Remdesivir row probe: Did Muraleedharan go wrong on diagnosis, prescription & treatment?

The probe announced by Keralam Health Minister K Muraleedharan to find out if expired doses of Remdesivir were given to Nipah patients may be delayed due to a possible conflict of interest. While announcing an expert panel headed by Dr Aravind Reghukumar, Head of the Department of Infectious Diseases, Government Medical College, Thiruvananthapuram, the government seems to have overlooked the fact that Dr Aravind had been the convenor of the Medical Board for Nipah disease.

Whenever an outbreak is confirmed, the Medical Board convenes regularly and finalises a host of aspects including contact tracing, drug availability, quarantine and other probable situations arising out of disease spread. All these meetings were held with Dr Aravind in attendance.

Sources said that Dr Aravind has not been given any formal orders to begin the probe. Besides, he is learnt to have communicated about the situation to the Directorate of Medical Education. Dr Aravind said he cannot comment on the matter. Meanwhile, officials with the Office of the Health Minister said that in the wake of allegations about expired drugs being given to patients, a probe has become imperative.

The minister's reply kicked up a political row in the state as the LDF government had often touted Nipah management as exemplary, which brought down the case fatality rate (CFR) from 91% to 33% in the recent outbreaks reported in 2023 and 2025. In his reply to a submission in the Kerala Assembly, the minister, quoting figures from Kozhikode Medical College, made serious statements about administering Remdesivir.

According to his reply, KMSCL (Kerala Medical Services Corporation Limited) had last bought Remdesivir in June 2021, and these medicines had an expiry date of May 30, 2023. These medicines were used in 2023, 2024 and 2025 (102 vials in 2023, 34 vials in 2024 and 10 in 2025). The minister said that the committee will look into whether Nipah patients died because of using expired medicine and whether other patients complained of any side effects.

Former health experts associated with Nipah management in Keralam as well as doctors who had taken Remdesivir as a prophylactic while treating Nipah patients said that the minister's statement is problematic in many ways.

Remdesivir was procured from multiple agencies by the state government in 2021 to manage the second wave of COVID-19. "These batches had different expiry dates -- 2023 and 2025. The allegation stems from the assumption that one batch expired in 2023 and hence the expiry period is two years, which is not the case. Also, the KMSCL has a default system which flags expired medicines before it is supplied. It's not just patients, but several doctors had also used this medicine as a preventive, and it is highly improbable that none of them would check the expiry date," Dr Anish T S, former Nodal Officer for the Kerala One Health Centre for Nipah Research and Resilience, told Onmanorama.

It's a broad-spectrum antiviral which has been considered a safe drug. Between 2023 and 2026, 6 Nipah patients were given this medicine and all of them survived. There are multiple levels to check the expiry of this drug, he added. A doctor who treated a Nipah patient told Onmanorama that he had been administered Remdesivir and he was certain that the drug was within the expiry date.

Onmanorama tried to contact two former officials responsible for procurement and supply of this drug during COVID period, but they didn't respond. The Nipah management plan for Kozhikode prepared by the Health Department in 2021 notes that no approved drugs or vaccines were currently available and that there was an unmet need for newer therapeutic options for NiV(Nipah virus) infection. "In diseases like NiV infection, any new drug can be tried only during an outbreak situation and that too strictly adhering to the clinical trial protocol," it said.

The treatment algorithm also showed “considering” use of MAB (Monoclonal Antibody) Remdesivir/Favipiravir/Ribavirin after discussion with the patient, and that the treatment plan has to be formulated by the Institutional Medical Board. The resource group, which prepared this document, also included Dr Aravind.

The treatment protocol published in 2023 also lists Remdesivir for broad-spectrum antiviral activity. While the minister's statement was mainly based on information from Kozhikode Medical College, officials said that the medicines were supplied to three other hospitals where the disease was confirmed. According to former officials who managed Nipah, the drug details, including the expiry date, are entered on software by the store superintendent and the pharmacist, and the drug reaches the patient only after cross-verification by the nursing officers.

Another report has also emerged which says that an American company had supplied Remdesivir without a manufacturing date. Officials said that the US Food and Drug Administration (FDA) insists on an expiration date on a drug product, but does not explicitly mandate a manufacturing (MFG) date on the label. The government has not responded to this allegation.