While Kerala has often been praised for its effective surveillance of multiple Nipah outbreaks, recent controversy surrounding Remdesivir at Kozhikode Government Medical College Hospital (MCH) has shown the issues surrounding how drugs are sourced, stored and managed.
The issues were highlighted in a Comptroller and Auditor General (CAG) report and raised in the Kerala Legislative Assembly. Concerns have been raised about using remdesivir past its expiry date on patients.
The CAG's Report No. 6 of 2024, which examined public health infrastructure and healthcare management in Kerala, identified instances of expired medicines and supplies being issued to hospital wards. The audit covered the period from 2016-17 to 2021-22 and examined 26 hospitals. It identified 60 instances of expired medicines and supplies being issued to wards, with a total value of Rs. 0.89 lakh. The report also identified 530 instances involving items under stop memos across 148 hospitals, valued at Rs. 11.69 lakh.
This controversy surrounds a batch of 3,000 vials of Remdesivir that were purchased by the Kerala Medical Services Corporation Limited (KMSCL) in June 2021 for around Rs. 42 lakh. They had an expiry date of May 30, 2023, however, hospital records show they were recorded as having been used in subsequent financial years.
A separate inquiry has also emerged over Remdesivir manufactured by US-based pharmaceutical company Gilead Sciences.
According to records maintained by Kozhikode Medical College, 690 vials of Gilead-manufactured Remdesivir were received on January 1, 2022. Of these, 10 vials were reportedly administered to Nipah patients on September 13, 2023, while another 256 vials were subsequently supplied to patients in different phases.
However, records identifying the original supplier, the quantity purchased and the date on which the medicine reached KMSCL have reportedly not been found.
The vials were labelled "For clinical trial use only" and reportedly carried an expiry date of September 2025 but did not mention a manufacturing date. According to Onmanorama, such vials are required to carry details of the patient receiving the drug, the prescribing doctor's name and the treatment protocol followed.
KMSCL will conduct an internal inquiry into the procurement and supply of this medicine to establish how the vials reached the hospital and whether the required records were maintained. This is a separate issue from the 3,000-vial batch purchased in 2021 that expired in May 2023.
In 2023/24, 102 vials were recorded as having been used. In addition, 34 vials were used in 2024/25 and 10 vials in 2025/26.
The Health Minister also clarified that 50 vials recorded as used during 2026-27 had been separately procured from Bahrain on June 12, 2026, for a Nipah patient. The patient recovered. These vials were not part of the 3,000-vial batch purchased in 2021.
This led to concerns being raised about why drugs were being kept in stock when they should have expired and if checks were carried out.
The issue was raised in the Kerala Assembly on October 29 2026 by Congress MLA Mathew Kuzhalnadan. The Health Minister, K. Muraleedharan, admitted there were concerns with the hospital records regarding potential use of expired Remdesivir.
Some of the vials had been labelled without the date of manufacture. As noted by the Health authorities, the packaging had an expiry date; however, no manufacturing dates were present.
In response, the government has announced an investigation will be carried out by Dr. R. Aravind, Head of the Infectious Diseases Department, Thiruvananthapuram Medical College Hospital.
One of the main concerns was whether Nipah patients received Remdesivir from the controversial batch.
However, Dr. A.S. Anoop Kumar, a critical care expert, told The New Indian Express on October 31 that none of the Nipah patients who died between 2023-2025 received Remdesivir from Kozhikode Medical College.
He said some patients had passed away before receiving treatment, whilst others were only diagnosed with Nipah after death. Remdesivir was given to patients who recovered.
Although this shows the drug was not given to any patients who died, concerns still remain as to whether other patients received vials from this batch. He also noted Remdesivir produced in India in 2022 would typically have a 2-year shelf life. It will be important to understand the manufacturing and expiry dates of the controversial vials.
According to the US Centers for Disease Control and Prevention (CDC), Remdesivir has demonstrated preventive effects against Nipah virus in exposed non-human primates. However, its effectiveness in treating human Nipah infections has not been established. The CDC also notes that ribavirin was used to treat a small number of patients during the 1999 Malaysian Nipah outbreak, but its effectiveness remains unclear. Therefore, Remdesivir remains an investigational treatment option rather than an established therapy for Nipah infection.
