KARACHI: The federal government is yet to respond to the repeated alarm raised by relevant quarters over the persistent acute shortage of medicines — some of which are life saving — prevailing across the country for the past many months, it emerged on Sunday.

According to these sources, these medicines include those required to treat complicated cases of tuberculosis (TB), cough and cold, thyroid diseases and neurological disorders. The inexpensive folic acid medicine is also no longer available in the market.

The shortage of various medicines, according to sources, is directly linked to the failure of the federal government to resolve pricing issues with drug manufacturers that has lingered for many years.

“The problem (shortage of anti-TB medicines) has been going on for six months but a crisis-like situation has occurred in the past two months. Two major anti-TB drugs (Ethambutal and Pyrazinamide) are hard to find in the market. Treatment of complicated TB cases couldn’t be done without these two first line life-saving drugs,” said Dr Javaid A. Khan, a professor of medicine and consultant physician at the Aga Khan University Hospital (AKUH).

Tuberculosis, he said, was a serious public health issue and the present situation could lead to cause multi-drug resistant-TB. “Irregular use of medicines is a major risk factor for multi-drug resistant TB whose treatment is not only costly, long but also painful.”

A fixed-dose combination (a four-drug formulation) for treating TB was available in the market but it couldn’t be used in complicated cases, he pointed out.

Dr Javaid was of the opinion that the government should provide subsidy to companies manufacturing essential drugs so that they did not lose money by making a drug at a low price.

“Besides, the ministry of health should also see the price of a particular medicine in regional countries and then set a price locally.”

The matter of anti-TB drug shortage is also pending with the human rights cell of the Supreme Court which was recently informed by the Drug Regulatory Authority of Pakistan (DRAP) and some pharmaceutical companies that there is no shortage of anti-TB drugs in the country.

“This is not true. The cell asked for my comments on the stance of DRAP/companies and I have submitted my response along with letters from major hospitals (AKUH, Fauji Foundation Hospital, Rawalpindi and Gulab Devi Hospital, Lahore), confirming that the country faces serious shortage of anti-TB drugs.

“The letters were sent a week ago and there has been no development on the issue so far,” Dr javaid said.

Absence of cheap folic acid medicine

According to Dr Nazli Hussain, a professor of obstetrics and gynaecology at the Dow University of Health Sciences, the inexpensive folic acid medicine, reportedly being manufactured by only one local company, has simply disappeared from the market for the past six months.

“It was very low cost and, hence, easier to buy. Unfortunately, now high cost versions of the medicine are available, which obviously is difficult to be purchased by poor families,” she said.

Folic acid medicines, she pointed out, were generally recommended to pregnant women all over the world. “Maintaining healthy eating habits and proper levels of vitamins and minerals (such as folic acid) before conception and during pregnancy help to reduce the risk of some birth defects.

“Folic acid lowers the risk of birth defects such as neural tube defects, heart and limb defects and urinary tract anomalies,” she added.

Qaiser Waheed representing the Pakistan Pharmaceutical Manufacturers Association said around 70 to 80 medicines, 50 of which fall in the category of essential drugs, were no longer available in Pakistan due to delay on part of the government to resolve price issues.

Many cases for price increase had been pending with the government for five years, he said.

“More and more people in the pharmaceutical industry are taking away their investments and ultimately it will be poor patients who will suffer. You can bear a loss for sometime but you can’t survive with continuous losses,” he argued.

“Like rest of the world, the government should control prices of only essential drugs listed with the World Health Organisation and let the market forces determine prices of other medicines. Nowhere the state has a blanket control over prices of all medicines.”

Chief executive officer DRAP Dr Mohammad Aslam said that price increase for certain drugs had been sent to the government for approval while a meeting would be convened on the issue of orphan drugs (around 50) to resolve price issues.

“Price increase has been allowed in the case of Pyrazinamide but the application for Ethambutal has recently been received. As for the folic acid medicine, the manufacturing company has assured us of its availability in the market on voluntary basis.

“The DRAP committee has already recommended its price increase in its last meeting and the matter is under approval by the federal government. The major company supplying medicines for thyroid diseases has told us in writing that they are supplying medicines,” he said.

Published in Dawn, April 25th, 2016