Life-saving Aids medicine out of stock in Gauteng
Amphotericin B is an essential medicine for treating cryptococcal meningitis – a large cause of death for people with HIV in South Africa.
Yet, there’s no shortage of the drug in Gauteng. Instead, activists say that dysfunction and tardiness at the province’s drug depot is to blame.
Between November 13 and December 5, the Stop Stockouts Project (SSP) – a consortium which monitors essential medicines in South Africa – heard from five major Gauteng hospitals that stocks of Amphotericin B had run out.
These were the Chris Hani Baragwanath, Helen Joseph and Charlotte Maxeke hospitals in Johannesburg; Leratong hospital in Krugersdorp, and Dr George Mukari hospital in Pretoria.
Although stocks at these facilities have now been replenished, staff at Zola Jabulani hospital in Soweto warned on Monday that they had only three days worth of the drug left. If the drug is not restocked by Thursday, the hospital will be forced to put patients on sub-optimal treatment.
“This is such a fundamental drug. It staggers me that running out of it is regarded so casually. The number of fatalities that could result is both unacceptable and unnecessary,” said a Gauteng doctor, who wished to remain anonymous.
SSP this week called on Gauteng health MEC Qedani Mahlangu to intervene to rectify the drug shortages which are being experienced in clinics and hospitals across the province. Many of the medications which run out – 53 of them according to SSP – are crucial in the treatment of HIV, tuberculosis, and mental health.
An SSP investigation found that requests for new stocks of Amphotericin B had not been properly processed at the Gauteng health department’s central depot in Auckland Park, Johannesburg.
Amphotericin B is supplied to the public health sector by pharmaceutical Bristol-Myers Squibb (BMS), which has offices in South Africa. In 2013, BMS refused to renew its contract for supplying the drug to the health department.
Melinda Scoones, the company’s distribution analyst, says that this was because the company could not assure that it would be able to meet the supply volumes requested for in the department’s tender.
The company’s refusal to renew its supply contract came after the Treatment Action Campaign (TAC) blamed BMS’s “inefficiency” for the drug running out in 2011, accusing it of “putting lives at risk”.
Since 2013, the drug has therefore only been available for purchase by provincial health departments on a “buy-out” basis, which is subject to a lengthy supply chain process for each new order.
This means that provincial depots, like the one in Auckland Park, need to aggregate and sign off on requests for the drug from individual hospitals, and order the needed supplies of Amphotericin B from BMS.
By contrast, contracted medicines are kept in bulk storage at the depot, ready for distribution when needed.
“We want to make the assurance that there is no current shortage of the drug Amphotericin B available for purchase by the government,” said Scoones.
“This is a perpetual problem. Often [hospital managers] come to BMS asking about supplies, and our staff have to track the original requests, which are often found to be at the depot awaiting approval and sign-off. It is frustrating to our business, not to mention to hospital staff and their patients.”
An investigation confirmed that the central financial officer had not signed off on the depot’s order for 2 900 Amphotericin B vials, retarding the procurement process and resulting in the problem, said SSP project manager Bella Hwang.
“We have not been able to establish the reason for the delay,” added Hwang.
“Last week a doctor at Chris Hani Baragwanath hospital reported to us drug shortages of anti-psychotics, anti-depression [medication] and several antiretrovirals. He was unable to discharge patients without medicines. We reported it immediately to a senior official in the ministry of health.
“Several hours later he called back and said that the head of the hospital says there are no drug shortages! We then contacted the doctor who sent us eight photographs of empty shelves in the pharmacy. We sent these on to the ministry, but heard nothing further,” says the TAC’s Mark Heywood, who is also the executive director of the public interest law centre SECTION27.
GroundUp’s queries and phone calls to the MEC’s spokesperson, Prince Hamnca, also went unanswered.
This story was originally published on GroundUp.