With all the money that pharmaceutical companies spend on advertising and promoting drugs, one would think that there is an abundance of drugs in the supply chain. For the most part there is but the U.S., India and other nations are facing shortages of tuberculosis (TB) drugs. In India, some clinics are turning away sick children due to short supplies of pediatric doses, and in a risky move, adult pills are sometimes being split to approximate children’s dosages. In the U.S., some patients who are infected, have lacked access to the most commonly used drug for that form of TB. Leaving them instead to wait for the supply to improve or take another drug that doctors fear could worsen drug resistant TB if not properly used.
Turbeculosis is becoming increasingly drug-resistant and untreatable. The demand for treatment has outstripped supply. To make matters worse if a patient starts and then stops taking a TB drug, even briefly, the disease can quickly become resistant to the treatment. So you would think that pharmaceutical companies would be producing these drugs daily. So why hasn’t pharmaceutical companies ramped up production? There has been limited availability of rifampicin, the most powerful TB drug, and two other medicines, streptomycin and kanamycin.
Supply Chain Errors
The shortages reflect fundamental problems including poor government purchasing systems, weak supply chains, poor profitability for some drugs and inadequate methods of gauging demand. The extent of global shortages is difficult to assess for some of the very reasons shortages occur: poor tracking of drug supply and a lack of good global reporting system. Once drugs are manufactured and sold to distributors, no one knows if more is needed under there is very little supply left. Think of it this way, TB killed 990,000 people in 2011, according to the World Health Organization.
In India 1.5 million people currently receive free drugs at 13,000 Indian government centers nationwide. India’s supply woes arose soon after the planned expiration of a five-year grant from the British government providing TB drugs to a big portion of the country. The Indian government needed to quickly begin the months long process of soliciting bids from companies to buy the vast volumes of drugs needed, but instead delayed. Without these orders, drug manufacturers can’t schedule drug production. Here is the real kicker, Indian drug manufacturers account for most of the global production of turbeculosis drugs.
New forecasting tools, an early warning system for stockouts and other measures are being introduced worldwide to try and prevent drug shortages. Governments are also working on ways to consolidate orders for TB drugs, to create steadier demand so manufacturers aren’t flooded with last-minute orders. The goal is to become a “customer of choice” for drug makers. At present, drug makers say governments agencies order so erratically and estimate demand so poorly that it is hard to manufacture the right amount. To add to the pain, governments aren’t often customers of choice because they drive prices down so low that it often is not profitable to sell to them. A balance has to be struck between price and demand.
Are you taking any medication that has had a shortage?