Shortage of medical drugs hits Trinidad and Tobago
Janelle De Souza
The covid19 pandemic has caused shortages of medicines around the world, including TT, mainly due to the death and illness of employees and blockages affecting the supply chain.
Pharmacy Board Chairman Andrew Rahaman told Newsday on Sunday since the start of the pandemic in 2020 there have been issues shipping raw materials to manufacturers, factories closing or not operating at 100% and shipping delays in supplies.
He said that in TT there was a shortage of methylprednisolone, a steroid that relieves inflammation and is approved by the World Health Organization (WHO) for the treatment of covid19 along with a few other drugs.
He called on the government to get methylprednisolone. He said that although the alternative health system used another type of WHO-approved steroid, he believed that methylprednisolone was more effective.
“I want the best for our fellow citizens and methylprednisolone is the first line treatment. We may be using something that is WHO approved, but our mortality rate is high and increasing. I think it’s very possible that the lack of methylprednisolone is contributing to this because, just like antibiotics, one can work well for one person but not work at all for another.
Potassium chloride injections used to treat or prevent low levels of potassium in the blood are also rare in the country; injections of oxytocin, a hormone used to induce labour; Nimbex, a neuromuscular blocking agent used before general anesthesia in preparation for surgery; liquid prednisolone, a corticosteroid used to treat inflammation of joints and organs, as well as respiratory problems, cancer and severe allergies; and Actemra which is used to treat several inflammatory diseases including rheumatoid arthritis.
Rahaman added that for months there has been a shortage of adrenaline injection used for the emergency treatment of anaphylactic shock, but TT recently received a supply of EpiPens for adults. However, there was still a shortage of pediatric doses.
He said some countries were producing drugs but hoarding them for home use. He therefore called for government-to-government negotiations to take place as was done to procure vaccines against covid19.
In a virtual press conference on January 8, Health Minister Terrence Deyalsingh said the country has never lacked essential medicines for an extended period despite global supply chain issues.
“So at the public sector level, at this stage, because we monitor this literally on a daily basis when the emergency operations committee meets, which I chair and that is one of the issues and one of the reports that reach us. So right now, as things stand, there’s no major, long-term shortage of anything that’s needed to fight both covid and the normal healthcare system .
Medical Association President Dr Vishi Beharry acknowledged that the supply chain disruption has caused drug shortages.
“Vendors told me the problem started with a lack of access to US currency. But when the pandemic hit, even though the drugs were considered essential and measures were put in place to try to ensure continuity of service, there were a lot of little things along the way in different countries that would have impacted the global supply chain.
“There have been shutdowns across the world, from raw material levels to manufacturing to shipping and customs, that whole supply chain has been disrupted and it has affected the supply and delivery of medications.”
He said it affected all drugs, including a blood pressure drug called CoAprovel, as well as consumables in the country.
According to Beharry, there have been periodic shortages of morphine for some years. And, for the past few months, it has been available for use in hospitals but not for purchase by individuals or doctors. However, he said a supply has recently entered the country.
The pandemic has also affected the supply of reagents to carry out tests. As a result, doctors can’t do certain tests or have to select who they think needs the tests the most.
Aerobic and anaerobic blood culture bottles have also been missing for several months. He was informed that a doctor in the public health system had prescribed blood culture bottles and blood tubes for a family.
“This is a basic consumable required for blood tests in the hospital. For some reason there was a shortage of tubes and vials, so the doctor had to ask the family to buy it privately and bring it for them to do the testing for the relative.
Despite this, he pointed out that just because individuals cannot find a drug does not necessarily mean there is a shortage in the country. They may not search in every possible place, not all pharmacies carry certain drugs, and pharmacies in different parts of the country carry different drugs.
Beharry explained that the shortages have led to cost increases for most drugs, although less so for generic drugs, and affect the ability of the patient’s condition to be managed or for the patient to recover.
“If a patient is unable to get the medicine, they miss their doses. Over time, complications can develop and their conditions spiral out of control.
He said the stress of the pandemic on the health system has already affected the system’s ability to handle non-communicable diseases (NCDs) and other services as before.
While many regional health authorities have innovated and moved to telemedicine, it is not necessarily reaching all patients due to redeployment and turnover of staff to manage covid19 units and vaccinations.
A pharmacist in West Trinidad told Sunday Newsday that in general the Chronic Disease Assistance Program (CDAP) and covid19 treatments were “covered”.
“Sometimes there is a problem with shipping and clearing the goods, but eventually we get it. If nothing else they make sure we have everything to deal with this covid.
He said some drugs, especially cancer drugs, are very expensive and because customers don’t often ask for them, pharmacies simply don’t stock them. In addition, the allocation of drugs to pharmacies has been reduced, so that a pharmacy can order 24 boxes of a drug but only get six.
Currently, there is a shortage of Bisolvon liquid, which helps with pulmonary congestion, as well as its generic brands. He said that at one point his pharmacy had a limited stock which sold out in less than a day. And Buscopan is rare because, he was told, the cargo has been in port since October and has yet to clear customs.
Another reason for the apparent shortages, he said, is that the government owes money to several distribution companies. Even when companies win tenders, they don’t get paid for six months to a year. So some companies may have certain drugs, but don’t want to do business with the government.
Mainly due to the effects of the pandemic, shipping costs have increased and there has been a 4-11% increase in drug prices. And if a distribution company rushes shipments by air freight rather than sea freight, prices tend to rise more.
Due to temporary shortages, parallel or suitcase trade has also increased.
“There are a couple of things we can’t get from our wholesalers that we get from shadow traders. They get things in faster and it’s still cheaper than wholesale prices.
Cancer Society Clinic Director Sherma Mills-Serrette added that some companies that made certain drugs have gone out of business while some brands have been discontinued due to manufacturing issues.
However, she said, while these issues can lead to shortages of certain drug brands, there is no shortage of the drugs themselves as there are always alternatives available.
“It’s best to have a conversation with your oncologist or treatment team and they’ll help you find the right drug for you or even help you source a certain brand privately through the appropriate channels.”