LAHORE: The Punjab government has slapped a ban on the use of Avastin injection for eye patients for an indefinite period across the province, besides launching a portal to collect data of the patients affected by the drug and provide them treatment facilities.

The data collection through the portal launched by the Primary and Secondary Healthcare Department will help the government prepare a policy regarding the use of the injection.

Provincial health ministers Dr Jamal Nasir and Dr Javed Akram said this while addressing a joint press conference here on Tuesday.

They said the ban was imposed as a high-level inquiry was underway to find out the prime factors leading to vision loss among patients administered the injection in Punjab.

68 affected patients have surfaced in Punjab so far

They asked the affected patients to provide necessary information on the portal to get treatment and help the government in assessing the true impact of the drug’s reaction.

They said that so far 68 patients affected by this injection have been reported in the province, for whom special beds have been allocated in the Holy Family Hospital Rawalpindi, Mayo Hospital, Lahore and Nishtar Hospital, Multan.

The ministers said a new 10-member committee has also been constituted by Punjab Chief Minister Mohsin Naqvi to analyse the situation caused by Avastin injection’s reaction.

The committee will point out deficiencies and weaknesses at various levels in handling and use of the injection and prepare a comprehensive action plan to prevent recurrence of such incidents in future.

Primary Healthcare Minister Dr Jamal Nasir said this injection, available in the market in 100mg pack, was primarily meant for the treatment of colon cancer and its use for the treatment of eyes in diabetic patients falls under the category of “off-label” use, adding that the injection was neither fake nor locally manufactured.

“The diabetes patients require only 1.2mg dose and some people sell this injection in small syringes for this purpose,” Dr Nasir said.

He said the injection should be kept at 2 to 8 degrees Celsius temperature and administered to the patient within six hours of opening the pack. However, he said, apparently due to increase in temperature its chemical composition changed and this might have happened because of not maintaining the required temperature during its transportation.

Dr Nasir said that efforts were under way to arrest those who sold this injection in small syringes illegally, adding that the Punjab Healthcare Commission (PHC) has also been directed to trace the doctors and hospitals involved in this issue.

The minister said that 11 drug inspectors in eight cities of Punjab have been suspended from service and an inquiry has been ordered against them for failing to check the illegal sale of the injection in small doses.

Punjab Specialized Healthcare Department Minister Dr Javed Akram said new members have been added to the committee constituted by the chief minister, including Professor of Microbiology Dr Sidra, Professor of Ophthalmology Dr Moin and Professor of Forensic Medicine Dr Allah Rakha.

He said the committee would also inspect the premises where the injection was being packaged in small syringes and determine whether those places were suitable for the process or not.

Apart from this, he said, the record of temperature maintained during shipment, off-loading and transportation etc of the “contaminated” lot of the injection would also be sought from Switzerland-based company.

Dr Akram apprehended that it seemed good clinical practices had not been taken into account while using this injection for eye treatment. He said it was mandatory to seek consent of the patient in local language before administering the injection, adding that those responsible for this episode would be held accountable without any leniency.

PHC: The Board of Commissioners of the Punjab Healthcare Commission (PHC) has directed the senior management of the commission to be prepared for special inspections of the hospitals where eye infection cases were reported due to the administration of Avastin injection to the patients.

The directions were issued in an emergent meeting of the PHC Board of Commissioners (BoC) headed by chairperson retired Justice Muhammad Bilal Khan.

A representative of the PHC, who had attended the meeting of the recently formed committee by the government also attended the BoC meeting.

He briefed the BoC regarding the proceedings of the meeting convened by both interim health ministers – Prof Javed Akram and Dr Jamal Nasir.

The BoC was informed that the issues related to import, compounding and dispensing of the dosage for eye patients will be investigated by the committee, while the PHC was asked to investigate the practices in the hospitals where the injection was administered.

After deliberations, the BoC directed the PHC senior management to make preparations for any action, especially, the inspections of the hospitals where the infections have been reported.

The BoC also ordered inspections of these healthcare establishments to ensure implementation of the minimum service delivery standards, especially pertaining to infection protection and control, medication management, qualifications of the medics, and sterilisation of operation theatres.

The BoC also ordered issuance of an advisory for the affected patients to initiate complaint about these incidents. For this, they can also WhatsApp their complaints at 0306 0843500, for initiation of investigation by the PHC.

In a related development, the Lahore police arrested a suspect, Bilal, from Arifwala, in connection with Avastin injection scam.

The police said a case had been registered against the suspect by Faisal Town police.

A special police team investigating the case traced the location of the suspect at Arifwala and arrested him in a raid on a premises, with the help of local police, sources said.

Published in Dawn, September 27th, 2023