Most people living with HIV in low- and middle-income countries are treated with generic antiretroviral(ARV) drugs produced by manufacturers in India – the “pharmacy of the developing world”. India’snationwide lockdown in March 2020 in response to the coronavirus disease 2019 (COVID-19)pandemic therefore prompted concerns about disruption to this essential supply. A preliminaryassessment of ARV drug manufacturers in India in March 2020 indicated a range of concerns. Thisprompted a rapid questionnaire-based survey in May 2020 of eight manufacturers that account formost of India’s ARV drug exports. The greatest challenges reported were in international shipping,including delays, increased lead times and rising costs. Contrary to expectations, lack of access tothe active pharmaceutical ingredients (APIs) required for ARV drug manufacture was not a majorhindrance, as manufacturers reported that their reliance on China for API supplies had reduced inrecent years. However, their reliance on overseas markets for the raw materials required for local APIsynthesis was a major challenge. The findings from this survey have implications for addressing someof the immediate and medium-term concerns about the production and supply of generic ARV drugs.Long-term orders to support multi-month dispensing and buffer stocks need to be in place, togetherwith computerized inventory management systems with real-time information from the lowest-leveldispensation unit. Manufacturers and industry associations should have regular, formal interactionwith the key ministries of the Government of India regarding these issues. Measures to improve theresilience of the generic ARV drug supply system are essential to minimize ongoing supply shocksresulting from the COVID-19 pandemic and to prepare for future emergencies.
Impact of COVID-19 on the global supply chain of antiretroviral drugs: a rapid survey of Indian manufacturers