Days after the stock-out crisis of anti-tuberculosis drugs, the country is facing another crunch in the form of out-of-stock multi-drug-resistant TB medicines.
Stocks of second-line medicines like Kanamycin, an injectible drug used for treating multi-drug resistant (MDR) TB have dipped alarmingly. According to Central TB Division (CTD) officials, there is stock only for two and a half months. There is a high burden of MDR TB in India.
The shortage could prove to be a race for life for the patients, especially paediatric and MDR TB afflicted cases. States with lower disease prevalence have been asked to transfer drugs to those facing extreme shortage of drugs.
In Bihar, in almost every district, there are no drugs. A CTD official said that in two days Kanamycin, along with Pyridoxine (used to mitigate the side effects of Isoniazid), will run out. Against the requirement of 35,000 doses of Kanamycin, currently just 2500 doses remain.
Likewise, there are only 4000 doses of Pyridoxine instead of the required 14,000. For the moment, the CTD has asked Rajasthan to transfer 10,000 doses of Kanamycin to Bihar but that is inadequate to deal with the current crisis.
The official said that patients who come for testing every day for MDR TB at the drug resistant TB testing facilities are not being informed of their status since there are no medicines for new patients to be treated. Day by day, the numbers are rising since many have not been able to take the correct course of treatment, he said.
In an internal briefing within the World Health Organisation (WHO) on June 27 Dr Nata Menabde, WHO representative, India, was apprised of the true status who initially maintained that there was no shortage of drugs in India.
The shortage of drugs is believed to be due to procurement failures and delays at the level of the government of India. It also confirmed stock-out of paediatric doses, Rifampicin (the key drug to treat TB), streptomycin injection as well as diminishing stockpiles of Kanamycin injections and other first line drugs. Emergency procurement of paediatric drugs was delayed by six months and the orders had just been placed.
As for Kanamycin, emergency procurement of over 400,000 vials, done with the support of the Geneva-based Global Drug Facility (GDF) through WHO’s intervention had not reached the country because of delays in processing orders, payments and the ministry not issuing the necessary customs duty clearance on time.
The pressure is now building up on the government. In a letter to Anshu Prakash, Joint Secretary, Health, the Independent Commission on Development and Health in India, states that the ground situation belies the ministry’s stand.
Its team has reported drug shortage in the field, especially paediatric drugs and that there is a risk of developing drug resistant TB in India. It has also asked the government to look into the factors that led to the crisis and take measures to correct the procurement process so that such a situation does not occur in the future.
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