“Belize is plagued with a myriad of issues related to the quality of pharmaceuticals’ and cited some of those problems as “counterfeit medications, prescription medications sold over the internet, selling over-the-counter and prescription items without a licensed Pharmacist and the importation of sub-standard pharmaceuticals.”
The dialogue over counterfeit pharmaceuticals has continued and on Rise and Shine morning show, Dr. Francis Smith talked about his own experience and the dangers of counterfeit medication.
“I was most distraught some years ago when I prescribed a pain killer medication called Traumadol to an elderly nun and to a member of our staff who is a younger woman. It produced some very serious side effects that included nausea, vomiting, palpitations and diarrhea. Obviously, these people doubted about my care and I doubted myself. Relatives were rightly upset. In fact, I stopped for some time, prescribing this medication, only to notice that American tourists visiting, would ask me for a prescription and I was asking them if they were having similar effects, and I realized that the brand that they used was Ultrum compared to some other products that we use here. So, what I did was to use the drug myself, and I realized that indeed, there was a problem”.
Counterfeit medications are both in the private and public health systems and we understand that a lot of it can be found in the free zones where people can buy prescription medication over the counter. In their March 12th press release, the Pharmacists Association made four demands of the Ministry of Health after it was learned that a new post of Director of Drug Inspectorate had been created.
1. The situation of the post of Director of Drug Inspectorate Unit be immediately rectified.
2. Proper procedure be adhered in the creation and filling of the post.
3. An entire unit be created to realistically carry out the necessary work.
4. The unit be properly equipped with suitably trained personnel.
According to former CEO in the Ministry of Health, Henry Anderson, the regression in state of affairs is regrettable because from early 2000 a system was in place to ensure the safety of Belize’s pharmaceuticals. That system was put in place as a part of the public sector health reform.
“There is a system in black and white that was developed and I don’t know if it is being used, but that was pushed in as part of the Health Sector Reform that was started under the UDP administration, and later transferred under to the PUP administration, there was an effort to strengthen the way in which pharmaceuticals were per queued. What was done with the assistance from Barbados was to benchmark the system used in Barbados which is called “the Maximum Price Contract System”. A list was sent out with the prescriptions of all the different types of pharmaceuticals that the Ministry needed that is on the formulary is what the professional of the Health services sector and the director of health services say the y will use . The tender is sent out and the listed prices paid the previous year for each of those items. So, somebody who wants to bid, would know what it was bought for. The Drug Inspectorate was set up under that initiative. When you bid, you had to provide quality certificates that says you are prequalifying the item you bid on. There was a big committee headed by the Chief Pharmacists, you had Chief Specialist for each key area. It was a huge committee of about 20 people. So, pollution in something like that was next to impossible. Now, every batch that comes in, the Drug Inspector comes and checks and there are certain things that had to be looked for. The drug had to be used in the country’ where it was manufactured. We were made to understand that; that was a good safety thing”.
According to former Health Minister Jose Coye, his administration picked up where the former administration left off and invested over 20 million dollars in improving the system.
“It is a fact that the UDP initiated the diagnosis of the health system before the PUP came to office in 1998. When we came to office, that process continued. The solutions were developed to transformed the health system. We then invested over $20m with funds of the IDB, CDB and our own funds. The reform system had national consensus because the opposition wasn’t good. What I find which is very strange, including the CEO who was on that team involved in the reform and the implementation of those reforms. How comes that the very people who were there, have decided to discard not just the structural side of it because that can’t just be done, except that they have not been maintained, but to discard the administrative side like the protocols or the procedures which were tested to suit countries like Belize and was in fact working. The World Health Organization provides countries in the world with what it is considered to be acceptable generic drugs. So, it is evident to me and all those who are in the Ministry right now who were in there before, that the real thwarted being subverted is clearly because of the insatiable greed, and a self advertisement agenda which is driving this government”.
Even former Health Minister Vildo Marin called in to Rise and Shine to share his experience.
“Certainly, we had good professionals like Dr. Cuellar, who at the time, was at the KHMH. They were the ones responsible to say which medications they want and which generics they want. I remember, for example, APO from Canada. That was a very good generic. The committee had the say where the Chief Pharmacist was involved in the entire process. No one was involved at the political level to make a decision as to what kind of medication and from who they were going to purchase it. It was the committee. It was very transparent and accountable”.
Plus News was able to confirm that the chief pharmacist who headed the tendering process for the acquisition of medicines for the public health system, was removed from the entire tendering process a few years ago.
According to Dr. Smith, beside the establishment of a properly functioning drug inspectorate, there is also the need for collaboration with international agencies to safeguard the Belize Pharmaceuticals.
Dr. Francis Smith: “Usually, there are hollow grams, there are watermarks that if you are trained in this, is easily identifiable and especially if there is collaboration. So, the companies can actually send you information the same way you can tell the difference between a counterfeit U.S. dollar bill and a genuine one (they have little threads and water marks and so on. There is a way of telling, But it is not obviously in our practice because we don’t have access to such thing and that is the least thing a medical professional should be worried about. My main concern is to make sure that I am doing my due diligence, delicately to come up with a correct diagnosis and then I prescribe”.
Neurologist, Dr. John Sosa, told Plus News that it is imperative that an independent committee be formed to investigate the sources of generic medicines sold to GOB. He also said “GOB should also try to either open its own lab to check drug concentrations or ask Jamaica to answer in a reasonable time” and “ … the Ministry of Health has to forward this information to doctors and pharmacists and not hide it to protect certain providers who are politically connected and selling junk to GOB.”
Plus News has received a copy of an internal email where the Ministry of Health is just now asking suppliers to validate the authenticity of pharmaceuticals that have already been purchased; this request appears to be as a result of the recent media coverage on the pharmaceutical issues in Belize.
As we said, the dialogue continues and the Pharmacist Association met with Ministry of Health officials today to discuss the way forward. We’ll continue to follow this story as it develops.