Desperate over withdrawal of a life saving drug, children living with HIV (CLHIV) have written to Prime Minister Narendra Modi for help.
The letter, written on March 4, is signed by 637 children ranging from ages 3 to 19 and states that, “the pharmaceutical company Cipla has in various forums cited delay in payments by the national programme for the HIV medicines by several years and even non-payment of its dues in many cases. Profits on child doses of HIV medicines are small and delayed payments are having a chilling effect on the ability of the National AIDS Control Organisation (NACO) to convince the company to participate in the bids it invited annually.”
Stocks of Lopinavir syrup — a child friendly HIV drug — ran out after Cipla, the sole manufacturer of the drug, stopped manufacturing it over the issue of non-payment from the Health Ministry. Cipla is the dominant player in the Indian market across the HIV segment and has not stopped participating in government tenders after the Health Ministry failed to pay Cipla for consignments sent in 2014.
Emergency tender
Faced with a crisis, the Health Ministry says it has instructed State AIDS Control Societies (SACS) to purchase from local markets. “An emergency tender has been placed but we have instructed SACS and State Governments to purchase from local markets,” said Arun Panda, Additional Secretary, Health Ministry.
However, since the syrup has gone out of production, they are not available in retail markets. “Across the country, in every State, there is no one to make this drug. How can we buy this from retail shops? The sole producer is not manufacturing it,” said Paul Lhungdim of DNP+.
While Cipla has declined to comment, emails made available to The Hindu reveal that Cipla asked for guarantees of payment from HIV patients. In an email exchange between by Umang Vohra, Chief Executive Officer (CEO), Cipla Pharmaceuticals, and patient-activist Loon Gangte, Mr. Vohra states that, “Cipla has always stood for the patients — not just in India but also all per the World (sic). Quite naturally, we also expect that issues regarding payments are also addressed expeditiously,” indicating that Cipla will not move from its stand until either Global Fund or the Indian government settles the bills.
The email from Cipla's Umang Vohra 
The heated three-way communication between Cipla, the Indian government and the HIV community ended on March 4, with an email being marked to the entire top brass of Cipla Pharmaceuticals, Indian government officials and Clinton Health Access Initiative (CHAI) with Mr. Loon Gangte, making it clear that he was “in no position” to guarantee payments. Mr. Gangte writes that he had “been told by officials in Cipla that we should ensure payment for any future procurement of the medicine from Cipla. I would like to tell you that the community is in no position to do so. We can neither force the government nor donors like the Global Fund. But at the end of the day, we are the ones who are hit by these shortages and stock-outs.”
Experts say the critical shortages are proving to be both tragic and embarrassing for India’s HIV programme. “The government is abdicating its constitutional responsibility to make available life saving medicines for the HIV community. It is also unfortunate that the present management of Cipla is walking away from its commitment to access to medicines all over the world, for which they are globally renowned,” said Anand Grover, Senior Counsel at Lawyers Collective’s HIV/AIDS Unit.
For the HIV-infected children, the letter to Mr. Modi, Finance Minister Arun Jaitley and Health Minister JP Nadda is a last resort. “We humbly request you to look into the matter of HIV drug stock out, in general, and in particular paediatric HIV medicines to ensure that they are not merely exported but also actually available to the children in this country.”
