KUALA LUMPUR, June 14 – Malaysia is facing a crisis no one wants to admit. Pharmacy staff provide accounts of growing aggression and hostility from increasingly frustrated doctors and patients, as more medicines become unavailable in private health care facilities.
Health officials and medical groups have so far admitted to limited shortages of common drugs such as antibiotics, paracetamol, and over-the-counter (OTC) medications for fever, flu, cough, and cold, as well as syrups for children.
However, anecdotal accounts reveal a growing list of dwindling drug supplies – now affecting critical medicines for asthma, epilepsy, and anxiety – as well as behind-the-scenes scrambles as pharmacists scour to get enough doses for their hospitals and clinics to get by for a short period of time.
“Most, if not all, private hospital pharmacists in charge of procurement are frantically calling everyone we know to source for supplies,” a procurement pharmacist who works at a private hospital outside the Klang Valley told CodeBlue on condition of anonymity, as she was not authorised to speak to the press.
“Some days, if we’re lucky, we get small deliveries that can last us for a week or two. Then the whole cycle restarts again a week later. The amount of stress we face daily is huge.”
She disputed Association of Private Hospitals Malaysia (APHM) president Dr Kuljit Singh’s view that the current medicine shortage was not critical.
“I’m not sure how much his pharmacists updated him on the ground situation, but every single night, I go to bed worrying about our supplies. Many drugs are running critically low.”
Medicine shortages in Malaysia are not uncommon. It typically involves certain medicines, with stocks running low as the year draws to a close – but it’s not that time of the year yet.
The pharmacist explained that private hospitals used to occasionally experience shortages of certain drugs due to delayed shipments or suppliers inaccurately forecasting demand. “But it has never been this bad and involved so many drugs,” she said.
She added that previously, buffer stocks could “last us for a while”, but the shortage this time around was worse as delays in deliveries of medicine supplies sometimes extended to over a month, amid increased demand from high patient loads.
“We’ve always faced shortages, but it has gotten worse since early this year to a worrying level in May since the list keeps getting longer and longer each day,” the pharmacist said.
“Technically, we have not totally run out of treatment options for now. There are small supplies of alternative brands or drugs with similar therapeutic effects that we managed to buy or are fortunate enough to loan. Whether doctors are willing to change their treatment plan to alternatives offered – well, that’s another story. With unstable supplies these days, I really don’t know how long we can last.”
She pointed out that not all medical practitioners understand the severity of the ongoing medicine shortage where usually prescribed innovator drugs have run out, forcing a switch to either generic alternatives, or even to different drugs with similar therapeutic effects when the generic medications themselves become scarce.
“It’s not surprising that my colleagues get shouted at with very harsh words (like incompetent, useless, bodoh) when they call up certain doctors to notify them of the stock-out issues,” the private pharmacist said.
“We understand the frustration of doctors when they’re left with limited treatment options. We have tried hard to source for alternative supplies, but it’s not always that someone has spare stocks lying around to loan us. I’ve driven a five-hour return trip to borrow medications from another hospital.”
She said she has lost count of how many times she and other pharmacists across private hospitals, clinics, and community pharmacies borrowed and loaned medicine stocks from each other during the ongoing shortage.
“We will help each other based on good will. If we have sufficient supply and can spare our stocks until the next shipment comes in, we won’t say no. Patients always come first. We also don’t wish to see patients coming to hospitals and being told ‘we have no medication for you’.”
Growing List Of Unavailable Drugs: Epilepsy, Anxiety, ADHD, Parkinson’s Disease
Malaysia’s current drug shortage experience is largely concentrated on respiratory-related drugs, including asthma medication that was recently highlighted by a private children’s clinic in Miri, Sarawak, but has now extended to medicines for mental or brain conditions like epilepsy, anxiety, attention deficit hyperactivity disorder (ADHD), and Parkinson’s disease.
The procurement pharmacist from a private hospital outside the Klang Valley similarly cited salbutamol syrups to treat severe or acute asthma as among the medicines that are running “critically low” in her facility.
Other drugs in short supply that she named are other paediatric medicines like antibiotic syrups, ibuprofen syrups, antihistamines, phlegm thinning drugs, singular sachet and tablets for children, and nebulising solutions, besides throat gargling solutions and sprays, as the reopening of schools leaves many children at risk of infectious disease transmission.
“We also have low supply for some seizure and central nervous system (CNS)-related medication like Epilim injection, Rivotril tablets, Stesolid rectal tubes, and lorazepam tablets,” the pharmacist said.
Epilim (sodium valproate) is used to treat epilepsy (seizures or fits) and bipolar disorder; Rivotril (clonazepam) treats epilepsy and anxiety disorder. Stesolid, which contains diazepam, is used for severe anxiety and epileptic and febrile convulsions; while lorazepam is used to treat anxiety. Clonazepam, diazepam, and lorazepam belong to a class of drugs known as benzodiazepines that produce a calming effect by working on the brain and nerves.
Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib, in an interview with Awani Tonight last Friday, said he received accounts of some patients travelling from Penang to Perak for neurological medicines.
“What we’re hearing right now – and this is anecdotal information from patients – is that drugs used to treat conditions such as ADHD and even Parkinson’s disease are limited in stock. So, this has forced some people to cross state lines to look for their medication and this is something that is very worrying,” Azrul said.
Azrul suggested rationing drug supplies as a potential near- to long-term plan to ensure there’s “optimal treatment” for different diseases and sufficient drug supply in the country.
