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, anti-psychotics, 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."It's a silent, yet chronic crisis, with more and more concrete evidence emerging of how big the problem of stockouts and medicine availability is," says spokesman Bella Hwang.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.This should be corrected by June 10, he said.In the interim, the drug was being imported from a different supplier, under a special licence.A paediatrician warned that an inconsistent supply could lead to children becoming resistant to the drug, and substitute drugs had severe side effects.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 had 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."This is bad practice and can lead to antibiotic resistance."But clinicians have no choice. [It's] terribly frustrating."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."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," he said.Eastern Cape doctor Karl le Roux, who represents rural doctors at Stop Stockouts, said shortages were demotivating for doctors and nurses: "If you take away one of their biggest tools, medicines, they leave rural hospitals and then patients to suffer more."Fifteen pharmaceutical companies supply the drugs on the shortage list. Only three responded to queries from The Times.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; orThere 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.He said KwaZulu-Natal and Western Cape always paid on time.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.It is unclear why orders suddenly dropped when there is no evidence that fewer people are getting TB and more than 400000 in South Africa contract the disease every year. Missing treatments can lead to drug-resistant TB, which can often be deadly.