Over the last two weeks a number of pharmacies across South Africa ran out of the 150 mg 3TC tablet, one of a combination of drugs used in the treatment of AIDS. The shortage has affected clients in the private health care sector who have, at worst, had to default on their intake of 3TC or at best, substitute the drug with a generic version. All because Glaxo-Smith-Kline, manufactures of the drug did not have enough units of the drug to meet the demand.

KHOPOTSO: Southgate Pharmacy, situated in a shopping centre of the same name in the south of Johannesburg, is one of a number of chemists that experienced a complete shortage of 3TC. I first leaned of the problem when I went to get a repeat prescription for a close friend. Upon enquiry as to why the drug was not available I was informed that it was a national shortage pharmacies were experiencing. For purposes of this report I called the pharmacy. Nicholas Slear is the Dispensary Manager.

NICHOLAS SLEAR: Southgate Pharmacy, hello.

KHOPOTSO: Hi, Nicholas?

NICHOLAS SLEAR: Yes?

KHOPOTSO: Khopotso, here.

NICHOLAS SLEAR: Yes.

KHOPOTSO: You say you have been running low or rather not having’€¦

NICHOLAS SLEAR: Not having stock, no.

KHOPOTSO: Not having stock of 3TC for a while. Please tell us about that.

NICHOLAS SLEAR: For about two weeks we haven’€™t had stock. From about mid-March ‘€˜til now we’€™ve had nothing.

KHOPOTSO: What has the explanation been as to why you do not have stock?

NICHOLAS SLEAR: No explanation. I just phoned the company who distributes the stock and they say can’€™t tell us when. The company who manufactures it haven’€™t given them any reason why.

KHOPOTSO: How have you been coping with the problem, so far?

NICHOLAS SLEAR: The only thing we can do at present is recommend giving the generic. People can’€™t go without anything. They have to have something ‘€“ Aspen Lamivudine and there’€™s a CIPLA Lamivudine.

KHOPOTSO: What impact has this had on your clients, really?

NICHOLAS SLEAR: Clients are very nervous of taking something that they are not used to. And some of them want us to phone their doctors to confirm that it is alright. We tell them that they can’€™t go without it for even one day because resistance does develop quite quickly. So they have to take something.

KHOPOTSO: Glaxo-Smith-Kline South Africa, the local office of 3TC manufacturer, is adamant that lack of the drug in pharmacies is only a low shortage. It maintains that the drug is available. Here is Dudu Ndlovu, the company’€™s Corporate Affairs Manager.

DUDU NDLOVU: A few weeks ago we had a low stock situation, not an out-of-stock situation. The drugs have been available and it (the problem) has been resolved. And it this stage there is stock currently available. So, people should be accessing the 3TC tablets from their pharmacies.

KHOPOTSO: This problem occurred particularly in the private health care sector. In the public health care arena this kind of shortage was not experienced. If you can tell us why there is that kind of difference in availability?

DUDU NDLOVU: We’€™ve got differential packs that go the public sector and to the private sector and obviously, the increased demand came up for the private sector.

KHOPOTSO: Can you explain that increase then, it jumped from what to what?

DUDU NDLOVU: I would have to come back to you with those figures because I would to extrapolate those figures out.

KHOPOTSO: Lack of the drug was only experienced in the private health sector. However, this unfortunate development highlights a crucial factor: that the success of South Africa’€™s bold antiretroviral rollout strategy depends heavily, amongst others, on the ability by drug companies to sustain the supply of medicines as required by the Plan and as promised by the companies themselves. Glaxo-Smith-Kline is one of several companies that government has awarded tenders to supply antiretrovirals to the public health sector. As demand for AIDS medication is set to increase in the public health sector, it would appear that drug manufacturers would need to strike a balance to cater for the two health systems of the country. Vicki Ehrich is Chief Operations Officer of the Pharmaceutical Manufacturers’€™ Association of South Africa.

VICKI EHRICH: Companies that contract to the government to supply antiretrovirals have planned for that separately from their private sector business. They work on projected figures in the government contracts, and of course, the challenge is always: are those quantities taken up or are they exceeded? Which, in some cases does create some problem in the supply of medicines. The private sector, at this stage, is probably a more mature market in terms of the fact that antiretrovirals have been supplied there over a number of years and that that is now an on-going situation. So, really the government sector contract side should not actually, really, create a problem between the two sectors.

*Over the festive period of 2003 into early January last year, three young South African AIDS patients missed their doses of anti-retrovirals after the supplier, Merck, Sharpe and Dohme (MSD) ran out of stock of its 50mg tablet of Efavirenz, or Stocrin, one of the principle AIDS medicines for children aged three and older.

E-mail Khopotso Bodibe