1. Swine Flu Outbreak Not
Massive, But India Treads with
Caution
KEEPING GUARD UP WHO is closely watching the situation on the ground &
its assistant director general Flavia Bustreo says there are no alarming signs
indicating the makings of a large outbreak of H1N1 virus in India
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2. Contd..
A lesson that we have learnt from the Ebola outbreak in West Africa last year is that
one can never be too careful in these cases, a senior World Health Organisation
(WHO) official admitted early this week when asked about the state of swine flu
virus in India.
The WHO assistant director general Flavia Bustreo said the global health watchdog
is closely watching the situation on the ground and there are no alarming signs yet
to indicate the makings of a large outbreak of the H1N1 virus in India.
However, the country this year has already seen 16,235 confirmed cases of the flu,
claiming 926 lives, the highest in the past five years, testing the government's
response system to a public health crisis in a manner Ebola didn't. The virus flared
up significantly over the past three and half weeks, adding about 600 cases each
day. Seven states of Rajasthan, Gujarat, Delhi, Telengana, Maharashtra, Karnataka
and Madhya Pradesh account for 91.9% of all reported cases and 86.9% of the
death toll.
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3. Contd..
“We cannot scientifically explain the reasons behind this
skewed distribution pattern of the virus but there is hardly any
public health system in the world which is fully geared to deal
with the hysteria that comes with a flu outbreak like this,“ said
Manish Kakkar, epidemiologist at Public Health Foundation of
India. Since January , the Centre has been frequently reviewing
the situation at states, procuring and proffering drugs,
protective gears through meetings with senior bureaucrats. But
performance of the states varied. For instance, Delhi has seen
almost 2,500 cases and eight deaths, but Rajasthan which has
witnessed double the number of confirmed cases, has reported
a death toll 30 times higher at 234. Experts said late diagnosis
was one of the reasons behind the higher toll.
“The communication to physicians, health workers, high-risk
groups and even general public could have been better to
prevent the panic and mad rush which have erupted,“ Kakkar
added.
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4. DRUGS & DISTRIBUTION
There's no question of shortage of swine flu drugs as Indian
compa nies have enough capacity to tackle even a global
epidemic, said a top executive at a domestic drug firm that
makes the drug. Besides Swiss innovator Roche, several leading
domestic pharma companies including Cipla, Hetero, and
Strides Arcolabs make this drug, Oseltamivir Phosphate, in
sufficient quantities. The executive quoted above said his firm
at full capacity can churn out over six lakh tablets and over six
tonnes of bulk drug in a single day.
But apart from the government hospitals, the drug is sold only
through 2,800 drug stores, which hold a special licence to stock
drugs under Schedule X, leading to shortages in some regions.
“People today are not aware which are the stores with valid
licences, so they end up searching for the drug in four-five
unlicensed outlets and get frustrated,” said Suresh Gupta,
general secretary, All India Organisation of Chemists and
Druggists.
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5. Contd..
The health ministry has put up the names of the stores on its
website but the distribution of Schedule X licence holder
pharmacies across states and districts is un even. For instance,
Sikkim has over 60 such stores but Bihar has just four, despite
being over 150 times more populous. Also, not every such store
stocks the medicine.
ET found out and many people don’t prefer to visit the public
health facilities to procure medicines at a time when the
chances of contracting the infection is high.
After a meeting with the Drug Controller General of India, the
drug traders’ body has advised licence-holding chemists to stock
the drug and procure directly from company-appointed
distributors and agents to save time. “We have strictly warned
our members against any cases of black marketing. The moment
we get to know of such cases, we will be the first to urge
suspension of licence,” said Gupta, on reported cases of drugs
getting sold at higher prices.
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7. Contd..
The drug regulator has been identifying affected districts where there are no chemists with
a valid licence for the swine flu drug and talking to the states and local administrations to
fast-track the grant of Schedule X licences in these areas, officials confirmed. Affected
states have put in place a surveillance system, with round-the-clock monitoring cell to
check the availability of drugs. “We are telling drug regulators of the affected states to urge
chemists with Schedule X licence to keep their stores open round-theclock,“ said an official.
The government has till now refrained from relaxing the restrictions around the drug,
fearing that it may lead to abuse and resistance, which would pose a much bigger
challenge. However, the Drug Technical Advisory Board, the apex drug safety body, in a
meeting last week had recommended that restrictions on the sale of the drug be lifted and
over 4.8 lakh chemists in the country be allowed to sell it against prescription.
“We are constantly in touch with the states and checking on the availability of drugs. We
can lift the restriction on sale of drug and place it under schedule H1, if the situation
demands,“ said a government official.
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8. IMPORT DEPENDENCE
Besides the list of public health facilities, one can get tested at select private
labs but only after furnishing a prescription. As the flu outbreak intensifies,
at least testing in high-risk groups such as the elderly, pregnant women,
diabetics, people with weakened immune system and children can be
allowed without prescription for faster diagnosis, Kakkar said.
“We have observed a huge surge in swine flu testing from the past month
and it indicates panic. Our main lab at Chennai is working round-the-clock
and we have readied a second lab at Mumbai, for which we are expecting
inspection in the next few days,” admits Nilesh Shah, group president of
Metropolis Healthcare, a leading diagnostic centre which has tested about
500 samples this season and slashed prices of swine flu tests by 12% to .
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9. 4000 two days ago.
Private labs which faced a shortage of diagnostic kits about two months ago, say that they
are well stocked now but over 95% of the diagnostic kits used across the country in swine
flu tests at present are imported from two companies — Swiss firm Roche Diagnostics and
US-based Life Technologies, industry executives told ET.
Same is the case with vaccines — most of which are imported. “With the recent outbreak,
we’ve seen a sharp increase in demand, and are currently in the process of sourcing on an
emergency base, additional doses from our global manufacturing facility in Lyon (France),”
said a Sanofi Pasteur India spokesperson, one of the major vaccine providers. Lack of clarity
on protocols of vaccination has resulted in confusion among doctors and public. The
practices around vaccination since the last outbreak in 2009 has changed and doctors are
not advising mass vaccination, even for family members of the infected. Experts said early
and clear guidelines from the government in this regard could have helped.
Many physicians and health workers handling such cases are not vaccinated while healthy
people with common cold are queuing up for vaccinations, doctors told ET. “In 2009, we
knew very little of the virus and how it will behave and that panic led to mass vaccination.
Now we know that most of those infected will face mild illness and mass vaccination for
healthy people is not recommended,” said Kakkar. Brought to you by
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