Drug shortages jeopardise patients - NGOs

The cost of certain HIV/AIDS drugs has dropped in recent months, but shortages are placing many patients at risk, says a coalition of NGOs. Many pharmaceutical companies reduced their prices last year by between 50 and 98 percent for governments, international agencies and NGOs fighting HIV/AIDS in Africa. However, the Kenya Coalition for Access to Essential Medicines, which groups together several NGOs, has accused the drug companies of "giving with one hand and taking with the other". The coalition says price reductions have not been matched by consistent drug supplies. This has in turn made the use of the drugs more dangerous because they have high levels of toxicity and are usually administered under strict therapy regimes. "Our problem is being tied to monopolistic supply," Liza Kimbo, executive director of the Cry for the World Foundation, a member of the coalition, told a news conference in Nairobi on Tuesday. "The pharmaceutical companies accepted to reduce the prices of the drugs, but they are not willing to back it up with sufficient supply. It is a question of giving with one hand and taking with another," she said. GlaxoSmithKline and Boehringer Ingelheim, two of the pharmaceutical companies with HIV/AIDS drugs on the Kenyan market, suggested on Tuesday that the shortages were being exaggerated. The coalition urged the Kenyan government to allow more than one supplier of the a medicine into the Kenya market. It also asked for pressure on pharmaceutical companies to extend credit to local distributors of all anti-retrovirals (ARVs) - including reduced-price ones - to "adequately buffer their stocks" and to ensure that treatment regimes are not interrupted or upset by risky switches to substitutes. According to official figures, at least 700 people die from AIDS-related diseases in Kenya every day - a health burden which has prompted the Kenyan government to declare HIV/AIDS a national disaster. John Wasonga, a doctor with the HIV project at Mbagathi Hospital in Nairobi, told Tuesday's press conference that the majority of his 15 patients who can afford to buy ARVs were being forced to default on their treatment due to the shortage of the required drugs in the market. As a result, he said, some were suffering severe side effects from frequent changes in treatment regimes. Wasonga cited "regular" shortages of reduced-price Videx (25 mg) and Zerit (30 mg) tablets, produced by pharmaceutical company Bristol-Myers Squibb (BMS). The shortages, he said, had forced HIV/AIDS patients to switch to alternate medicines or to interrupt their treatment altogether. "To get a patient to adhere to a strict therapy is a difficult job," he said. "To [have them] default for weeks because drugs are out of stock is making an already difficult job even more difficult." International medical NGO Medecins Sans Frontieres (MSF), which is spearheading a global campaign for access to essential medicines, said there were two reasons for the shortages. Manufacturers were not delivering their discounted medicines regularly and local distributors were unable to keep buffer stocks of discounted ARVs because credit facilities were typically offered on normally-priced ARVs only. MSF also cited shortages of drugs, such as AZT pills, from GlaxoSmithKline. It said these were unavailable in Kenya for two weeks in March and April. Epivir, another GSK anti-retroviral, was also unavailable in August last year. "A guaranteed drug supply is crucial in antiretroviral treatment as correct dosage and rigorous adherence to scheduling are needed for the medicines to work successfully," said MSF. "Furthermore, patients who do not closely adhere to their treatment run a higher chance of developing drug-resistant strains of HIV." GlaxoSmithkline commercial director for East Africa, William Kiarie, told PlusNews on Tuesday that his firm was caught off-guard by the surge in demand for ARVs following the price reductions, and was trying to remedy the situation by increasing its buffer stocks. "Obviously, with prices going down, the demand for these drugs multiplied. Nobody was prepared for this," Kiarie said. "The impression being created by the coalition is not true. Our biggest ARV product, Combivir, has never been out of stock. We have only been out of stock of two items, whose demand was much lower." Kiarie said GlaxoSmithKline was committed to making its products available at discounted prices to the Kenyan market. "We feel we have worked hard for products we don't make any profit from. We have now increased our buffer stocks, and should not experience any shortages," he added. Joseph Ng'ethe, local manager for Boehringer Ingelheim, told PlusNews that his firm had not only reduced the price for its main ARV product, nevirapine, but had always maintained a constant supply of the drug, which is used in the treatment of acute AIDS infections and to prevent mother-to-child transmission of the disease. "As far as we are concerned, our product has always been on the market," Ng'ethe said. "We can guarantee that. It has never been out of stock."