Chloroquine has been stirring up a great deal of controversy among medical professionals, governments, regulators, and the general public around the world. The anti-malarial drug, along with the less harsh hydroxychloroquine, has been rumored to treat or even cure the coronavirus, but evidence of its effectiveness is still hard to come by. However, with world leaders beginning to adopt the drug and medical trials ramping up globally, demand for chloroquine and hydroxychloroquine has skyrocketed. Manufacturers, retailers, and health professionals now face the challenge of trying to meet this new demand.
Can Chloroquine cure COVID-19?
While there have been some small studies suggesting that chloroquine could be effective against COVID-19, research has so far been limited and the completed studies are not enough to reach a reliable conclusion. A recent trial in France found positive results, but one in China didn’t find the drug to have any impact. Both were too small to provide conclusive evidence one way or the other. Larger trials have begun around the world, with the World Health Organization (WHO) launching a multinational study and other trials taking place in the US, Europe, and other countries and regions. However, it will still take some weeks before initial trials are concluded. Despite this, health institutions and governments around the world are beginning to approve the drugs for use in emergencies, and both are already in short supply.
A market on the rise
With global demand reaching new heights and many people pinning their hopes on chloroquine and hydroxychloroquine, the market is expected to grow by over $80 million between 2020 and 2024. The drugs previously were most in demand from areas such as Africa and South America, and those places will continue to be significant markets over the next several years. However, demand will rise globally as trials are conducted and healthcare professionals continue to treat COVID-19 patients.
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Supply chain challenges
India, the world’s largest exporter of generic drugs and one of the biggest suppliers of the chloroquine phosphate active pharmaceutical ingredient (API) banned exports of several key ingredients towards the end of March in order to maintain a national supply. The country has recommended that healthcare workers and high-risk individuals use hydroxychloroquine as a preventative measure, and is in the middle of a 21-day nation-wide lockdown. However, the country recently lifted the ban, reportedly as a result of a call with the US president. Producers in India are ramping up production in order to meet the rising demand for chloroquine ingredients.
Outside of India, other manufacturers are increasing their supplies as well, and some of them are giving away the drug or selling it at cost. But while this will help meet demand in the short term, manufacturers will need to keep an eye on global supply and export restrictions. India’s temporary ban has highlighting the risks involved when one or two countries are the primary sources for critical items such as pharmaceutical ingredients.
Consumers aren’t waiting for trial results
Because chloroquine and hydroxychloroquine are being widely discussed in the media, with some sources and even global leaders endorsing them as treatments, many consumers are buying up the drug and taking it without prescriptions, or taking non-pharmaceutical versions that are not intended for consumption. This has already led to overdoses and deaths in places such as the US, Nigeria, and Vietnam. It has also prompted stockpiling by individuals and institutions, as well as causing some health professionals to prescribe the drugs widely despite them not being approved as a prophylactic or treatment for the general populace in many countries. Even when regulatory bodies have approved the drug’s use, it is typically restricted to trials and emergencies when other treatments have failed or are unavailable.
Regulators taking a chance on chloroquine
The US Department of Health and Human Services, recently authorized prescription of the drugs “to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible.” The agency stresses that clinical trials are needed to determine its effectiveness, but states that the potential benefits currently outweigh the risks. The immense impact that COVID-19 is having on the world has led many countries and organizations to make similar decisions, with France recently authorizing hospitals to deliver it to patients to treat the disease. Meanwhile, some Swedish hospitals have stopped administering chloroquine to coronavirus patients due to its side effects, which include cramps, headaches, and vision loss. Health professionals remain divided on whether the drug should be used before more thorough trials have been completed.
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Non-COVID patients impacted by shortages
The fervor surrounding chloroquine’s potential to treat the coronavirus has also been impacting people who use the drug to manage other illnesses, such as malaria, lupus, and rheumatoid arthritis. These people are having difficulty filling prescriptions as the drug is bought up by those who don’t need it or stockpiled for trials and COVID-19 treatments. This has been creating supply chain challenges and raises the question of how to treat patients with these conditions in the midst of the global pandemic, as well as how strictly to regulate prescriptions for the coronavirus. In response to these issues, the American Medical Association (AMA) has called for doctors to stop any inappropriate prescription of medications and to act with professionalism and ethics.
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Looking to the future
All of this change and uncertainty in the global chloroquine market is creating both opportunities and challenges for manufacturers, retailers, and those in the healthcare industry. While high demand means there is more room in the market for growth and new entrants, there’s still a great deal of uncertainty to deal with. And while the world is currently desperate to obtain these drugs in the hope that they can cure the coronavirus, demand could drop off significantly if the multinational trials find it to be ineffective or its side effects to be too harmful.
Clearly there is a need to increase supply right now: it’s important that healthcare institutions have enough of the drugs to perform these trials and to treat people who need it for other illnesses. If it’s proven to be effective, demand will become even higher. It’s also clear that the industry would benefit from more diverse sources of critical APIs. But companies considering expanding or stepping into the market for the first time would do well to prepare for the possibility of either an increase or a decrease in demand, as well as for supply bottlenecks, in order to not be caught off guard as the situation evolves.
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