Nipah (NiV) is a zoonotic infection. It belongs to the genus Henipavirus and family Paramyxoviridae. Natural hosts include fruit bats of the genus Pteropus, commonly known as flying foxes.
Humans can become infected either by coming into contact with infected animals, eating contaminated food by infected bats or coming into close contact with infected individuals.
Patients can suffer from symptoms such as fever, headaches and respiratory problems, to more severe neurological problems such as encephalitis (inflammation of the brain). Severe cases can cause seizures, changes in consciousness and respiratory issues.
It has an estimated mortality rate of between 40-75% according to the World Health Organization.
There are currently no approved vaccines or antiviral medications available to treat Nipah infections. Treatment consists of supportive care and managing complications. While Remdesivir has been considered as a possible treatment option, it is not an approved treatment.
India had its first Nipah outbreak in 2001 in Siliguri, West Bengal. There were 66 cases reported with 45 deaths. Healthcare-associated transmissions caused medical staff and those visiting the hospital to become infected.
A second outbreak occurred in Nadia district, West Bengal, in 2007. 5 cases were reported with 5 deaths.
Following over a decade without any outbreaks, Nipah returned to India in May 2018. This impacted Kozhikode and Malappuram districts in Kerala. 19 cases were reported with 17 deaths.
Since then, there have been further outbreaks and isolated cases in Kerala. These occurred in 2019, 2021, 2023, 2024 and 2025. Extensive contact tracing, isolations and collaboration between medical facilities were needed.
This Remdesivir controversy raises many questions. During a public health emergency, it is crucial hospitals keep track of huge amounts of medical supplies. This means accurate records need to be kept of what stocks are in, what batches they are and when they expire.
Just because the drugs have been used from stock doesn’t mean that a particular patient received an expired vial. The investigation will need to determine what drugs were used and look at individual patient records.
As Kerala has faced multiple Nipah outbreaks, this is an opportunity to look into where issues arose with the pharmaceuticals.
It will be important to determine whether expired medication was given to patients and how this happened. They will also want to know if any patients suffered from any adverse effects. This will help to identify any responsible parties and avoid similar issues in future public health emergencies.
References:
1. World Health Organization. “Nipah Virus.” January 29, 2026. https://www.who.int/news-room/fact-sheets/detail/nipah-virus.
2. Arunkumar, Govindakarnavar, Radhakrishnan Chandni, Devendra T. Mourya, Sujeet K. Singh, Rajeev Sadanandan, Preeti Sudan, and Balram Bhargava. “Outbreak Investigation of Nipah Virus Disease in Kerala, India, 2018.” The Journal of Infectious Diseases 219, no. 12 (2019): 1867–1878. https://doi.org/10.1093/infdis/jiy612.
3. Harit, A. K., R. L. Ichhpujani, Sunil Gupta, K. S. Gill, Shiv Lal, N. K. Ganguly, and S. P. Agarwal. “Nipah/Hendra Virus Outbreak in Siliguri, West Bengal, India in 2001.” Indian Journal of Medical Research 123, no. 4 (2006): 553–560. https://pubmed.ncbi.nlm.nih.gov/16783047/.
4. Arankalle, V. A., et al. “Genomic Characterization of Nipah Virus, West Bengal, India.” Emerging Infectious Diseases 17, no. 5 (2011): 907–909. https://pmc.ncbi.nlm.nih.gov/articles/PMC3321761/
5. Comptroller and Auditor General of India. Public Health Infrastructure and Management of Health Services, Kerala. Report No. 6 of 2024. New Delhi: CAG of India, 2024. https://cag.gov.in/uploads/download_audit_report/2024/Report-No.-6%2C-2024%2C-Kerala-06a2bd10de77a70.75432165.pdf
6. Centers for Disease Control and Prevention. “Nipah Virus: Facts for Clinicians.” Accessed October 31, 2026. https://www.cdc.gov/nipah-virus/hcp/clinical-overview/index.html
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