“We certainly, probably cannot afford anymore to give drugs that are like one-month worth’s given in one visit. Perhaps it needs to be rationed to maybe two weeks’ worth? And this is to avoid a situation where we run out of certain drugs that would cause doctors to prescribe suboptimal treatment.
“So, the government has probably got to start thinking about rationing some of the drugs used for cardiovascular disease, hypertension, maybe even diabetes, looking at planning for disruptions to occur up until the end of the year,” Azrul said.
Hospitals Competing With Clinics In Sarawak
Separately, in Sarawak, a doctor described a frantic situation where major private hospitals are competing with smaller private clinics for drug supplies from local pharmacies that are intended for the latter – from cough medicine to oral antibiotics – before many general practitioners (GPs) knew about the supply shortage.
“Many local GPs depended on local pharmacists either as a main supplier or as back-up due to storage space issues in their clinics, but when there’s more competition with local medical centres and a growing number of private GPs, local pharmacies also ran out of stock due to the volumes purchased by some,” the doctor told CodeBlue on condition of anonymity.
The doctor said there is also a concern that shortage of medicine for asthmathic children has forced some doctors to prescribe cough suppressants, which he said are “counter productive” in treating asthma.
CodeBlue previously reported that the Children and Heart Specialist Clinic in Miri, Sarawak, was on its last few bottles of Ventolin syrup – a prescription medicine used to treat acute or severe asthma attacks.
Dr Philip Raja, a paediatrician and paediatric cardiologist who runs the private paediatric clinic in Miri town, wrote to CodeBlue earlier, pleading for assistance from the Ministry of Health (MOH) to share drug supplies with it.
Health Minister Khairy Jamaluddin, in a statement yesterday, said the MOH has opened its medicine stocks to private health care facilities that are facing drug shortages, including critical asthma medications.
Khairy said private health care facilities can request to borrow medicine supplies from the nearest public health care facility or from other private centres.
The private hospital procurement pharmacist who spoke to CodeBlue said private hospitals will usually only borrow from public facilities as the “very last resort” when all options have been exhausted.
“There are layers of approvals to get through dealing with public hospitals. Too much hassle and a lot of times, we get rejected,” the pharmacist said.
Piecemeal Deals For Medicine Supplies
Meanwhile, among private hospitals, APHM president Dr Kuljit described the sharing of medicine stock with one another as common practice.
“One thing about private hospitals is we do share our stock – we can easily cater to our neighbouring hospital even though we may not belong to the same group,” Dr Kuljit told Astro Awani’s Consider This last Friday.
Dr Kuljit later told CodeBlue, when contacted, that private hospitals will borrow from each other first and “if needed”, from public hospitals. Dr Kuljit said he’s not aware if some private hospitals have started to borrow medicines from MOH facilities.
“[I’m] not aware, but [there should] be a few. The private hospitals will not inform APHM unless they have difficulty,” Dr Kuljit said.
CodeBlue was made to understand that “loaning” medicine supply means to borrow and to then return the stock once the borrower receives their supplies.
“Usually, when we place orders, we’re only left with about two to three weeks of buffer stock. So when our orders don’t arrive in a week’s time, we will follow up with our suppliers. Imagine our anxiety and stress level when we are told, ‘Sorry, it’s out of stock. Shipment will be coming in next month.’
“Delayed shipment, or the suppliers only get small quantities, and they’ll [likely] supply by first come first served basis. Some more organised suppliers will prioritise hospitals and allocate more since we see more critical cases,” the private hospital procurement pharmacist said.
Pharmaniaga Bhd, the main supplier of drugs to MOH, yesterday claimed that the company has three to six months’ worth of buffer stock for most medicines under its portfolio.
Not only has the company ramped up production ahead of anticipated spikes in demand for various drugs, Pharmaniaga also has a diversified supply chain, with each of the company’s products having at least three alternative suppliers in the event of any shortage or fluctuation of active pharmaceutical ingredient (API) prices.
Pharmaniaga is a producer of salbutamol expectorants in Malaysia, which the company said it had sufficient stock of. Salbutamol expectorants are primarily used to treat coughs. It can also be used to treat bronchospasm (tightening of airways), chronic obstructive pulmonary disease (progressive lung disease that causes breathing difficulties), and chest congestion (mucus buildup in the lungs).
Pharmaniaga’s salbutamol expectorant contains guaifenesin and salbutamol sulphate as active ingredients. Pharmaniaga said it does not produce epilepsy or psychiatric drugs.
No Ordinary Shortage
Bandar Kuching MP Dr Kelvin Yii, like many others, described Malaysia’s current medicine supply shortage as an extraordinary one.
“This is not any ordinary shortage that we face on an ordinary basis. That is why the government must come up with a short term plan, mid-term and even long term to guarantee our medical security,” Dr Yii told Consider This.
Dr Yii, who also chairs the Dewan Rakyat special select committee of health, science and innovation, called for immediate intervention from the federal MOH to assist health care facilities in Sarawak, or other states, that are running low on medicine supplies.
In a statement yesterday, he highlighted the case of the private Children and Heart Specialist Clinic in Miri that complained about running out of common paediatric medications, including salbutamol syrups to treat acute or severe asthma, since a week ago.
“Since last week, I have warned that this issue is slowly rippling through the system now, and it’s only a matter of time before the public really feels it, especially once the stockpiles are gone, including generic drugs, then it may be too late to do anything,” Dr Yii said.