COVID-19 Access to medicine
ACCESS to medicine in a modern world is a human rights issue. But drug shortages in hospitals have been an ongoing problem in Fiji and a reality for Small Island Developing States of the Pacific for many years.
Part of the challenge is the size and geographical location of our islands, incapacity in our local drug administration and management systems, as well as our purchasing power in comparison to larger pharmaceutical consumers of the world.
If not effectively addressed, the periodic drug shortage we face now can become perennial.
We must first recognise that even large hospitals of the western world may, from time to time face a number of shortages, both new and ongoing.
However, this does not mean that every drug shortfall should be justified or we must accept our chronic shortages as a public health service norm and just sweep things under the carpet.
It simply means that as an issue, it must be identified and those in positions of authority must take responsibility and demonstrate a commitment to addressing it.
The World Health Organization (WHO) agrees that drug shortage has been increasing and has become a complex global problem afflicting high, middle and low-income countries like those in the Pacific.
But now we have an unforeseen problem of unimaginable magnitude at hand — the coronavirus (COVID-19), which only until this week, has been declared a pandemic and is quickly spreading across the globe.
Since February, public health experts from bigger economies of the world have kept a close tab on the development of COVID-19 to, among other things see, whether massive factory shutdown and shipping challenges in China would cause a major shortfall in drugs and medicines.
It must be noted that China is a key world supplier of raw ingredients needed in the manufacture of common drugs like antibiotics and painkillers. It is the world’s biggest exporter of pharmaceutical products.
Many Chinese factories have closed as a result of the COVID-19 outbreak, with millions of citizens ordered to remain at home as towns and citizens remain on lockdown mode.
While many plants have reopened, experts in the drug supply chain say those opened are operating at reduced capacity and severely interrupted by irregular shipping movement.
On Thursday, US Food and Drug Administration Commissioner Stephen Hahn released a statement announcing the first drug shortage related to the COVID-19 epidemic—but stopped short of saying what drug it was.
If that announcement is something to go by, then in Fiji, any shortage could greatly impact public health and patient care, especially so because drug supply problem has been an ongoing issue for many years.
Without sounding like an alarmist, our public health officials should be on their toes and strategising over this concern.
In an interview this week with retired Fiji National University Professor of Surgery Eddie McCaig said Fiji’s hospital drug shortage was serious.
“In the last few weeks, in one of the major hospitals, which I won’t name, 67 per cent of essential drugs were out of stock,” Dr McCaig said.
“I would say 40 to 60 per cent of drugs are out of stock in the country. In the laboratories, 40 to 60 per cent of reagents are out of stock so it’s not unusual for us to be treating diabetes, when we don’t have the main drug. So we have a big problem with drugs.”
Now that our regular drug shortages could exacerbate due to COVID-19, especially so if it persists, authorities must ensure that transparency forms an integral part of their communication strategy from now on.
There should be a clear flow of information between our Fiji Pharmaceuticals and Biomedical Services Centre and professionals at the public health headquarters to allow clinicians in hospitals to make patient care plans in advance of a chronic shortage.
There also needs to be conversation with hospital and private pharmacists. The media needs to be kept in the loop for any major plans and implementation activity.
Also, a major civic education campaign could help in allaying fears, building the public’s trust in authorities and line departments, equip citizens with information they need to know in regards to the disease and provide regular media alerts on how to take care of their health and observe necessary precaution.
Best practices should be established for accessing widely used and critical drugs.
This will be helpful in the event of a shortage and will also reduce waste and in turn help to prevent shortage situations.
Alternative suppliers must be pursued to supply any shortfall.
While we are still to record our first COVID-19 patient and yet to experience the impacts of the pandemic like other countries have, as the disease continues its rage across the globe, it will certainly expose the weakness we have in our drug management and health care system.
Hopefully, this will trigger among stakeholders debates around how to deal with drug shortages, or rather how to best avoid them in the future.
“What we need to do is to have experts intensively discuss the problem we have and the way forward. We also need someone to be forthright about the problem, to take responsibility and say yes it is serious and this we’ll need to do,” Dr McCaig said.
“But as health professionals we do our best to help patients all the time and at the end of the day all hospital staff does an outstanding job. Miracles are happening under these almost impossible conditions.”
At home, in the office and other places of gathering, ensure you practice hygiene at all times so that you avoid falling ill. Keep your surroundings clean, drinks lots of water, eat healthy and keep fit.
Until next week, stay safe, stay blessed and stay healthy!