Problems with drug supply of antiretrovirals have come to the surface in both Nigeria and South Africa in the past few weeks as the realities of implementing large-scale treatment access begin to hit home.
In South Africa the Treatment Action Campaign (TAC) today issued a warning that supplies of the paediatric formulation of efavirenz (Stocrin) are running out in South Africa, with no stock guaranteed to be brought into the country by the drug’s manufacturer, Merck Sharp and Dohme (MSD), before January 28. TAC claims that one patient has already had to interrupt treatment as a result of the drug `stock out`, and highlights the risk of resistance that may arise if efavirenz treatment is interrupted without planning.
In a letter to MSD’s South African affiliate, TAC chairperson Zackie Achmat today accused the company of abuse of its patent rights. "Failure to meet market demand of a life-saving medicine constitutes patent abuse and is a well recognised ground under South African patent law for the granting of compulsory licences", he warned.
"This unacceptable situation points to the need for multiple suppliers of essential medicines”, he argues. “With more providers there will be less likelihood of all companies running out of stock. Competition will also ensure that companies are more careful about monitoring their stock."
In Nigeria, drug supply problems have arisen as a result of delay in processing of a $70 million grant from the Global Fund to Fight AIDS TB and Malaria. According to the advocacy group Journalists Against AIDS, patients are being asked to take medicines which are now beyond their expiry dates because the Nigerian government does not have the funds to buy new drug stocks yet.
The Network of People Living with HIV in Nigeria has also reported frequent problems of drug supply interruption at treatment centres throughout the country, and in a statement issued on January 6 2004 demanded that no drugs with a shelf life of less than one year should be procured.
According to Plus News the Nigerian Ministry of Health purchased one year’s supply of antiretrovirals when the programme began, which is now exhausted, and by August 2003 patients were receiving drugs due to expire in October 2003.
The development of supply chain management and logistics information systems has been emphasized by the World Health Organisation as a key component in scaling up antiretroviral therapy in resource-limited settings.
Further information on supply chain management
JSI Deliver – information on supply chain management
Powerpoint presentation on ARV supply chain management issues in Kenya, from WHO workshop on Strategic Information for Anti-Retroviral Therapy Programmes, July 2003.