By Shreya Shah and Krishna Pokharel
Tuberculosis patients and activists protested outside the federal health ministry in New Delhi Wednesday, angered at a shortage of life-saving medicines in government clinics.
“We are here today to demand answers,” 42-year-old Cassius Singh, one of the TB patients at the protest, said.
There was ample warning that a shortage of TB drugs was looming.
A five-year grant from the British government to provide TB drugs through the Stop TB Partnership’s global drug-procurement facility expired in 2011.
Instead of immediately soliciting bids from companies to replace the supply of drugs, a lengthy process the Indian government delayed, an official close to the Central TB Division told The Wall Street Journal earlier this month. The Central TB Division manages the distribution of the medicines throughout India.
More than 1.5 million people currently receive free drugs at 13,000 Indian government centers nationwide.
“When stocks of TB drugs run out, unplanned treatment interruptions lead to increased risk of drug resistant TB, treatment failure, and death,” health activists participating in the protest said in a memorandum that they gave to the ministry. “A continuous, sustainable supply of quality-assured medicines is vital for TB patients to have even half a chance of being cured,” the memorandum said.
Tuberculosis kills more than 300,000 people in India every year.
Blessina Kumar, a health activist and vice-chair for Geneva-based Stop TB Partnership led the protest Wednesday. She said that she wrote to the health ministry several times in the last one year warning about a looming drug shortage, but they “have been unwilling or unable to arrange the timely procurement of TB drugs.”
Ministry officials told protesters that they are “responding to the crisis,” according to Ms. Kumar, who attended the meeting. Niraj Kulshrestha, a senior official at the Central TB Division, spoke to activists and said all their questions were answered regarding the government’s procurement of drugs.
Since January this year, pediatric drugs for tuberculosis have been in short supply in many Indian states, according to TB officials.
Earlier this year, 3-year-old Reshma Khan was turned away from a government clinic in Mumbai, because they were out of children’s doses of TB medication, her family and a government TB worker familiar with her case said. Reshma, with lymph node TB, weighed only 18 pounds when her parents took her to the clinic.
The family is treating the child with drugs they purchase from a private pharmacy. They pay around 900 rupees ($15) a month for the medicines. Drugs from government clinics are free.
In India, states rely on the central government to supply TB medication. TB medicines are procured by the federal government, and then are distributed to states.
Government TB officers in several state and local programs say they began experiencing shortages of streptomycin, a TB drug, late last year. By January, some state and local officials say, they were also short of low dose rifampicin, a more powerful TB drug.
Anshu Prakash, the joint secretary at the Ministry of Health & Family Welfare, which oversees the Central TB Division, told The Wall Street Journal earlier this month that India had solved the shortages of adult dosages by letting states purchase the medicines themselves from private suppliers. The central government makes purchases on an emergency basis.
But the states could not buy the children’s medicines, according to another government TB official who refused to be identified, because private suppliers offer mainly daily dosages that differ from the government’s treatment plan, which is designed around alternate-day dosages.
Mr. Kulshrestha, of the Central TB Division, said the government placed orders for pediatric medicines earlier this month, and that the medicines will reach clinics by the first week of July. They are also seeking to manage shortages by sending medicines from districts with excess stock to those that had run out.
“Pediatric medicines were hit very badly, but we sorted it out now,” he said.
H. H. Chavan, the state TB officer in the western Indian state of Maharashtra said that his state will not be able to provide all children in the state with TB medicines if drugs aren’t sent to them by the end of this month.
“We will be in a crisis,” he said.
He says Maharashtra is now trying to procure these medicines at the state level to ensure that children get medicines.
To combat the shortage of pediatric TB medicines in the western Indian state of Gujarat, medical staff break up adult dosages and give them to children, according to Pradip Patel, head of TB drug distribution. “There is some difficulty in this because there are chances of increase and decrease in doses,” he says. The WHO warns that low dosages could lead to drug resistance in patients.
Kanamycin, a drug meant for patients with drug resistance are also in short supply.
“There are enough medicines for patients till September, but there are no medicines in the buffer stock.” they usually keep, Mr. Patel said.
Dr. Kulshrestha said the medicine will reach clinics by the first week of July.