The drug should have brought relief to a diabetes-related eye condition that had been bothering Mumtaz Akhter for weeks. Instead, it plunged her world into darkness.
“I was injected on Wednesday evening and next morning it was all dark in my eyes, I completely lost my eyesight,” said the 65-year-old, from the city of Sadiqabad, in central Pakistan.
Akhter is among 68 diabetic patients from Punjab, Pakistan’s most populous province, who went completely blind after being injected with Avastin, a cancer drug manufactured by the Swiss pharmaceutical company Roche.
Two men, who were believed to be distributing the drug in the province, have been arrested in relation to the matter.
Pakistani health authorities have since pulled the drug from shop shelves and launched an investigation, amid fears that counterfeit Avastin injections have been sold at scale on the country’s healthcare market, which has long been plagued by medicine shortages.
“Incidents of loss of vision in diabetic patients have been reported following treatment with Altered/Dispensed/Diluted Avastin injection,” the Drug Regulatory Authority of Pakistan (DRAP) said in a statement.
Javed Akram, Minister for Specialised Health in Punjab said police were questioning two men they believe to be the drug’s distributors.
“A high level committee has been constituted to probe the issue. A case has been registered against the distributor and his aide,” Mr Akram said.
Avastin is approved in more than 130 countries as a targeted drug for several types of cancer; however, when used off-licence in low doses, as is the case in many poorer countries, it can serve as a cheap option to treat certain eye conditions, of the type which can arise in diabetes patients.
Ms Akhter was recommended the drug by a local doctor in Sadiqabad, who pointed her in the direction of a middle man, according to her family.
She is currently in hospital in the eastern city of Lahore and facing uncertainty over what is to come. The 65-year-old has been suffering from high fever and vomiting for the past two days.
“My eyes still have swelling and I am unable to see,” Ms Akhter told the Telegraph. “Doctors are treating it with medicines and waiting for the swelling to end so that they can go for surgery … I have no idea if my eyesight will be brought back or not.”
Race to contain counterfeit drug
Doctors fear that the diabetes patients who were treated with Avastin may develop endophthalmitis, an inflammation of the eye, and could suffer from further complications in the coming days.
It is the latest pharmaceutical scandal to rock the region. Earlier this year, Indian-made cough syrups contaminated with toxic chemicals were linked to the deaths of scores of children in Gambia and Uzbekistan.
Another brand of cough syrup linked to several deaths in children in Cameroon was last month disclosed to have also been manufactured in India.
Health authorities and experts in Pakistan are now racing to determine how the 68 people developed blindness after being injected with Avastin.
“There is the possibility that these injections may not be genuine ones and a third unauthorised party may be selling counterfeit injections with Roche labels,” Osama Malik, a senior health law expert, told The Telegraph.
“Therefore, DRAP should take over the investigation and look into all aspects. It should also investigate if these injections have been supplied in other provinces.”
In a statement to the Telegraph, Roche said “the vision loss from Avastin has been identified by the authorities as a case of contamination by a third party supplier. Avastin is not approved for any use in the eye.”
It added: “Roche strongly condemns this criminal act of counterfeiting and is doing everything in its power to cooperate with the authorities to protect patients from counterfeits.”
Dr Qaiser Sajjad, a former Secretary General of Pakistan Medical Association, said the “supply chain of the drug has to be checked as it requires special temperature to keep it”.
He also suggested that the local distributors are splitting and repacking the drug from the vials in smaller doses to make a profit and sell it at affordable prices to the patients.
“This is the matter of people’s lives and those involved in this crime should be given exemplary sentences,” said Dr Sajjad. “I fear more cases ahead and the situation could be serious.”
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