AFRO-NETS> Supply crisis of Bristol-Myers Squibb ARVs in Kenya

[Janet Feldman <kaippg@earthlink.net>]

Supply crisis of Bristol-Myers Squibb ARVs in Kenya
---------------------------------------------------

Dear Friends,

I have received this message and thought I would pass it along to 
colleagues in Kenya, Nigeria, South Africa, Botswana, Zimbabwe, and 
to e-forums where there might be folks from other African countries 
who can give feedback. Please be in touch with me if you would like 
me to contact people in Uganda and Tanzania, and I can also come up 
with organisations in other countries as needed. Please contact our 
head office in Mumias, Kenya - and James Onyango, Exec. Director - if 
we can be of any help, and in Kenya we would be most honoured to join 
the campaign. Our e-mail there is: <kaippg@africaonline.co.ke> 
(http://www.kaippg.org), and mine in the USA is 
<kaippg@earthlink.net>

Many Thanks and 
All Best Wishes
Janet Feldman, Director
KAIPPG/International
mailto: kaippg@earthlink.net


----- Original Message -----
From: DANIEL BERMAN AT MSF-GENEVA
Date: 04/04/2002 05:36 PM
Subject: 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 sys-
tem. 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 
drug in France to supply our AIDS treatment project in Kenya and BMS 
plans to refund us the difference between what we paid and the dis-
counted price in Kenya. We are grateful to BMS for making this accom-
modation 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 re-
stricted to Kenya or is also happening in other African countries? 
Previously we have witnessed shortages of other discounted proprie-
tary 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
mailto:daniel_berman@msf.org
http://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: +254-2-570-021 / 570-025

18 March 2002
Mr. Billy Apola
Bristol-Myers Squibb
c/o Phillips Pharmaceuticals
PO Box 46862 Nairobi, Kenya
Tel: +254-2-823-660 / 352-067


Dear Sir:

We would like to address an important matter regarding two Bristol-
Myers Squibb (BMS) antiretroviral (ARV) shortages in Kenya. For a pe-
riod of weeks there has been a severe shortage 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 medi-
cal care to people with HIV/AIDS. As MSF's buffer stock became dan-
gerously 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 tab-
lets with a razor blade in order that the patient could slice a tab-
let into four for their 25mg dose, and in some cases has forced pa-
tients to switch to alternate 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 cer-
tain 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 with-
out 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 institu-
tions, 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, USA

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