The covid19 pandemic has caused drug shortages around the world, including Trinidad and Tobago, mostly due to the death and illness of employees and lockdowns affecting the supply chain.
President of the Pharmacy Board Andrew Rahaman told Sunday Newsday since the beginning of the pandemic in 2020, there have been problems with the shipping of raw materials to manufacturers, factories closing or not operating at 100 per cent, and shipping delays in supplies.
He said in TT there is a shortage of methylprednisolone, a steroid that relieves inflammation and is approved by the World Health Organization (WHO) for the treatment of covid19, as well as a few other drugs.
He called on the government to obtain methylprednisolone. He said although the parallel health care system was using another type of WHO-approved steroid, he believed methylprednisolone was more effective.
“I want what is best for our citizens and methylprednisolone is the first-line treatment. We may be using something that is WHO-approved but our death rate is high and increasing. I think it is very possible that the lack of methylprednisolone is contributing to it because, just like antibiotics, one might work well for one person but may not work at all for another.”
Also scarce in the country are potassium chloride injections used to treat or prevent low amounts of potassium in the blood; oxytocin injections, a hormone used to induce labour; Nimbex, a neuromuscular blocking agent used before general anaesthesia in preparation for surgery; liquid prednisolone, a corticosteroid used to treat inflammation of joints and organs, as well as breathing problems, cancer, and severe allergies; and Actemra, which is used to treat multiple inflammatory diseases, including rheumatoid arthritis.
Rahaman added that for months there was a shortage of adrenaline injection used for emergency treatment of anaphylactic shock but TT recently received a supply of EpiPens for adults. However, there was still a shortage of paediatric doses.
He said some countries are producing drugs but are hoarding hem for domestic use. He therefore asked for government-to-government negotiations to take place as was done to procure covid19 vaccines.
At a virtual press conference on January 8, Health Minister Terrence Deyalsingh said the country has never run out of any critical medication for an extended period despite global supply-chain issues.
“So at the public-sector level, at this point, 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 come to us. So right now, as it stands, there are no major, long-term shortages of anything needed to fight both covid and for the normal health care system.”
President of the Medical Association Dr Vishi Beharry agreed the disruption in the supply chain has caused drug shortages.
“Suppliers have told me the issue started with a lack of access to US currency. But when the pandemic hit, even though the medication was considered essential and there were things put in place to try to ensure that service continued, there were lots of little things along the way in different countries that would have impacted the global supply chain.
“There were shutdowns across the world from the levels of raw materials to manufacturing to shipping and customs, that entire supply chain was disrupted and that affected the supply and delivery of medication.”
He said it affected all drugs, including a hypertension drug called CoAprovel, as well as consumables in the country.
Beharry said there have been periodic morphine shortages 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 recently came into the country.
The pandemic has also affected the supply of reagents to run tests. As a result, doctors either cannot do certain tests or have to select who they believe needs the tests most.
Aerobic and anaerobic blood culture bottles have also been in short supply for several months. He was informed about a doctor in the public health system giving a prescription to a family for blood culture bottles and blood tubes.
“This is a basic consumable that is required for blood testing in the hospital. For whatever reason, there was a shortage of the tubes and the bottles so the doctor had to get the family to purchase it privately and bring it for them to do the testing for the relative.”
Despite that, he stressed that just because individuals may not find a drug does not necessarily mean there is a shortage in the country. They may not look in all the possible locations, not all pharmacies carry certain drugs, and pharmacies in different areas carry different drugs.
Beharry explained that shortages have caused cost increases for most medications, although less so for generic drugs, and affect the ability to manage the patient’s condition or for the patient to recover.
“If a patient is unable to get the medication then they miss their doses. As time goes on, complications may develop and their conditions become out of control.”
He said the stress of the pandemic on the health care system has already affected its ability to manage 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 every single patient because of redeployment and rotation of staff to manage covid19 units and vaccinations.
One pharmacist in west Trinidad told Sunday Newsday that, in general, the Chronic Disease Assistance Programme (CDAP) and covid19 treatments were “covered.”
“Occasionally there is an issue with shipping and clearing of goods but eventually we get them. If nothing else, they are making sure we have everything to treat this covid.”
He said some drugs, especially cancer drugs, are very expensive and since customers do not often ask for them, pharmacies simply do not stock them. Also, the allocation of medicines to pharmacies has been cut so a pharmacy may order 24 boxes of a drug but only get six.
At the moment there is a shortage of Bisolvon liquid, which helps with lung congestion, as well as its generic brands. He said at one point his pharmacy got a limited stock that sold out in less than a day. And Buscopan is scarce because, he was told, the shipment has been on the port since October and is yet to be cleared.
Another reason for apparent shortages, he said, was that the government owes money to several distribution companies. Even when companies win tenders, they do not get paid for six months to a year. So some companies may have certain drugs, but do not want to do business with the government.
Mainly because of the effects of the pandemic, shipping charges have increased and there has been a four-11 per cent increase in the prices of medication. And if a distribution company rushes its shipping by air freight rather than sea, the prices tend to increase further.
As a result of temporary shortages, parallel or suitcase trade also increased.
“There are one or two things we can’t get from our wholesale suppliers that we are getting from parallel traders. They are getting things in faster and it’s still cheaper than the wholesale prices.”
Cancer Society clinic manager Sherma Mills-Serrette added that some companies that manufactured certain drugs went out of business, while some brands were discontinued because of manufacturing issues.
However, she said while those issues may result in shortages of certain brands of medicines, there is no shortage of the medication itself as there are always alternatives available.
“It’s best to have a conversation with your oncologist or your treatment team and they will help find the right drug for you or even help get a certain brand to you privately through the proper channels.”