Wall Street Journal - April 11, 2002
Geoff Winestock, Staff Reporter of The Wall Street Journal

The failure is embarrassing for a pharmaceutical company that won praise for its bold decision a year ago to offer its antiretroviral drugs Videx and Zerit to African countries at a discount of 93% below the price in North America. The New York company said Wednesday that demand for the drugs grew so strong its supply chain between the U.S. and Kenya failed to keep pace. Videx and Zerit started to run out about three months ago, placing patients at risk.

Bristol-Myers said new supplies are either already arriving at distribution centers in Kenya or are being cleared by Kenyan customs. But the company called the "stock-out" of the drug a major breach.

"It's tragic," said Bob Lefebvre, the company's senior director for project access in New Jersey. "Stock-outs are unfortunate and can lead to wrong clinical decisions."

Stopping or interrupting a complicated aids drug regimen is potentially dangerous, as it can increase the chances of patients developing resistance and lessen the potential for successful treatment. The drug industry has argued that African countries need to improve their treatment networks and drug-distribution systems before it will make sense for companies to provide those countries with HIV drugs.

"The irony is that drug companies stress the need to have consistent, accurate use of their drugs but here, they are the ones creating the problems," said Wyger Wenthold, a spokesman in Kenya for the health group Doctors Without Borders. The group complained to Bristol about the problem in February and the Kenyan Coalition, an AIDS lobby group, requested action in a letter on March 18.

The supply glitch affects Bristol-Myers's 25-milligram dosages of Videx and 30-milligram dosages of Zerit. Larger dosages are still mostly available, but the stock-out of the smaller dosages made it difficult to give the precise, regular dosages required to maximize the benefits yet reduce the risk of side effects such as liver damage and anemia.

John Wassonga, a Nairobi doctor, said he had to issue knives along with the bigger pills, with instructions to cut them into the right shapes and dosage. But he said patients found it "bothersome" and often mixed up the amounts. The 30-milligram pill of Zerit, he said, was needed specifically for smaller patients weighing less than 132 pounds.

In some cases, hospitals tried to switch patients to a drug called Combivir, which British drug company GlaxoSmithKline PLC is offering at a discounted price to African countries. But the sudden increase in demand caused a stock-out of Combivir in March. That problem has been fixed.

Write to Geoff Winestock at geoff.winestock@wsj.com
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