The aftershocks of COVID-19’s stranglehold on the global supply chain are affecting the availability of some essential medicines in South Africa, with medical associations and pharmaceutical organisations concerned about the low supply of morphine powder and other medicines countrywide.
Jackie Maimim, CEO of the Independent Community Pharmacy Association (ICPA), said medicines for everything from anxiety to menopausal symptoms to inoperable breast cancer were in short supply.
They include:
• Morphine powder and ampoules used in palliative care for cancer and terminally ill patients;
• Irbesartan used to treat high blood pressure, heart failure and diabetic kidney disease;
• Provera tablets to treat abnormal uterine bleeding and restore the normal menstrual cycle;
• Depo-Testosterone for impotence delayed puberty in males and inoperable breast cancer in women;
• Denetrin and Halcion for anxiety; and
• Zithromax paediatric suspension, which is an antibiotic.
In a press statement, the DA said according to reports, there was a shortage of 150 essential medications. MedicalBrief reports that the party has submitted written parliamentary questions to Health Minister Dr Joe Phaahla regarding the complete unavailability of yellow fever vaccine stock in South Africa, as well as a host of other medical supplies, it said.
“At least 80% of our raw materials come from China and India,” Maimim told Health-e News. “Any slowdown in their production has a knock-on effect on us. We managed these shortages throughout the pandemic and continue monitoring them but it will take some time for production to catch up and distribution to normalise.”
Pharmacies under pressure for alternative medicines
“This may be a generic substitution, or if a particular medicine is out of stock across all suppliers, then we contact the prescriber and get a therapeutic substitution, which is a different medicine that does the same job, e.g. lowers blood pressure,” she said. Generic substitute medication rarely caused adverse events but some, like anti-epileptics, blood thinners and certain heart medicines, needed close monitoring.
“Therapeutic alternatives are more challenging and considered only when there is an option. The patient must be monitored and stabilised, as adverse effects are possible.”
Essential medicine shortage impacts palliative care
ICPA said the shortage of end-of-life drugs was concerning. Morphine powder alternatives were expensive, burdening the patient and their families, yet even these alternatives are in short supply. Morphine powder is crucial during palliative care for cancer and terminally ill patients.
“Ampoules and tablets are alternatives. But now the amps are out of stock, and tablets are not also viable because many very ill patients cannot swallow them. Pain relieving patches are another alternative, but these are very expensive, so there is a barrier to access for many,” said Maiman.
However, some palliative patients need a drug called Haloperidol, for which there is no suitable alternative.
Dr Margie Venter from The Association of Palliative Care Practitioners of South Africa (Palprac) said Haloperidol is often used at the end of life to manage patients with nausea and vomiting, confusion and restlessness.
“This drug is on the WHO essential medicines list and is available in many other African countries but is no longer available here. For the past two months, we have not had access to oral morphine – this is an absolute crisis as this is the only opioid available to patients with cancer pain in the state sector.”
The DA called the Minister to implement an urgent plan to ensure that the shortages are addressed. "While some of the medicine shortages might be attributed to COVID-19 related factors, it is certainly worrying that the situation persists.
"While many patients with chronic conditions, such as HIV and TB, had to make do without their vital medications during the nearly two years of COVID-lockdowns, it is outrageous that their needs are still not addressed. The Department of Health cannot continue to use the pandemic as an excuse for ineptitude."
Health-e News article – Essential medicines shortage (Open access)
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North West patients suffer as essential medicine stocks dwindle
Health Department ‘taking steps’ over shortage of antidepressants and antipsychotics
DoH confirms global ingredient shortage behind ARV stockouts
Contraception shortages are failing South African women – Stop Stockout Report
Cancer meds shortages: What crisis? says KZN Health
UK’s NHS running short of dozens of medicines
Widespread medicine shortages hit the UK