As the country is still calculating the tally of the vaccine stock and medicines stolen in last week's unrest in KwaZulu-Natal and Gauteng, calls are being made on the government to act rapidly to ensure that there will be sufficient medicine supply in the coming months.
Picking up the pieces
On Tuesday, pharmacists such as Jubi Nxumalo, executive director of Junxion Pharmacies were counting his losses in Katlehong, Gauteng. Junxion Pharmacies has three branches in Spruitview, Katlehong and OR Tambo International.
In Katlehong, the one pharmacy was burnt to the ground although the OR Tambo branch was unscathed. On Tuesday, Nxumalo was still trying to save what was left of the other pharmacy. He tells Spotlight besides the medicine, all the computers were taken, including the USBs on which their backup files were stored.
Nxumalo says there is already anxiety from patients about medicine. "I'm just trying to save what I can," he says in between shouting orders of what to pack up and what to leave in the looted pharmacy.
In search of medicine
Leonard Sikhakane from Ntuzuma near KwaMashu says he understands this anxiety very well. Last week he was driving around for hours to find a pharmacy when his grandmother needed a refill of her prescription. She has dementia, he says. "Driving up and down these hellish roads fearing for your life is one thing but having a grandmother without her medicine is a whole other story," he says. Sikhakane says after driving from pharmacy to pharmacy, his brother notified him of one in Yellow Wood Park about 30 kilometres from KwaMashu that was still open and could help him with a refill.
"Everything was either closed or emptied. We only got food on Monday. There was just nothing." Sikhakane says he is not sure what will happen with the next refill since all pharmacies in his area were looted or closed.
When Phillip Dix from Durban returned from the Drakensberg amid the unrest last week, he had similar challenges to find a pharmacy to refill a script for his girlfriend's anxiety medicine. "I went to about six places but couldn't find meds because stocks were depleted or there just wasn't any because pharmacies were cleaned out. Just to try and find something like a loaf of bread and milk, something you just take for granted, you couldn't get. Now just think how scary it is with medicine, especially if you really need it," he tells Spotlight.
Like Sikhakane, Dix could eventually source the medicine in Yellow Wood Park where residents barricaded the streets to keep looters from reaching the area. "Just trying to get in and out of places and try to get through barricades was quite a nightmare. But you know you have to. I was with my dad and we left the women at home and as chivalrous as we tried to be, it still was quite daunting to try and get around and there were a lot of people in the same boat. Thankfully it sort of subsided now."
Nosipho Buthelezi who lives in Yellow Wood Park said she last week received frantic calls from family in Umlazi struggling to get blood pressure medicine for her aunt and a refill for her sister's baby who developed a rash on his body. They could, fortunately, reach the doctor for a new script which was sent through WhatsApp and Buthelezi could get the medicine from a pharmacy in Yellow Wood Park. "Maybe if we can get other ways to get medication quicker and faster during this time, it would really help," she says. "We would appreciate that because timing is everything when one is sick."
What is the plan?
Shafrudeen Amod, a pharmacist in Durban says with big retail pharmacies closed many independent community pharmacists are now left to deal with patients running out of medication for both communicable and non-communicable diseases with crucial support and communication lacking from the government and the pharmacy council. "It's all good and well to make statements about stolen medicine, rightfully so, but now what? What are the plans? Instead, we now sit with a legal and moral abandonment of patients and pharmacists," Amod says.
"We understand that medicine was stolen, but that is not the biggest priority. It is those people who are alive now and to keep them alive by providing them with their prescription medicine. We are all waiting for guidance. What do we do to facilitate access to prescriptions?" Amod asks. He warns we may end up in a situation where people want to bulk buy and then what steps are there with rationing?
Amod says at the moment the big retail pharmacies tell their patients to go to their nearest pharmacy and get us (community pharmacists) to call them regarding prescriptions. "We don't have time to do that. How legal is that? Will it be acceptable for the Pharmacy Council and medical aids to do that when there are no physical prescriptions?" he asks.
