the sudden demand for respiratory devices, large medical device companies such as GE Healthcare are collaborating with manufacturing companies in automotive and aerospace. Ford and GE Healthcare are collaborating to provide the market with the necessary ventilators to help address the coronavirus pandemic,” Callum Corcoran, pharmaceuticals & health care analyst at Fitch Solutions, told BioWorld.

Ford has also partnered with 3M to increase the production of powered-air purifying respirators. Ventec Life Sciences, has partnered with General Motors (GM) to produce critical care ventilators to meet a target of more than 10,000 ventilators per month.

As India heads toward its own spike in COVID-19 cases, this collaboration with the automotive industry could prove crucial in reducing casualties from the disease.