Coronavirus deepens shortage of essential medicines

From shortage of masks, Intensive Care Unit beds, isolation facilities, testing kits and protective gears for health workers, the list of what the world needs to fight the Covid-19 disease is endless.
But essential drugs are running out too, with prices spiralling across wholesale and retail pharmacies in Uganda.
As the pandemic takes a toll on health care systems globally, healthcare systems are overwhelmed, and some countries such as Uganda, are running out of essential drugs and struggling to take care of non-Covid-19 patients.

Health experts say the increase in prices of essential drugs and the need for deliveries to other parts of the country require more attention than never before.
On Monday, President Museveni declared a 14-day nationwide lockdown that banned both public and private transportation except for cargo. The President also imposed a 7pm to 6am curfew for the same period. These, among other measures seek to contain the spread of Covid-19 as government monitors any incubation cases within institutional quarantine facilities and those at home. The confirmed cases as of yesterday stood at 44.

The president of Uganda Medical Association, Dr Richard Idro, warns that the people who are vulnerable to Covid-19, including the diabetic and those with other medical conditions should receive adequate care and attention.
In Uganda, more than 4.8 million people have illnesses that need constant medical care, including 1.4 million people living with HIV/Aids and 100,000 Tuberculosis patients, among other illnesses.
“These are people we are worried about if the disease hits us seriously. The people with diabetes, heart diseases, high blood pressure and asthma,” Dr Idro said.
What many Ugandans are wondering is whether service providers will be able to sustain the supply of essential drugs in their stores and clinics since most of them used public transport means to transport supplies from Kampala to the different parts of the country.

Pharmacies run out of drugs
Mr Sidney Amuhodwe, a drug dispenser in Masindi Town, says they have run out of Vitamin C tablets after the confirmed coronavirus cases started increasing around the world two weeks ago.
“People have been asking for it (Vitamin C) but we do not have. We hear even in Kampala, the prices have gone up. A packet of 100 tablet, which used to cost about Shs2,500, now goes for between Shs10,000 to Shs15,000.

Dr Martin Ogwang, the administrator of St Mary’s Hospital Lacor, a health facility in Gulu District, said the facility still has enough stock of essential drugs “as long as the current situation does not go out of hand” within the 14 days of lockdown.
The hospital receives more than 2,000 patients daily. The facility has capacity of only 482 beds.
As a not-for-profit organisation, they order for most of their supplies from the Joint Medical Stores (JMS) in Kampala. JMS is a joint venture between Uganda Catholic Medical Bureau (UCMB) and Uganda Protestant Medical Bureau (UPMB).
“We had already stocked the drugs and fluids. We only have very limited supply of overalls,” Dr Ogwang said.

Whereas government, through Uganda Nation Drug Authority (NDA) supplies drugs to government health facilities, the private health care providers say they are facing a challenge with limited supplies to meet local demand.
Dr Christine Lakop, the Omoro District drugs inspector, says drug shops and clinics have slightly increased prices of essential drugs because the wholesale prices have increased too.
Dr Francis Pebalo Pebolo, a gynecologist who owns a clinic in Gulu Town, says he used to get his supplies from Kampala through public means and but ever since the President banned public and private means of transport, they are not sure how long their supplies will last since demand for essential drugs have increased significantly.

“In the last four to five weeks, prices of some of the essential medicines have skyrocketed. Sometimes I think affordability will be a question. The prices of the drugs have since risen about three or four times their initial prices. Some of the drugs are not even available on the market,” Dr Pebolo says.
“With this lockdown, we need to understand how the drugs will be transported. I do not think they can be transported as cargo. We are wondering how long the few stock can sustain us in Gulu here,” he says.
Dr Pebalo suggests that government should involve private healthcare providers by providing them with protective gears so that they reinforce efforts by those in established government facilities.

“Government should look at the option of providing protective equipment to the private health service providers such as hospitals and clinics because these things are very expensive and yet these people work very hard to help Ugandans,” he says.
He also calls for specialised training of healthcare service providers in the area so as to be able to handle any coronavirus cases in case they emerge in the area.
Dr Emmanuel Ereru, a pharmacist at Abacus Pharmacy in Kampala, attributes the increase in prices of essential drugs to the lockdown in other countries such as China that used to provide raw materials for locally made medicines.

Other countries that significantly contribute to the imported essential drugs are Germany and India that are equally facing the wrath of the coronavirus pandemic.
Ms Betty Aol Ocan, the Leader of the Opposition in Parliament, during a televised press conference on Tuesday afternoon, asked government to show good leadership by caring about the needs of those with chronic illnesses and in need of urgent medical care.

Pharmacists raise alarm

The Pharmaceutical Society of Uganda has expressed concern over shortage of essential drugs following a decision by foreign manufacturers to stop export of life-saving drugs.
Dr Samuel Opio, the secretary of Uganda Pharmaceutical Society, said whereas a number of trials are being done to re-purpose some drugs to treat Covid-19, countries such as India that Uganda import from are stopping exports.
“Right now, one of the combinations, azithromycin and hdroxycloroquine that are promising treatment for the disease [Covid-19], India, where Uganda imports it from, has banned its export from their country,” he said.
He asked government to look into the issue of access to some of these drugs that are being tested as treatment for the scourge even as other activities of curbing the disease spread continues.

Dr Opio was reacting to one of the drugs being studied by a team of American scientists for use against coronavirus.
The drug that was already being used against heart attacks and stroke, is being tested for its potential to save lives of Covid-19 patients who lack access to intensive care services as cases overwhelm healthcare capacity across the globe.
At least five in 100 people with Covid-19 require intensive care ventilators to aid them due to severe respiratory distress the disease causes, according to the scientists.

In a press release on their website yesterday, researchers at the University of Colorado and Massachusetts Institute of Technology (MIT), said they are testing the drug, tissue plasminogen activator (tPA) that unblocks air pathway in the body.
The decision to undertake this follows increasing evidence from studies conducted in Italy and China showing that most deaths from Covid-19 is because of blood clot. This new drug, according to its developers, stops blood clotting.
Covid-19 patients have severe disorder of blood clotting, which contributes to respiratory failure, according to experts.

Dr Michael Yaffe from MIT, who is also an intensive care physician and project member, said in the statement that the tests are already ongoing in three hospitals in Massachusetts and Colorado.
“What we are hearing from our intensive care colleagues is that many of the critically ill patients with Covid-19 are hypercoagulable, meaning they are clotting off their IVs, and having kidney and heart failure from blood clots, in addition to lung failure. There is plenty of basic science to support the idea that this concept should be beneficial,” he said.

“If this were to work, which I hope will, it could potentially be scaled up very quickly, because every hospital already has it in their pharmacy,” Dr Yaffe added.
He said the only tricky thing to them as experts is figuring out the right dose and route of administering the drug.
“But the target we are going after is well-validated,” he added.
The clinical trial for the drug will be funded by Biomedical Advanced Research and Development Authority (BARDA).

However, according to Dr Opio, such drugs that are based on natural substances have a history of causing negative reactions on people.
“The trial can be successful but the challenge is that tPA is a natural substance and is prone to cause negative reactions in people. It was the same problem with Hepatitis B vaccine. Other people were getting negative reaction from it,” he said.
So far, there is, no drug or vaccine approved for treating Covid-19, according to World Health Organisation.

Drug prices in pharmacies in Masindi on April 1, 2020

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