"A chain reaction is now in place where patients are being deprived of access to proper pharmaceutical care. Innovative mechanisms should be put into place until services normalise." One such temporary measure, he says, is to issue the pharmacies with temporary Section 22A permits. Section 22(a) of the Medicines and Related Substances Control Act provides for a concession granted to an organisation or person rendering a health service (the right as authorised by the Director-General of Health) to acquire, possess, use or supply any Schedule 1 to 4 substance. "It will provide us with a temporary solution if certain pharmacists were issued with these permits, particularly in the hard-hit areas. It means that they can continue with diabetes, hypertension, and ARVs without patients having to consult a doctor first and especially since most of the prescriptions (repeat) records were destroyed," says Amod. Most chronic medicines are Schedule 3 to Schedule 4 medicines.
"We need to implement mechanisms to ensure continuity of supply of medicines." He says the pharmaceutical supply chain has been interrupted to the point where pharmacists had to collect their own supplies. Major medicine wholesalers, he says, were not delivering medicines due to security concerns.
One supplier, City Medical Wholesalers in Durban that supplies many community pharmacies and GPs of medicine, resumed operations this week. When Spotlight enquired about this, City Medical stressed that they are working through backlogs but deliveries have resumed.
Amod says there is a backlog of about 48 hours at present since he is still waiting on his dispensary stock.
55 000 patients redirected
In Gauteng, Right ePharmacy in a statement yesterday announced that it will permanently close all ATM pharmacies in the province. Three of their four sites were destroyed in last week's unrest. The ATM pharmacies, as they were known, are pharmacy dispensing units which "served almost 55 000 patients and dispensed more than 710 000 chronic medicine prescriptions". This pilot project, which "allowed patients to collect two months' supply of their medication in under three minutes offering an audio-visual tele-pharmacy consultation with each visit", was set to run until September this year. Now, these patients will have to be redirected elsewhere for their chronic medicine.
"The Right ePharmacy team, in collaboration with the Gauteng Department of Health, is assisting affected patients to transition to other facilities so that they may continue receiving their chronic medication uninterrupted," the statement reads.
Registrar of the South African Pharmacy Council Vincent Tlala told Spotlight looters last week left 131 pharmacies vandalised and without medicine stock. "80% of the 131 pharmacies in the two provinces, were also vaccination sites."
Tlala said the amount of vaccine stock and medicines stolen across the two provinces can still not be calculated as pharmacies would still have to reconcile their books with what was supplied.
According to him, the Council is still assessing the impact on pharmacies and their ability to fund the rebuilding of their pharmacies (through insurance pay-outs or other finance vehicles), and once this has been established an appropriate programme of action would be implemented, wherever necessary.
"We are currently encouraging relocations applications within affected communities by pharmacy owners with the ability to do this, and we are processing these applications free of charge to the owners affected," Tlala said.
Medicine access will continue to be a challenge in next few months
As some independent pharmacists express frustration about feeling abandoned and burdened without the necessary support, Tlala told Spotlight the council is "confident that its efforts in the past week to ensure that wholesale pharmacies commit to consistent medicine supply to the operational pharmacies in affected and nearby communities, will prevent medicine shortage". "However, accessibility will continue to be a challenge for the next few months," he stressed. "Large pharmacy groups and a few independent pharmacies have indicated that they are already putting plans in place to rebuild their looted pharmacies, as such, this will further improve accessibility in these areas."
Tlala said the Council is now also working on relocating interns and learners who are based at affected pharmacies at no cost to both the pharmacy and the learner/intern to ensure the continuation of training of much-needed health care human resources.
Meanwhile, the Treatment Action Campaign (TAC) and other CSOs are scrambling to ensure treatment of people living with HIV is not interrupted. TAC chairperson Sibongile Tshabalala told Spotlight most of the CCMDD (Centralised Chronic Medicines Dispensing and Distribution) sites in shopping malls were vandalised or closed and many people living with HIV could not collect medicine due to the unrest.
She says their numbers show that by end of last week between 12 000 and 15 000 people in Gauteng on the CCMDD programme may have been impacted.
