Photo: A meeting of cardiac surgeons celebrating 50 year anniversary of the first human heart transplant at Goose Schuur Hospital in Cape Town.
Lenias Hwenda. Cape Town, South Africa. Lenias is passionate about improving access to quality affordable treatments for the forgotten millions.
A week ago, from 2-4 December, we celebrated the 50th Anniversary of the first heart transplant by Dr. Christiaan Barnard at Groote Schuur Hospital in Cape Town. This medical breakthrough was a major feat of courage and innovation that has saved the lives of many cardiac failure patients over five decades.
Rheumatic heart disease is a major cause of cardiac failure affecting millions of the forgotten poor. It is caused by streptococcus throat infection that can be treated with injectable Benzathine Penicillin G. Lack of treatment can lead to heart failure. Unfortunately, the availability of Benzathine Penicillin G is affected by global shortages resulting from insufficient global production capacity. Only four companies in the world manufacture its active ingredient, three of them in China and the 4th in Europe. The few companies producing it are doing so at 20% of the potential production capacity.
Market pathologies include limited demand data is limited demand data and low profit margins that make production unattractive for manufacturers. It is one of the oldest forms of penicillin ranging in cost between £0.20-£2 on the international market. It is also complex to produce and the available therapeutic substitutes such as azithromycin and ampicillin are available in tablet formulations that are less effective than the injectable Benzathine Penicillin G and have greater risk of antibiotic resistance.
Many countries, in fact 18 in all, including South Africa, France and Brazil have experienced regular stock outs and shortages of this vital medicine and shortages over the past three years. In resource limited setting, such shortages lead to a greater number of heart failures that require more expensive surgical interventions. Shortages lead countries to perform emergency purchases, which results in excessive cost and compromises patient safety as purchases are done from suppliers without marketing authorization who may not have undergone adequate checks and balances to ensure that production is done in line with acceptable quality standards. Insufficient documentation, inadequate quality standards and risk of contamination have been documented for Benzathine Penicillin G by the EMA.
Ensuring access to these medicines remains crucial for the forgotten millions of patients in resource limited setting who are affected by rheumatic heart disease and who cannot afford cardiac surgery. Better availability of this vital medicine will yield enormous public health value by reducing the need for cardiac interventions that cost individuals and governments huge sums of money. We need new business models and incentives to keep old antibiotics on the market. The health of millions of the forgotten poor depends on them. Solving poor access to quality affordable treatments must be a top priority for all who are concerned about ensuring patient well-being.