India must address worrying stock out of tuberculosis drugs

Indian government drug tender process leads to deadly delay in drug supply
TB patients need to take up to 20 pills a day. Sami SivaThe treatment of TB involves taking up to 20 pills a day. 

New Delhi, 17 June 2013 – The Indian government must urgently address the persistent issues and almost routine delays of procuring drugs to treat tuberculosis, international medical humanitarian organisation Médecins Sans Frontières (MSF) said today. The issues are behind a worrying stock out of TB drugs which the country is currently experiencing.

"As a country with such a high burden of tuberculosis, MSF is deeply disturbed that India is experiencing stock outs of critically needed drugs to treat children and those with drug-resistant TB”, said Leena Menghaney, India Manager of MSF’s Access Campaign. “In this instance, it’s a stock out that can cost people’s lives and the government must act urgently to fix the problems.”

India is currently experiencing stock outs across the country of both paediatric TB drugs and those used to treat drug-resistant TB (DR-TB). Under India's public TB treatment program, the central government is responsible for buying drugs and distributing them to the states which then provide treatment.

The stock out is related to the never-ending issues with drug procurement that India faces in many of its public health programmes - the routine but deadly delay in tendering for these drugs - and the resulting drug stock outs are one of the reasons why India has one of the world's highest burdens of DR-TB.

“As a TB treatment provider, MSF is witnessing the impact this is having on our own patients”, said Dr. Homa Mansoor, the TB Medical Referent for MSF India. “In our Mon, Nagaland project, I’ve seen a 12 year-old girl on treatment arrive with her father after a long journey to get her medicine. The medicines were out of stock, but luckily we had six days’ worth of drugs available from a patient who had died. Otherwise, we’re having to resort to breaking adult pills to give to children, which is really dangerous as it could over- or under-dose them.”

Other patients have been forced to purchase medicines from private pharmacies, but have received lower-dosage drugs, which – if it causes a patient to under-dose on that drug – could lead to resistance.

“A continuous, sustainable supply of quality-assured medicines is vital for TB patients to have even half a chance of being cured”, Dr Mansoor said. “As a doctor, I know the disease, I know how to manage it, but I feel powerless because we don’t have the medicines to treat.”

“It’s just not good enough that India talks of scaling up DR-TB treatment, but finds the medicine cabinet empty at a time when the most vulnerable patients – those diagnosed with DR-TB - are most desperate to get the medicines that can treat them”, Dr Mansoor added. “The Indian Government must act now to address this dire situation.”

The stock outs in India are occurring as the World Health Organization late last week issued interim guidelines on bedaquiline, the first new drug to treat TB in 50 years, approved by the US Food and Drug Administration at the end of 2012. MSF has welcomed the release of the guidelines, but has said use of the new drug needs to be regulated and controlled, and studies must be undertaken to find combinations with the new drugs in shorter, more effective and less toxic treatment regimens.


In 2012, MSF treated 31,000 people in 36 countries for TB, 1,780 of whom had drug-resistant forms of the disease.