'the intent is not to lose people'
Tshabalala says many people had to resort to sharing medicine until the situation stabilises. In some areas such as Umlazi civil society organisations with the ward councillor took up loudhailers to tell people to get to their nearest clinic should they need ARVs. "As part of our treatment literacy programmes, we always encourage people to not interrupt treatment because you can develop treatment resistance. So, we cannot afford people not being able to get ARVs," she says.
Tshabalala says there are other challenges too. Where those who were part of the CCMDD programme report to clinics, they do not always know which medicine they are on. Staff shortages at the clinics and staff attitudes also make people not want to go to clinics. So with all of this, we fear that we will lose people because they would not want to go to clinics. She says another issue is that facilities often order according to their catchment area and so clinics will only order for their patient numbers and maybe a few 100 extra, meaning there is not a lot left to help additional people.
"All of us were shocked by this. We were not prepared and we, with government, have to go back to the drawing board and get a plan together. Right now we are just trying to get people to facilities and to make sure no one leaves without medicine. The intent is not to lose people," she says.
One community health worker doing house visits in and around Phoenix told Spotlight she only returned to work this week Tuesday, having stayed away since the unrest started. She wanted to remain anonymous. She said over 100 patients couldn't access their TB treatment last week but fortunately, some had three to four days' extra supply. She herself had to get her own TB medicine refill with the help of her brother, who drove from Richards Bay to Durban.
"When starting treatment, they say you must take your medicine every day. You can't just stop or skip. This thing (unrest) is pulling us backwards," she told Spotlight on Friday. By Tuesday, she told Spotlight the CHWs are back on their rounds and clinics are now fast-tracking chronic medicines like ARVs and TB medicines. "I'm just happy that people are getting their medicine. We are back to house visits and back to normal even as there are still cars with guys with guns driving around. But because they know us in the community (in and around Phoenix), we are fine."
When Spotlight asked Acting Minister in the Presidency Khumbudzo Ntshavheni about the contingency plans to restore medicine security especially for ARVs and TB medicine, she acknowledged medicine security in KwaZulu-Natal is currently a challenge also with ARVs and TB medicine.
Ntshavheni said "work is underway" to replenish stock and they are considering various options. "Because we know those who are HIV positive and TB cases can't afford to miss their doses otherwise we will be dealing with something that is unthinkable for our country and more so in KZN where the prevalence of HIV is at its highest. So we are moving quickly to deal with that to make sure ARVs and TB meds are available," she says.
Attempts to get more detail on the recovery plans from the KwaZulu-Natal Department of Health and the National Department of Health were unsuccessful.
Ntshavheni said stolen goods that government has confiscated or that were returned so far also include medicine. "Medicine was stolen and we don't know if it is safe for further use or must be discarded so the normal route is to just discard, first use as evidence in court and then discard because if tampered with, you cannot really vouch for its safety."
About 300 000 vaccination opportunities lost
The situation may still appear uncertain for medicine security but at least the country's vaccination efforts have not been floored by last week's riots. Deputy Director-General in the health department Dr Nicholas Crisp during an interview on ENCA on Monday said the country had its best performance yet with over 223 000 vaccine doses administered in 24 hours. "Things have been picking up nicely and once KwaZulu-Natal are completely in the swing of things, and Gauteng, I'm sure the figures will pick up even more," he said.
Tlala said that the COVID-19 vaccine follows a supply line, moving from a storage facility to the vaccination site in short intervals and as such, the impact on the rollout would not necessarily be the lack of vaccines, but diminished vaccination sites.
According to Crisp, most of the losses were in the private sector in KwaZulu-Natal. "We did lose some of these (vaccines) allocated to the distribution network of the private sector. Fortunately, there wasn't that much in the portions of the supply chain that were damaged, so it has not been too great a loss. And the public sector vaccines are spread over a large number of facilities and we are protected so, fortunately, we have not lost a lot by way of vaccines but we have lost a lot of opportunities to vaccinate people," he said.
Crisp quantified it as between 40 000 and 50 000 vaccine opportunities lost per day in the two provinces last week which amounts to about 300 000 vaccine opportunities during the unrest.
*A representative of the Treatment Action Campaign (TAC) is quoted in this article. Spotlight is published by SECTION27 and the TAC, but is editorially independent, an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.