Dying for drugs

Dire shortages of medicines at public hospitals and clinics are giving rise to fears of increased drug resistance among patients.

The current list of medicines that are out of stock or in short supply around the country runs to six pages. It includes antibiotics, TB medicine, antipsychotics, antiretrovirals for adults and children, and drugs to treat high blood pressure, anxiety, depression, bipolar disorder, epilepsy, constipation, fungal infections and pain.

The Department of Health says it is negotiating with drug suppliers to address the shortages. But the Stop Stockouts NGO warns the short supply is of crisis proportions. Spokesman Bella Huang said it is a silent, yet chronic crisis, with more and more concrete evidence emerging of how big the problem of stockouts and medicine availability is. One of the medicines in short supply is abacavir, prescribed for HIV-positive children and not easily substituted with other drugs. Stavros Nicolau, senior executive for the manufacturer of the drug, Aspen, said the current shortages were due to a shortage of the active pharmaceutical ingredient, produced abroad. He said this should be corrected by June 10. In the interim, the drug was being imported from a different supplier, under a special licence.

Huang said the most vulnerable people were suffering the consequences of a "systems failure". A doctor at a Gauteng hospital said though shortages were common, he was concerned that many "first line" antibiotics used for simple everyday infections were unavailable at present. The doctor - who asked not to be named due to explicit warnings against speaking to the media that the Department of Health has given to all doctors - said because of the "severe" shortages of first-line antibiotics, they had to use much more potent and expensive ones to treat simple infections.

He added that this is bad practice and can lead to antibiotic resistance. The antibiotics have run short at the same time that the government and doctors have officially committed to reducing misuse of antibiotics and so prevent resistance. The head of the programme to counter antibiotic misuse, UCT professor Marc Mendelson, said substitutes were available for the first-line antibiotics, but whether a hospital or clinic received them depended on their location and level. He said that at some district-level hospitals with a very limited list of drugs available, it is possible that patients would be treated with the incorrect antibiotic.

Fifteen pharmaceutical companies supply the drugs on the shortage list. Only three responded to queries. They indicated three reasons for medicine shortages: orders for the drugs dropped drastically, leading to decreased production; payment to smaller suppliers was delayed by some provinces; or, there was an international shortage of the active ingredients. The CEO of Gulf Drug Company, JP Mainguard, said his company tried to supply medicines even when certain provinces did not pay, but after months of non-payment it halted supplies to avoid running into severe financial difficulties.

Health Department spokesman Popo Maja said no suppliers had indicated that non-payment was the reason for supply challenges. The SA MD of Sanofi Aventis, John Fagan, said orders for the four-in-one drug used to treat TB had dropped unexpectedly in the third quarter of last year, leading it to reduce production. When the orders had later increased dramatically, there was a supply backlog.

The Times, 18 May 2015