KARACHI: A recent study has found that life-saving antifungal medicines are either unavailable or unaffordable in many countries, including Pakistan.

Titled ‘Global access to antifungal therapy and its variable cost’and published in the Journal of Antimicrobial Chemotherapy, the study is based on results of the largest survey conducted by the Global Action Fund for Fungal Infections (GAFFI) spanning 159 countries.

Fungal infections attack the skin, hair or nails, can cause serious infections in the lungs and may spread throughout the body and, without the necessary drugs to fight back, claim the lives of over 3,500 people every day, it says.

According to the research, the world is in the grip of a global crisis that kills the equivalent of the populations of Philadelphia, Kampala or Prague — around 1.6 million each year.

The report says that one of the critical drugs for fungal meningitis in AIDS — amphotericin B — is not available in 42 countries. The other key drug, flucytosine, is unavailable in at least 95 countries. Yet both have been available in Europe and the US for over 40 years.

The World Health Organization recommends that they be used together to bring down mortality from 100 to 25 per cent.

“The 25-year-old drug fluconazole is available in all countries and itraconazole is unavailable in just five countries. However, being available is not enough; price also matters as patients pay for their care in many countries.

“The daily cost of fluconazole varied from $1 to $31, and itraconazole from $1 to $102. In South Africa, which has the largest AIDS burden in the world and a massive TB problem, itraconazole costs about £11.60 per day — unaffordable for most people there,” it says.

“It is doubly tragic that though these antifungal medicines have been used since the late 1950s, the systems for delivering these drugs to the most needy are still not in place,” says professor David Denning of the University of Manchester, president of GAFFI and the paper’s lead author.

“Hundreds of millions of people cannot access the optimal therapy for fungal meningitis and fungal lung infections,” he added.

According to him, last year GAFFI called on governments to provide fungal diagnostics and antifungal drugs to all their citizens yet there has been a deafening silence.

“There is clearly a long way to go, but the tragedy is that every day thousands of people die needlessly while the world turns a blind eye.”

Associate Professor of Pathology and Laboratory Medicine at the Aga Khan University and Pakistan ambassador for GAFFI, Dr Kauser Jabeen said that it was becoming increasingly difficult to treat fungal infections in Pakistan as life-saving and safer antifungal medicines were either not available, available in limited amounts, or expensive and unaffordable.

“In Pakistan, a nationwide population-based survey of fungal infections has never been carried out and so the public health burden they represent is unknown. Only limited data is available from laboratory and hospital-based reports.

“Yet the population is at high risk from life-threatening fungal infections that are a consequence of other health problems such tuberculosis, diabetes, chronic respiratory diseases, asthma, cancer, organ transplant and HIV,” she pointed out.

Published in Dawn, August 12th, 2016

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