LAHORE/ISLAM­ABAD: The Punjab health authorities lodged a criminal case against the manufacturers of an adulterated eye drug that led to the loss of eyesight of over a dozen diabetic patients, including a brother of senior PPP leader Chaudhry Manzoor Ahmed.

An investigation team of doctors on Sunday expressed fears of a surge in the number of affec­ted pati­ents after learning that the drug had been supplied to many trust hospitals, other health facilities and the local market.

The issue of adverse effects of the locally manufactured injection, Aves­tin, was discussed at a meeting of caretaker federal minister for National Health Services (NHS) Dr Nadeem Jan with his counterpart in Punjab, Dr Jamal Nasir.

The former told the media after the meeting that a five-member committee, headed by Prof Asad Aslam, had been formed to determin whether the damage to eyes was caused by the medicine, cold chain management, sterilisation issues or doctors’ skills.

“The committee will submit a detailed report within three days,” Dr Jan said.

Deputy Drug Controller Hafiz Alam Sher of the chief drug controller office of Punjab earlier lodged the FIR with the Faisal Town police station under Drug Act, 1976 and Drug Regulatory Authority Pakistan (DRAP) Act, 2012.

He nominated Naveed Abdulllah of Kahna and Bilal Rasheed in the case, alleging that they manufactured the ‘controversial drug’ on the premises of a private hospital — Saira Memorial Hospital Faisal Town Lahore — and supplied the same across the province.

The diabetic patients who were administered the drug developed a life-threatening disease, Endophthalmitis, and the issue surfaced first time when several cases of drug’s reaction were reported from Kasur district.

A high-powered team of the health department also raided the manufacturing unit at the private hospital, confiscated the drugs and further initiated departmental proceedings when the officials found out that the owners were running the illegal unit in sheer violation of the drug rules and regulations.

The raiding team comprised deputy drug controller (Nishtar Town) Hassan Haider Shah, deputy drug controller (Muridke) Bilal Yasin, drug inspector (Wagha Town) Kamal Sikandar, deputy drug controller (Iqbal Town) Sher Zaman, drug inspector (Samanabad) Rameez Ahmad Khan and drug inspector (Sharaqpur) Amanullah.

According to the FIR, Deputy Drug Controller Hafiz Alam Sher alleged that the raiding team noted that the accused owners of the unit were illegally manufacturing several unregistered drugs including Avastin (1.25mg and 0.05mg). The team sent the report to the secretary of the district quality control, stating the accused persons committed a heinous crime by manufacturing the unregistered drugs in sheer violation of the drug rules which later led to the loss of eyesight of several patients in Punjab.

Several diabetic patients in Lahore, Kasur and Jhang districts had been administered Avastin injections to address retinal damage, but these injections led to severe infections, ultimately resulting in the loss of eyesight of around 12 patients, including the brother of PPP leader Chaudhry Manzoor and his friend. In Kasur, four individuals namely Chaudhry Shabbir, Main Aslam, Taufeeq, and Nasrin Bibi, also suffered ‘irreversible’ vision loss.

In his tweet, Chaudhry Manzoor alerted the health authorities, saying the drug severely affected the eyes of his brother who has been shifted to the Lahore General Hospital from Kasur for further treatment.

Manifold increase

Meanwhile, the five-member committee formed by the Punjab government started investigating the issue related to the locally manufactured injection.

Led by King Edward Medical University’s Dr Asad Aslam Khan as convener, the committee comprised DG Drugs Control Mohammad Sohail, Mayo Hospital’s Dr Muhammad Moin, Lahore General Hospital’s Dr Tayyaba and Services Hospital’s Prof Dr Mohsin.

While holding its first meeting on Sunday, the committee feared that the number of affected patients may increase manifolds as the drug Avastin was supplied all over the province in a large quantity.

Scope of probe

Finding that the controversial drug was also supplied to different trust hospitals besides the local market and the other health facilities, the probe panel decided to expand the scope of inquiry by seeking reports from all Punjab districts regarding the supply, use and ‘reaction’ of the drug on patients.

The committee shall also visit the hospitals of various districts, hold meetings with doctors and patients to get feedback in this regard, while drug inspectors were tasked with filing assessment reports immediately.

Drug recalled, banned

The health department decided to take strict action against the drug inspectors responsible for availability of non-sterile injections with a pending inquiry.

The Punjab health department has already issued an alert notice for public and the manufacturing company to stop further use of the drug for two weeks and recall the same from the market where it has been supplied under the controversial batch.

Meanwhile, federal and Punjab health minister discussed the issues of adverse effect of injection, unavailability of medicines and dengue cases on Sunday.

Talking to the media after the meeting, Dr Jan said: “FIR has been lodged against two suppliers. Upon receiving information from affected patient regarding adverse reaction of Injection Avastin. Immediate action to recall the injection Avastin causing adverse reaction was taken and sale and dispensation of the injection has been stopped,” he said.

“I am in constant touch with the Punjab government and we will not rest till the matter is thoroughly probed and action taken against those responsible. The affected patients will be looked after and all possible facilities provided to give them relief,” Dr Jan said.

Punjab health minister Dr Jamal Nasir said the actual drug was manufactured by a multinational company and it was of 100mg and worth of around Rs 45,000. “However, the injection is divided into almost 100 parts and given almost 1mg to a patient to treat capillaries in eye. Hospitals are selling this injection at abnormally high rate, [leading to illegal drug manufacturing],” he said.

He promised strict legal action in light of the laboratory results and the inquiry report.

Dengue cases

The minister also told the media that the discussed dengue cases. “The situation is being managed well by Punjab health authorities. In the entire Punjab province, 3,500 cases have been reported so far this year whereas in the corresponding period last year the number of cases was 10,000. I have been also informed that there has been no fatality so far. As dengue cases normally start showing a downward trend after October 15, we need to sustain the control measures for another three to four weeks with the same zeal and focus,” he added.

“On availability of medicines it was shared that now there is no scarcity of essential medicines in the province and adequate stocks are available.

Published in Dawn, September 25th, 2023