[e-drug] Supply crisis of BMS ARVs in Kenya

[daniel_berman@msf.org]

E-drug: Supply crisis of BMS ARVs in Kenya
---------------------------------------------

Below is a letter that was sent by the Kenya Coalition (a national
grouping of organisations and individuals advocating for access to
treatment) regarding a supply crisis in Kenya of two antiretrovirals
produced by Bristol-Myers Squibb (BMS). I am posting this first to
share the information that although BMS has devised an excellent
strategy of offering discounted ARVs in sub-Saharan Africa through
most traditional distribution channels, there is currently no drug
supply available in Kenya for two BMS ARV formulations.

MSF has been in direct contact with BMS and they are working on a
long-term solution with new packaging and a revised distribution
system.  But we are gravely concerned for people with AIDS in Kenya
that currently are without ddI and d4t because of BMS supply problems.
This crisis of supply needs to be addressed in the short as well as
long term.

Since MSF has operational centers in Europe we were able to secure
drugs in France to supply our AIDS treatment project in Kenya and BMS
plans to refund us the difference between what we paid and the
discounted price in Kenya. We are grateful to BMS for making this
accommodation but remain concerned that many Kenyan clinics,
physicians, pharmacies and patients do not have the option of buying
abroad.

We are wondering if this supply problem with BMS products is
restricted to Kenya or is also happening in other African countries?
Previously we have witnessed shortages of other discounted proprietary
company antiretrovirals. We are also wondering, at this time, if there
are shortages of other companies' ARV products?

Daniel Berman
MSF Access to Essential Medicines Campaign
daniel_berman@msf.org
www.accessmed-msf.org

++++++++++++++++++++++++++++++++++++++++++++
Kenya Coalition for Access to Essential Medicines
c/o box 38897 Dik Dik Gardens off Mandera Road
Kileleshwa Nairobi Kenya
tel: 570021/570025

18 March 2002
Mr. Billy Apola
Bristol-Myers Squibb
c/o Phillips Pharmaceuticals
PO Box 46862 Nairobi Kenya
tel: 823660/352067


Dear Sir:

We would like to address an important matter regarding two
Bristol-Myers Squibb (BMS) antiretroviral (ARV) shortages in Kenya.
For a period of weeks there has been a severe shortages of
reduced-price Videx 25mg tablets and Zerit 30mg capsules.

On 25th February 2002, the local distributor, Phillips, could not fill
an order for these products for MSF which is administering medical
care to people with HIV/AIDS.  As MSF's buffer stock became 
dangerously low drugs were ordered from Paris (BMS affiliate in 
France) and are being shipped for MSF patients. However, this 
solution still leaves other physicians and facilities that provide 
AIDS care in Kenya  without BMS drugs. Patients are having to 
interrupt treatment putting their health at risk and potentially 
causing resistance that will lead to future treatment failure.
Between 28 February and 06 March 2002, a member of our coalition
contacted the chief pharmacists of seven area hospitals to assess 
local supplies of these two drugs.  This research revealed that six 
of the seven hospitals are either completely out of stock of both 
drugs (and have been for between 2-6 months) or have experienced 
irregular supply or shortages at some time over the last year. 
Attempts to deal with the current 25mg Videx shortage included cases 
of the pharmacist dispensing Videx 100mg tablets with a razor blade 
in order that the patient could slice a tablet into four for their 
25mg dose, and in some cases has forced patients to switch to 
alternative medicines.  The current shortages are  not the first with 
BMS products here in Kenya.  Additional shortages occurring recently 
include Amphotericin B 50mg for one month in the fall of 2001, Videx 
100mg tablets in January 2002 (during which certain patients were 
using 4x25mg tablets to reach prescribed doses).

Clearly these shortages are unacceptable given the nature of ARV
therapy for HIV:  correct dosing, rigorous adherence to scheduling and
absolute compliance are all paramount factors that affect outcomes and
endpoints of treatment.  Positive results cannot be achieved without a
guaranteed drug supply.

The Kenya Coalition was pleased with the price reductions announced by
BMS last year for their ARVs for use in Africa by public institutions,
international agencies and non-governmental organizations.  These
resulted in a 51% and a 98% decrease in cost for Videx 25mg and Zerit
30mg respectively.  But price reductions without consistent drug
supplies are dangerous. We now need to be assured of a reliable and
uninterrupted supply of these drugs at these preferential prices.

Assurance of drug supply is one barrier that can definitively be
overcome for the people of Kenya where HIV/AIDS has been declared a
national disaster and where more than 700 people die each day from 
this disease.    A simple solution is the availability of a 'buffer' 
supply, as was implemented both by GlaxoSmithkline and Merck last 
year after similar shortages.

In closing, it appears these shortages only affect the reduced-price 
ARV supply, as distributors for full-price ARVs have not experienced 
any delay with their orders.  The reasons behind this discrepancy of 
supply are unclear, and we trust both this matter and the current 
shortage be addressed with due urgency.


Yours sincerely,

Kenya Coalition for the Access to Essential Medicines


cc. Mr. Robert D. Lefebvre, Senior Director Project ACCESS Worldwide
Medicines Group, Bristol-Myers Squibb Company, PO Box 4000, Princeton,
NJ 08543-4000
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