• Inoculation of class 9-12 students begins in province today
• Drap allows use of alternatives for Actemra

KARACHI / ISLAMABAD: In a significant development, the Sindh health department has decided to introduce obligatory Covid-19 vaccination regime in restaurants, hotels, banks, post offices and courier services.

Meanwhile, the Drug Regulatory Authority of Pakistan (Drap) has approved alternative drugs and allowed health facilities to use them for critically-ill Covid-19 patients.

As many as 3,747 people were infected and 61 lost their battle against the disease in a single day. The national positivity rate was 6.47 per cent, according to data shared by the National Command and Operation Centre (NCOC) on Sunday.

The Sindh home department approached the NCOC to get the decision about banks and post offices enforced.

The provincial government also decided to start vaccination of students of class 9 to 12 from Monday (today).

While critically-ill patients fail to get Tocilizumab — sold under the brand name Actemra — because of its shortage or their inability to buy it from black market at almost 10 fold higher rates, Drap has approved alternative drugs and allowed hospitals to use them to treat seriously-ill Covid-19 patients.

An official statement of the Ministry of National Health Services (NHS) said that Tocilizumab, especially in combination with dexamethasone, had been effective at lowering mortality rate among Covid-19 patients whose respiratory systems decomposed rapidly and who required oxygen delivery through a high-flow device or noninvasive ventilation.

“However, there is now shortage of this life-saving drug (Tocilizumab) not just in Pakistan but across the world. Regulatory bodies in various countries have re-directed healthcare providers to alternatives. As per the latest guidelines issued by the Ministry of NHS, baricitinib or tofacitinib are appropriate alternatives to Tocilizumab. Both belong to the same class of anti-inflammatory drugs i.e. the Janus Kinase (JAK) inhibitors. Baricitinib (or tofacitinib) should only be given in combination with dexamethasone or another corticosteroid,” it said.

“Healthcare workers, especially those involved in critical care of Covid-19 patients, should visit the National Command and Operation Center (NCOC) website and review the guidelines which include more details about dosage and precautions,” the statement concluded.

A senior official of the ministry, requesting not to be named, said Tocilizumab — sold under the brand name of Actemra — was given to critically-ill patients but its shortage was being experienced across the globe.

“We tried to get 1,000 vials of Actemra last month but even the company could not arrange the injection as the medicine has run short. We are left with no option but to go for alternatives that have the same characteristics as Actemra but were not allowed by Drap to be administered to Covid-19 patients,” the official said.

Replying to a question, he said some countries were also using the alternatives and Pakistan was now doing the same.

Talking to Dawn, a pharmacist said that Actemra contained monoclonal antibodies and was used to lock the immune system.

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses.

“During Covid-19, the immune system becomes hyperactive and starts killing human cells that have coronavirus and as a result the patient gets affected more. Medicines such as Actemra lock the immune system and stop it from killing the cells. However, this process can also be dangerous because a patient is prone to attacks from all diseases as the immune system stops working,” the pharmacist said.

He said Pakistan had less than two third of the population compared to the United States (US) but “we have used 10 times more Actemra than America”.

He said that the medicine had side effects and could be very dangerous. “There are a number of other monoclonal antibodies and they also lock the immune system,” he added.

The pharmacist said the injection was priced at Rs55,000 but was being sold for Rs400,000 in the black market.

“It is a positive step that Drap has approved alternatives of Tocilizumab,” he added.

Spokesperson for the Ministry of NHS Sajid Shah told Dawn that it was a fact that Actemra injection was not available in the market.

“Drap discussed the issue in a meeting and finally reached the conclusion that some medicines, having same properties, can be used as an alternative,” he said.

Sindh govt’s decisions

Spokesperson for the Sindh health minister Mehar Khursheed said in a press statement that the latest decision had been made to ensure mandatory vaccination.

Attached to the statement were copies of two letters. One of the letters written to the additional chief secretary home by Senior Technical Officer of the health department Dr Sohail Raza Shaikh says: “To make the vaccination drive more successful, it is highly recommended that all the restaurants/hotels may provide their hospitality services (check in/outdoor dining services) to only those people who are vaccinated.” The health department asked the additional chief secretary home to issue directives to concerned quarters for strict compliance.

Another letter sent to the NCOC says: “For further increase in vaccination coverage and to make vaccination drive successful, it is highly recommended that necessary directions to all commercial banks, post offices and other courier services may be issued to offer their services only to the people who are vaccinated through verifying their Nadra vaccination card.”

In a related development, a meeting chaired by Sindh Education Minister Syed Sardar Ali Shah on Sunday decided that vaccination of students of class 9 to 12 would start from Monday (today), said the minister’s spokesperson Saeed Memon.

The meeting, attended by Secretary Schools Education Ghulam Akbar Leghari, Secretary Colleges Education Khalid Hyder Shah and the directors of education of all districts of the province, reviewed steps being taken for vaccination of teachers and students in all government schools and colleges.

Mr Leghari expressed his displeasure over performance of the regional directors, said the spokesperson. “I am receiving complaints that you people (regional directors) did not visit the field and such negligence would not be tolerated,” the minister said.

Published in Dawn, September 6th, 2021