KARACHI: Tuberculosis (TB) patients across the country continue to suffer from an acute shortage of drugs in the market as the row over prices is yet to be resolved by the federal government, sources told Dawn on Saturday.

They said the government had been sitting on a proposal to settle the pricing of these medicines for the past two months.

Speaking to Dawn, medical professionals representing various hospitals regretted what they described as official apathy towards public health and said that the anti-TB drug shortage, prevalent for the past six months, had been causing immeasurable suffering to patients.

They also rejected claims by the Drug Regulatory Authority of Pakistan (Drap) that anti-TB drugs were available at selected pharmacies in the country.

“If a major hospital such as the Aga Khan University Hospital can’t get individual anti-TB drugs despite its best efforts, how can patients get them?” said Dr Javaid A. Khan, a professor of medicine and consultant physician at the AKUH.

Patients, he said, daily reported at the hospital with complaints that they couldn’t find the relevant medicines anywhere and asked for alternative drugs.

“But, we don’t have any alternative medicine to suggest,” he said.

Dr Khan had taken the case to the Human Rights Cell of the Supreme Court, where he produced certificates from pharmacies of four hospitals around the country, verifying that they couldn’t get individual anti-TB drugs from any source. The case is still pending.

According to experts, TB is normally treated with a fixed-dose combination (a four-drug formulation). Complicated cases, however, require individual drugs and the disease cannot be treated without their support.

“Not being able to get individual drugs either is also an enormous problem. If a patient gets an allergic reaction to the fixed-dose combination (FDC) like rash or hepatitis, the next step is to stop FDC and let the liver recover. Each drug is then individually added every week to see his/her tolerability,” observed Dr Naseem Salahuddin, senior expert on infectious diseases currently associated with the Indus Hospital.

The country, she said, had run out of anti-TB drugs for the past six months or so, and the authorities seemed to be totally unconcerned.

“We have approached the director general health and the ministry of health, however, no one seems to be moved by this problem of profound concern,” she said.

Tuberculosis is a serious public health issue and the situation might lead to multi-drug resistance tuberculosis (MDR-TB) that can spread beyond control, she warned.

According to experts, the main causes of MDR-TB are poor patient management, non-adherence to the prescribed regimen, and a poor national programme, or a combination of these three. The treatment is costly, difficult and painful because the disease develops when germs become resistant to treatment with at least two of the most powerful first-line anti-TB drugs.

Agreeing with the view that the country faces an acute shortage of anti-TB drugs, Qaiser Waheed representing the Pakistan Pharmaceutical Manufacturers Association, said though drug manufacturing was a noble profession, companies in this industry were not charity organisations.

“The government has to rationalise prices of these medicines and other drugs to ensure their availability in the market. A number of companies have stopped manufacturing anti-TB drugs mainly because the government didn’t take notice of their applications [for drug price increase] which had been pending for many years,” he argued.

He also called upon the government to change its approach towards pharmaceutical companies and control prices of only WHO-listed essential drugs.

Upon contact, Drap chief executive officer Dr Mohammad Aslam admitted that anti-TB drugs were in shortage all over the country but insisted that these medicines were being sold at a few selected shops in all major cities of the country.

“The matter is pending with the government to whom we have forwarded a proposal to settle the row over their prices for good,” he said.

Published in Dawn, June 26th, 2016