Paediatric Cancer Drug Stock Outs Threatening Lives in South Africa
From the Eastern Cape to Limpopo, medicine shortages continue to be reported at hospitals and clinics throughout South Africa, and this often includes a shortage of medications required to treat Childhood Cancers.
As recently as August, Charlotte Maxeke Johannesburg Academic Hospital and Pretoria’s Steve Biko Academic Hospital were just two facilities facing drug stock-outs.
As multiple drug suppliers are failing to keep up with demand, doctors are left scrambling to treat children with what they have and it may not always be the best course for kids (Reuters)
One of the drug shortage, for instance, was the drug leucovorin used to treat childhood leukaemias and lymphomas (cancer of immune cells called lymphocytes). The drug is one of several cancer treatments that the health department has confirmed were in short supply nationally – largely because of supplier problems, according to department deputy director general for regulation and compliance Anban Pillay.
Pillay says Teva Pharmaceuticals, which supplies the government with leucovorin, was unable to meet demand for the drug following manufacturing problems at its factory.
Head of paediatric haematology and oncology at Charlotte Maxeke Hospital, Janet Poole, said her department was only informed of the shortage once it had already begun to affect patients.
“The company only sent out a letter when there was nothing,” she said, “they have done nothing to alleviate the problem and, as far as I am concerned, have had no communications with doctors.”
Teva Pharmaceuticals did not respond to requests for comment at the time.
South Africa’s national drug regulator, the Medicines Control Council, granted permission for an unregistered alternative to leucovorin to be imported to meet public sector demand until supply stabilises.
The Medicines Control Council took similar measures on a per-patient basis to provide adult and paediatric cancer patients with the generic version of dexamethasone. Used to treat leukaemia as well as terminal brain tumours, brand name dexamethasone is no longer available after patent holder Merck & Company discontinued production.
No generics of the drug are registered for use in South Africa. It can take up to four years to register a new drug in South Africa due to Medicines Control Council delays, according to a 2016 South African Medical Journal article.
Poole says the council has been slow to respond to special requests for access to dexamethasone.
As failed batches of the leukaemia drug cytarabine and unexpected demand for other cancer drugs mesna and cisplatin continue to fuel stock-outs, the health department is looking to contract more suppliers.
In the meantime, oncologists and patient groups had to scramble. Oncologist William Stevens* had just diagnosed a young boy with Hodgkin’s Lymphoma, a type of blood cancer. Stevens can treat the boy, but drug shortages mean his young patient isn’t getting the best care.
“I can’t use my usual treatment protocol because I don’t have [the drug] procarbazine,” says Stevens who works in the public and private sectors.
“We now have to put him on chemotherapy, which is more toxic to the heart. On a personal level, that is difficult because we’re putting him more at risk [of complications].”
Children with Cancer are already embroiled in a fight for their lives that they do not deserve, and the potential of not curing the child (given treatment interruptions) could actually cost them their lives when they could have been cured. This is unacceptable!!
Andy Gray, a pharmacist and senior lecturer at the Department of Therapeutics and Medicines Management at the University of KwaZulu-Natal’s School of Medicine says that stock-outs can be caused by a range of factors,but added that what is needed to help solve drug stock outs is better – and more transparent – information about drug shortages. As a country, this will mean letting go of the sensitivity that surrounds stock out information
“There are a number of overlapping potential causes (of stock-outs), but not a lot of clear and transparent information about real causes,” he says. “(South Africa) could do more to gather and disseminate accurate information about the causes, mitigation and resolution of shortages.”
“We saw an attempt to do so, but then a political backlash,” he added. “We need to get over that sensitivity.”
My question is how is this allowed to happen and would changing the patent laws governing medications for diseases such as cancer so that generic medications could be used not stop these shortages from occurring? Surely if we were to use generic medications hospitals could afford to purchase a bigger stock of the drug so that they would have sufficient on hand should there be any supply problems?
The Stop Stock Outs Project
MSF, the RHAP, RuDASA, SA HIV Clinician’s Society, SECTION27 and the TAC have launched a national Stop Stock Outs Project (SSP) to assist the thousands of health care users whose lives remain threatened by the chronic plague of essential medication stock outs.
The Stop Stock Outs Project will crowdsource stock out reports from patients, healthcare workers and sentinel surveyors, mapping the reported cases and tracking specific issues. All reports will be escalated through the supply chain and resolution sought through the direct engagement of civil society with accountable government individuals and entities.
It is the hope of the Stop Stock Outs Project that the data from the reports will provide essential information to identify and understand the root causes of stock outs and shortages and bring visibility and transparency to a struggling health system.
The Stop Stock Outs Project is calling on patients and healthcare workers to report any medication stock outs or shortages that have resulted in patients’ treatment being changed, patients being turned away from their clinic and referred elsewhere and/or being given an insufficient supply of medication.
1. Report Stock Outs and Shortages
2. Help Monitor Stock Outs at Your Facility
For all clinicians and patients who would like to report regularly, sign up to be a sentinel surveyor by going to: stockouts.co.za/surveyor
OR for Mobile Browsers: surveyor.questionpro.com. We will SMS or email you on a monthly basis and ask you to report on any stock outs or shortages in the health facilities that you access
Posted on 18 October, 2016, in Blog and tagged cancer, cancer treatment, Child Cancer Awareness, childhood cancer, Children with Cancer, Fighting Cancer, Little Fighters Cancer Trust, paediatric cancer, Pediatric cancer, south africa. Bookmark the permalink. Leave a comment.