KARACHI, Feb 5: The Sindh lawmakers apparently did not do adequate homework and consultations with stakeholders before passing the bill on auto-disable syringes recently as representatives of medical practitioners and drug traders have expressed reservations over the government move.In principle, they agreed with the need for the auto-disable syringes that ensured a single-time use of a syringe, but contended that the government should have attended to stakeholders' concerns before bringing about the change in prevalent medical practices.
Their major concerns were related to the cost of the new syringes, technical problems in their use and the failure of the government to create awareness about the new medical device and giving enough time to syringe manufacturers to switch to the new mode of syringes before the bill was passed.
Some of them also raised suspicions about the government intentions and said the decision made in haste would benefit the sole manufacturer of auto-disable syringes in the country.
No consultation was carried out with the Pakistan Medical Association (PMA) and the Pakistan Islamic Medical Association (Pima), two prominent bodies representing the medial fraternity.
'No market for auto-disable syringes' The Sindh Assembly unanimously passed a bill — Sindh Regulation and Control of Disposable Syringes Act, 2010 — on Jan 11 to prohibit the manufacture, sale and use of disposable syringes other than the 'auto-lock, auto-destruct or auto-break' variety.
It imposes imprisonment for a term, which may extend to two years, or with a fine, which may extend to Rs500,000, or with both for a person who contravenes its provisions.
The term of punishment may extend to three years and the amount of the fine may extend to one million rupees provided that a person is again convicted for the offence.
The rationale given for introducing new syringes was to control the spread of communicable diseases, including acquired immune deficiency syndrome and hepatitis.
The bill contains a clause that could seriously hamper its effective implementation. It says no court shall take cognizance of an offence under the act except upon a complaint in writing made by the secretary for health or any other officer authorised by him on his behalf in the prescribed manner.
The offence punishable under the act shall be non-bailable and would be tried under the provisions of the code of criminal procedure, 1898 by a judicial magistrate.
A random survey of pharmacies around major public sector hospitals and conversations with wholesalers revealed that currently there was no market for auto-disable syringes and hence shopkeepers didn't have any stocks of the medical device. Most of them had never heard of the special type of syringes.
According to the representatives of major public and private health facilities, there is no use of auto-disable syringes at their hospitals and no government instructions have yet been received to shift to other type of syringes.
The disposable syringes currently being used in medical procedures are disabled with the help of cutters after use, collected in special boxes and later incinerated, they said.
In the absence of any strict regulatory mechanism by the government, however, syringes are often used multiple times and large quantities of syringes also end up at garbage dumps, and are recycled.
Some pharmacists say auto-disable syringes are only used in government health programmes and are bought through tenders.
Concerns over law Talking to , representatives of the PMA and PIMA said that though they agreed that there was an immediate need for a mechanism to discourage the reuse of syringes, the government should have allayed stakeholders' concerns, which, they said, could be raised at a later stage.
“Though the government move would benefit the common man suffering due to the fast spread of deadly infections, it would have been appropriate if stakeholders were consulted. In fact, representatives of the common man should also be part of consultative meetings so their interests could be safeguarded,” said Prof Dr Idrees Adhi, heading the PMA Karachi chapter and practising at the Civil Hospital Karachi.
Sharing his concerns, Salman Ghauri, Karachi president of PIMA, said the cost of auto-disable disposable syringes was higher than the other disposable syringes and the government should have made the entire process transparent by giving enough time to manufacturers to shift to the other mode of syringes.
“The availability of new syringes should have been ensured in adequate quantities and at the minimal price before the passage of the bill,” he remarked.
Expressing suspicions at government motives, Dr Iqbal Soomro, chairman of the Pakistan Chemist and Drugs Association, said the government had done no homework and it seemed that the attempt was aimed at benefiting a party in Islamabad who was the sole manufacturer of such syringes in the country.
Citing flaws in the law, he said that the bill made no mention of insulin patients who were allowed by the World Health Association to use a single syringe more than one time.
“It also makes no mention of syringe use by veterinarians. It says that no law currently exists to regulate manufacture and sale of syringes. But, in fact, the federal government has already included syringes in the drug act last year and has also started the process to register manufacturing units,” he said, adding that the current mode of auto-disable syringes could only take limited quantities of drugs. Dawn
Replying to 's queries, Dr Sagheer Ahmed, provincial health minister, said that stakeholders were consulted and sufficient time was available to manufacturers to convert their plants for production of auto-destruct syringes as the draft bill on syringes was approved by the cabinet in August 2009 and it was approved by the assembly this year.
“And more time is available as the bill would become act after the signing by the governor. The bill was the need of the hour as the common man's health was being compromised due to the reuse of disposable syringes.
“The draft bill was consulted at the federal level by former director-general for health Dr Rasheed Jooma. Rules of business for implementing the act will be formed in due course of time and all stakeholders will again be taken on board.”
The health minister claimed that the syringes were available in the market and being used in the hepatitis control and prevention programme.
“When the demand for auto-lock, auto-destruct and auto-break syringes would increase and more competitors would arrive in the market, the prices of such syringes would automatically fall.
As for diabetic patients, he said they would be allowed to continue to use disposable syringes, and the health department was open to recommendations.