Falls on Centre to save some lives if not all: Delhi High Court directs formulation of policy on priority administration of black fungus drug

Considering the acute shortage of Liposomal Amphotericin B which is used to treat black fungus, as well as the upward trend in the number of cases, the Delhi High Court on Tuesday directed the Central government to formulate a policy on the manner of distribution of the drug to the patients. .Remarking that it was passing the order with a "heavy heart", a Division Bench of Justices Vipin Sanghi and Jasmeet Singh said, "If all can't be treated - which would be an ideal situation- it falls on the Union of India to spell out its policy on priority of patients so that at least some lives can be saved if not all..".The Court took cognizance of the fact that on account of non availability of choice of drug ie. Liposomal Amphotericin B and lack of clarity on administration of alternate drugs, a large number of fatalities were taking place. ."Despite best efforts, availability of the drug in the country remains acutely short is evident.", the Court remarked. .The Court opined that it was the duty of the government to lay down the way forward and secure the future of the country i.e the youth. "Other countries have done it. In Italy, they said 'sorry, for old people we don't have beds'.. and rightly so", Justice Sanghi stated. .Those who are younger and hold the promise of future have to to be prioritised over the older generation which has lived its lives and may not have dependent, the Court observed. ."80 year olds are not going to take this country forward. They have lived their lives. Ideally, we should be able to save everyone but if we have to choose, we have to save the younger people..We need to protect our future, the youth. That is where our promise is. That is age group that is going to build the country.. :", the Court opined. .The Court nonetheless acknowledged the emotional support that the older generation provides to families, particularly Indian families that are so closely bonded. "In times like these, difficult choices have to be made and should be made by the State.", the Court said. .Any policy decision, the Court said, has to be taken on the basis of inputs from medical professionals on the aspects of who has better chance of survival and other parameters..The Court clarified that the Central government may create exceptions for good reasons in case of older persons who are serving the nation in high position and whose safety and security is necessary in view of the pivotal role that they play. .In its order, the Court also directed the Indian Council of Medical Research to come out with clear guidelines on use of Liposomal Amphotericin B, conventional Amphotericin B and other alternate drugs for treatment of black fungus. .The Court has inter alia asked ICMR to also clarify if it was medically prudent to administer two vials to a patient when the requirement is of 6 vials per day, and if any other drug can be given in place of Liposomal Amphotericin B. .The Court recorded that while the number of active cases in the national capital rose from 752 on May 31 to 792 within a day, the allocated supply to Delhi remained at 33% of the demand. .During the course of the hearing, Justice Sanghi also remarked that in his view, the vaccination policy of the Central government, which prioritises the older generation, was not satisfactory. ."When you did not have (the vaccines), why did you announce? We have to invest in future.. and we are side lagging them. We want to vaccinate those who are 70-80..So many young people have lost their lives. It is the younger people who are the future. We are on our way out. I don't understand this policy at all.".The Court also pulled up the Central government for having "no clarity" on the projections of Liposomal Amphotericin B for the upcoming month. .Earlier, the Central government had informed the Court that it was looking an additional figure of import of 2.30 lakh vials from companies in eight countries. .Central government Standing Counsel Kiritman Singh today, however, told the Court that some of these suppliers had either refused to make any supplies or were willing to give limited supply. .Justice Singh questioned, "Are you kidding us here? You don't know if the figure is 2.30 or 30? There is no clarity. How is this system working.. the company says sorry we can't give you.. We don't have know, you don't know. The Ministry doens't know what the figure is.. There is no clarity anywhere. If the company says we can't provide, the figure of 2.30 lakh is just notional..".With respect to the availability from domestic production, Singh stated that expectation is 3.25 lakh vials in June. ."Conventional AmphotericinB should be 3.52 lakh in June. The alternative drug Posaconazole will go up from 10 lakh to 67 lakh in June. The imports were 7 lakh from Mylan. In addition, in the past few days 50k more have been received. 2 lakh orders have also been placed additionally.", Singh informed the Court. .The Court was hearing a batch of petitions concerning COVID19 related issues in the national capital. .This aspect would be taken up next on Friday.