Significant steps must be taken to prevent a recurrence of the current shortage of medicines
The Covid-19 pandemic, the surge in influenza and hand, foot and mouth disease (HFMD) cases, dengue fever and the Ukraine war crisis, are severely disrupting the world supply chain, resulting in significant disruptions to everything from food production to electronic items and cars.
This has resulted in shortages of food products and soaring prices of essential items such as chicken, cooking oil and eggs, not to mention labour and other costs. But even more worrying is the shortage of vital medication and drugs.
As a result, consumers resort to hoarding and panic buying, making the shortage even more acute as demand outstrips supply. There are also some patients who insist on getting only certain brands of medicines when there are other equally efficacious brands available in the market available. A good example is paracetamol.
While most consumers can make do with cutting down on food consumption, eating out and even defer buying consumer products, getting the proper medication is not an option – it is vital to treat their illness and regain their health.
The Health got the views of various stakeholders such as the Pharmaceutical Services Programme (PSP) of the Ministry of Health (MoH), the Federation of Malaysian Consumers Associations (FOMCA), the Association of Private Hospitals Malaysia (APHM) and the Malaysian Pharmaceutical Society (MPS) on the current medicine shortage.
FOMCA President Datuk Dr Marimuthu Nadason did not mince his words when he urged the authorities to buck up and address the shortage of medicine supply fast. He said: “This should not happen again. The government should come up with corrective and preventive action to address the medicine shortage issue.
“The government needs a master plan to attract pharmaceutical companies to set up manufacturing facilities in Malaysia. Such a move would be a crucial security measure to prevent a drug shortage crisis should another pandemic outbreak or war.”
Senior Director of MoH’s PSP, Norhaliza A Halim, said they had formed a task force to identify a mechanism to overcome the issue holistically and proactively on drug shortage. One measure is to strengthen the local manufacturing capacity for medicines and increase the production of locally sourced raw materials to reduce dependence on imported medicines and raw materials.
President of the MPS Amrahi Buang said pharmacists play a crucial role in monitoring the situation and giving weekly data to the MoH. Pharmacists were also giving alternative medications. He said the seriousness depends on localities, the issue of logistics along the supply chain and unstable supply affecting pharmaceutical services.
Scope and scale of the current medicine shortage
Norhaliza said most of the reported shortages were medication-related to fever, cough and cold and primarily affected private healthcare facilities.
“However, the disruption of drug supply in Malaysia is still under control. For products under the MoH Central Contract, the current shortages are still manageable with alternative supply through several suppliers.”
As for the situation in private hospitals, APHM President Datuk Dr Kuljit Singh informed: “The current shortages we see in private hospitals are pretty isolated with certain kinds of medications.
“While some private hospitals are affected a little more than the others, most are managing quite well.
“We’ve heard one or two hospitals saying there’s no supply. The association is trying to assist and talk to the manufacturers.
“We are looking out for whoever said they do not have medications because they could not get alternatives.”
According to Dr Kuljit, as the public returns to work and social activities increase during the endemic phase, people tend to get a lot of upper respiratory tract infections. “So most medications for upper respiratory tract infections are in shortage.”
Norhaliza said the PSP had also engaged with the relevant pharmaceutical industries stakeholders and identified the following contributing factors, which include:
i. A sudden demand for fever, cough and cold medicines due to the Covid-19 and HFMD cases
ii. Preference for a certain brand, although there are other brands available in the market
iii. Delay in the supply of active pharmaceutical ingredients (API), excipients, analytical reference standards, and packing materials due to logistic challenges caused by the Ukraine war and China lockdown restriction
iv. Shortage of human resources in terms of foreign workers
v. The closure of the main solvents’ manufacturer (e.g. chloroform spirit, denature alcohol, absolute alcohol, alcohol) by the Department of Environment due to a river pollution issue. The solvent is required for the manufacturing process of pharmaceutical products
Efforts to mitigate the current shortage
Based on the media statement by the MoH on June 13, 2022, the short-term measures that could be taken by private healthcare facilities to tackle the current medicine shortages include:
i. Private healthcare facilities could obtain the stock from government facilities and replace the product after the new stock arrives.
ii. Patients from private healthcare facilities may be referred to government health facilities.
iii. Patients from private healthcare facilities may approach the community pharmacy by showing their medication prescriptions.
On June 16, 2022, a guideline regarding the supply of medicine to private facilities during emergencies, crises, and disasters was issued to MoH facilities, should they receive any request for medicines stock from private healthcare facilities.
According to Norhaliza, the task force has been identifying products reported to be in shortage and the stock levels at the warehouse.
“We have also identified the products’ alternative list and potential distributors for these alternatives according to the region; Klang Valley, Northern, Eastern and Southern Malaysia, Sabah and Sarawak.
“The alternative product list and the distributor list is shared with associations such as APHM, MPS, Malaysian Medical Association (MMA), and the Medical Practitioners Coalition Association of Malaysia (MPCAM).”
Sharing medicine supplies is a good move
While Dr Kuljit opined that sharing resources between private and
government facilities is a good suggestion, he highlighted some downside to the strategy.
“The private facility can buy borrow medications from government hospitals and vice versa. We don’t mind sharing. The idea is very good, but the mechanism of doing it has to be made clearer.”
He explained: “Government medicines are government property. So when you want to acquire government medicines, you will have to undergo many tedious steps and processes. We need to make sure that those processes are made easy.
“Another factor is that not every medication procured in bulk by the government is used in private hospitals. In private hospitals, our medications may differ as we have various medicines, some specifically used in private facilities only.
“Patients also tend to request specific brands or latest medications in the market as they can afford the cost of these medications.
“Government, however, tends to buy medications of a particular brand in bulk as it is cost-effective. They may procure the latest medicines, but it may not be a large amount.
“Essentially, we may not be able to procure the needful type or quantity from the government.”
Amrahi believes borrowing stocks from public facilities may or may not solve the problem in this complex health system. He said: “The dichotomous state of the health system is contributing to this. And facilities exist in a silo.
“A national-level intervention needs to be done under the purview of the PSP of the MoH. A national track and trace system involving medicines is needed and requires the cooperation of everyone.
He added: “Support Health Minister Khairy Jamaluddin’s effort to present a health white paper in Parliament in November 2022.” — The Health
Minimising impact on patient care
Drug shortages can adversely affect drug therapy, compromise or delay medical procedures. Lack of drug supplies could also lead to worsening of disease, hospitalisation, and even death if no alternative drugs are prescribed to treat patients.
Senior Director of the Pharmaceutical Services Programme (PSP) of the Ministry of Health (MoH), Norhaliza A Halim, said the MoH facilities medicines used for the treatment of patients are based on MoH Medicines Formulary (MoHMF). The MoHMF is the reference list of medicines allowed to be prescribed in the MoH facilities.
It is a policy and administrative approach to control and promote the rationale and quality of medicines in all hospitals, clinics and MoH institutions. It ensures access to safe, effective and cost-effective treatment.
In a situation with a shortage of a particular medicine, other medicines with the same indication as listed in the MoHMF may be used as an alternative. However, if no suitable options are listed in the MoHMF, special approval for using other suitable and available registered medicines not listed in the MoHMF will be considered.
To minimise the impact of medicine shortage on patients in the private hospitals/clinics/community pharmacy, the MoH has taken the initiative to gather information from industries on the availability of alternative products with the same active ingredients and share the list with them. — The Health