Life-saving AIDS medicine out of stock in Gauteng

Cryptococcal meningitis is a large cause of death for people with HIV in South Africa. Amphotericin B is an essential medicine for treating this illness.

Yet, there’s no shortage of the drug in South Africa. Activists researching the stockouts say that dysfunction and tardiness at the province’s drug depot is to blame.

Between 13 November and 5 December the Stop Stockouts Project (SSP), a consortium which monitors essential medicines in South Africa, heard from five major Gauteng hospitals that stocks of amphotericin B had run out. These were Johannesburg’s Chris Hani Baragwanath, Helen Joseph and Charlotte Maxeke Hospitals; Krugersdorp’s Leratong Hospital and Pretoria’s Dr George Mukari Hospital.

Although stocks at these facilities have now been replenished, staff at Zola Jabulani Hospital in Soweto warned on Monday that they only had three days worth of the drug left. If the drug is not restocked by Thursday, the hospital would be forced to put patients on sub-optimal treatment.

“This is such a fundamental drug, it staggers me that running out of it is regarded so casually. The number of fatalities that could result is both unacceptable and unnecessary,” a Gauteng doctor, who wished to remain anonymous, said.

SSP this week called on Gauteng Health MEC Qedani Mahlangu to intervene to rectify drug stock outs which are being experienced in clinics and hospitals across the province. Many of the stocked out medications —53 of them according to SSP— are crucial in the treatment of HIV, tuberculosis (TB), and mental health.

An SSP investigation has found that requests for new stocks of amphotericin B had not been properly processed at the Gauteng Department of Health’s central depot in Auckland Park, Johannesburg.

Amphotericin B is supplied to the public health sector by the multi-national pharmaceutical company Bristol-Myers Squibb (BMS). In 2013 BMS, which has offices in South Africa, refused to renew its contract for supplying the drug to the national Department of Health. Melinda Scoones, the company’s distribution analyst, says that this was because the company could not assure that it would be able to meet the supply volumes requested for via the Department’s tender.

The company’s refusal to renew its supply contract comes after the Treatment Action Campaign (TAC) blamed BMS’s “inefficiency” for resulting in a 2011 stockout of the drug and accused it of “putting lives at risk”.

Since 2013, the drug has therefore only been available for purchase by provincial health departments on a “buy-out” basis - which is subject to a lengthy supply chain process for each new order. This means that provincial depots, like the one in Auckland Park, need to aggregate and sign off on requests for the drug from individual hospitals and order the needed supplies of amphotericin B from BMS. By contrast, contracted medicines are kept in bulk storage at the depot ready for distribution when needed.

“We want to make the assurance that there is no current shortage of the drug amphotericin B available for purchase by the government,” said Scoones.

“This is a perpetual problem. Often [hospital managers] come to BMS asking about supplies and our staff have to track the original requests which are often found to be at the depot awaiting approval and sign-off. It is frustrating to our business, not to mention to hospital staff and their patients.”

An investigation confirmed that the central financial officer had not signed off on the depot’s order for 2,900 amphotericin B vials - retarding the procurement process and resulting in the stockouts, said SSP project manager Bella Hwang.

“We have not been able to establish the reason for the delay,” added Hwang.

According to the Treatment Action Campaign’s Mark Heywood (also director of SECTION27), “Last week a doctor at Chris Hani Baragwanath hospital reported to us drug shortages of anti-pshychotics, anti-depression and several antiretrovirals. He was unable to discharge patients without medicines. We reported it immediately to a senior official in the Ministry of Health. Several hours later he called back and said that the head of the hospital says there are no drug shortages! We then contacted the doctor who sent us eight photographs of empty shelves in the pharmacy. We sent these on to the ministry, but heard nothing further.”

GroundUp’s queries and phone calls to the MEC’s spokesman, Prince Hamnca, also went unanswered.