EDITORIAL Drug supply and resistance
- Published: 31/07/2009 at 12:00 AM
- Newspaper section: News
The Public Health Ministry has made a high-risk decision in extending its distribution of the anti-viral drug oseltamivir to clinics across the country, to ensure speedy access of the medicine for 2009 flu patients. While Health Minister Withaya Kaewparadai should be commended for his political courage, all Thais now can only hope that his decision in battling the flu is correct and that it will not lead to the problem of drug resistance now widely feared among experts in the field.
There is no doubt that the present flu pandemic has reached an alarming stage and this requires decisive responses by policy-makers holding political power like Mr Withaya. However, doubts have still remained whether his decision to expand the drug distribution network to the clinic level, which may compromise its control, was well thought-out and should actually be reviewed.
It has been obvious from the start that top ministry officials have been split over whether the distribution of oseltamivir should be extended from hospitals to some 7,000 private and state clinics around the country. The pandemic fatalities which jumped from 44 deaths last week to 65 this week has apparently compelled the health minister to act despite the voice of disapproval from virologists. The virus experts are concerned that without proper control of the drug's distribution, the uncontrolled prescription of the medicine may lead to the problem of drug resistance and further complicate their efforts to fight the flu.
The virologists' concern is highly understandable. Reports about drug resistance cases in some countries such as Denmark, Hong Kong, Canada and Japan are a warning sign for more discretion in drug use. The government's decision in ordering 20,000 doses of zanamivir, the second-line flu drug in case patients developed resistance to the first-line medicine oseltamivir, demonstrates that the health authority is aware of this possible problem.
Reports that some of the second-line drug have been sent to Siriraj Hospital to treat patients developing resistance to oseltamivir, show that the problem has actually already taken place here.
In pushing for wider distribution of oseltamivir, the Ministry of Public Health is apparently gambling on the hope that a set of drug distribution guidelines drawn up by a ministerial sub-committee will work.
These guidelines include the requirement that these clinics must have doctors who are trained by the ministry to prescribe the medicine. They are also required to provide daily reports on all cases experiencing drug side-effects to the ministry. The clinics must also be equipped with sterilised rooms and a post-treatment monitoring system.
Provincial public health in each province, under the same guidelines, has to closely monitor treatment standard, the prescription process and the upkeep of the sterilised rooms at clinics joining the programme monthly. These clinics have to strictly follow the standard issued by the Ministry of Public Health at all times.
Despite all these stringent requirements to ensure drug distribution efficiency, no one can rest completely assured that the system set up by the ministry will work as it should.
It is, therefore, the duty of the ministry to make sure that these guidelines are strictly followed.
Without a serious monitoring system and strict enforcement of the measures, the country could risk seeing a deadlier pandemic at hand. And the damage could be far beyond our imagining.
