The bidding to fight malaria

Sometimes the forest is not seen because of the trees. Often times it may be due to a deliberate refusal to step back and see that larger picture. This appears to be the case in the insistence of some in the local media houses, especially the Kaieteur News and the Stabroek News, not to examine the government’s procurement practice as it relates to pharmaceuticals, in a dispassionate and objective fashion. And of course, most opportunistically, the opposition politicians jump in.
Concerns about government procurement worldwide are undoubtedly valid. The experience of most jurisdictions has shown that unless strict controls are in place there will be abuse. After the release of the last auditor general’s report, there were sensationalised reports centred both on the quantum of purchases made from the New GPC and also on the system of ‘pre-qualification’ used to procure certain pharmaceuticals. The reports betrayed a serious lack of knowledge about the demands of the pharmaceutical trade, for instance, in terms of securing authentic drugs; rationales for using brand-name rather than generics and storage to maintain their efficacy and ensuring that supply chains remain unbroken.
“Pre-qualification” is an effort by the government to ensure that bidders have already achieved the minimum benchmarks that would ensure that the above demands are satisfied. Even though the government and other institutions, including this newspaper, attempted to explain the nuances of the issue, it appears to have fallen on deaf ears. The same newspapers have repeated the identical alarmist spurious charges over a submission of bids in response to a government’s request for anti-malarial drugs. Incredibly, this time, the tender board has not even made its selection between two bids submitted.
What triggered the latest feeding frenzy was the large monetary difference between the two bids and their reflexive assumption that mischief was afoot. Interestingly enough, such mischief was thought capable of emanating only from the higher bid. The fact that that bid came from the NEW GPC, which they had consistently attacked since its CEO launched this competitive newspaper, only ratcheted up their attacks.
The SN and KN were standing so close to the pharmaceutical trees with their corruption-coloured glasses that they could not (or would not) see the lower bid could have been flawed.
They were either too lazy to investigate the background on anti-malarials or were too consumed with bitterness to care. In either case they were mis-educating the Guyanese public on a critical public health issue. Malaria, according to the WHO, caused approximately 650,000 deaths in 2010, which was a five per cent decrease from the previous year.
The primary cause in the previous decade was the WHO’s advocacy of bed nets, better diagnostics and a new treatment that included the brand-name drug Coartem.
In 2004, Guyana was brought aboard the standard and we saw the same decrease in malaria rates as other countries using the formulation. Countering this welcomed progress, however, was a new development: the emergence of poor quality and fraudulent anti-malarial medicines. In an article, “Poor-quality anti-malarial drugs in south-east Asia and sub-Saharan Africa” the prestigious medical Journal “The Lancet Infectious Diseases” warned in June that “Poor-quality anti-malarial drugs lead to drug resistance and inadequate treatment, which pose an urgent threat to vulnerable populations and jeopardise progress and investments in combating malaria.”
In August of this year, a study in Malaria Journal demonstrated that 58 per cent of all anti-malarials sold in Guyana outside the government’s health distribution system (Coartem distributed for free) was defective in one way or another. If drug resistance is allowed to develop and spread, our interior potential will never be realised–not to mention the unnecessary deaths we will suffer.
The company making the lower bid has now admitted that theirs was not based on the original Coartem but a generic substitute. It is integrity of these ‘substitutes’ that the WHO and all experts warn against. Should we pay dice with this dreaded killer in the official health system? Let us be warned.