From 2020 to now, our country has had 3 outbreaks of botulinum poisoning with many people infected and this poisoning can only be saved by antidotes. However, after the Minh Chay pate poisoning incident in 2020, Bach Mai Hospital proposed the need for a national rare medicine storage center, managed by the Ministry of Health, located in the regions, when an incident occurs, it will be immediately coordinated to the locality to promptly treat the patient. However, up to now, after 3 years, Vietnam still does not have a national rare medicine storage center.
The medicine is slow, the patient has no chance to live.
Botulinum poisoning is a very rare poisoning in Vietnam and in the world, but it has appeared in our country. For botulinum poisoning, antidotes are the most optimal treatment. But unfortunately, because this is a rare drug, Vietnam does not have it.
Doctors from Cho Ray Hospital collaborated with Quang Nam Regional General Hospital to save a patient with botulinum poisoning.
When the carp poisoning incident occurred in March in Quang Nam, Vietnam only had 5 vials of antidote from Cho Ray Hospital (Ho Chi Minh City) and they were transported to save the seriously ill patients. During the treatment process, only 3 vials were used up, so when there was a botulinum poisoning incident involving 3 siblings who ate street-side ham in Ho Chi Minh City, Cho Ray Hospital transferred the remaining 2 vials of antidote from Quang Nam to save the lives of these 3 children. Currently, 1 child has been discharged from the hospital, 2 children are still being treated.
As for the cluster of botulinum poisoning cases that occurred shortly after, including 3 people in Thu Duc City (18, 16 and 45 years old), these patients were not so lucky because they ran out of antidotes. All 3 progressed very quickly, requiring ventilators and maintenance medication. However, without antidotes, their lives would be in danger. Meanwhile, the whole country ran out of antidotes. Cho Ray Hospital sent an urgent document to the Ministry of Health and the Ho Chi Minh City Department of Health requesting urgent import of BAT antidotes for patients as well as to prepare for the possibility of new cases.
More than 10 days later, although the Ministry of Health asked the World Health Organization (WHO) for urgent support to import the antidote BAT, by the evening of May 24, 6 vials of Botulism Antitoxin Heptavalent sent from the WHO warehouse in Switzerland had arrived in Ho Chi Minh City, but unfortunately, the patients did not wait in time. The 45-year-old patient died on the night of May 24, two critically ill patients (18 and 26 years old) being treated at Cho Ray Hospital have passed the most effective time for drug infusion. Currently, these two patients have been holding on for more than 10 days on ventilators in a state of almost complete muscle paralysis.
Regarding this issue, Mr. Le Viet Dung - Deputy Director of the Department of Drug Administration, Ministry of Health said: To speed up the progress of receiving medicine, the Ministry of Health has proactively contacted WHO to request support in searching for medicine reserves in the region and globally to be able to meet domestic treatment needs as soon as possible. WHO announced that there are currently 6 tubes of medicine left in the global warehouse in Switzerland and immediately sent an expert to transfer the medicine to Vietnam on the same day. On May 24, the medicine was transferred to Vietnam and the Ministry of Health immediately transferred it to medical facilities to treat patients.
However, the antidote arrived too late. According to an anti-poison expert, for rare drugs, hospitals are almost unable to bid because there is only one manufacturer. Therefore, a special mechanism needs to be put in place.
National level negotiations needed
According to anti-poison experts, not only botulinum but all types of poisoning are in an emergency situation. Antidotes are emergency drugs that can save the patient's life immediately and cannot be scarce. Antidotes have a really clear effect and can even reverse the patient's symptoms. In fact, the number of poisonings caused by bacteria with strong toxins is not much, but antidotes are really effective in saving the patient's life and reducing the cost of long-term treatment. There are diseases that if there is no antidote, death is certain and cannot be cured, such as cyanide poisoning. If there is no immediate infusion, the possibility of death is high. Or for patients poisoned by cobra venom, if there is an antidote, it will help shorten the treatment time and avoid long-term hospital infections, which is very dangerous.
If the antidote is used late, the treatment will be less effective. However, in cases of force majeure, there are drugs that are still good for the patient even if used late, except in cases where they are a month late. Anti-poison experts explain that there are two types of rare drugs: Rare drugs for diseases that often occur at regular frequencies (specialized diseases such as hematology, oncology, metabolism), this type can be planned and bid for in stable quantities; Rare drugs, equipment, and supplies for emergency situations such as single or mass poisoning, especially special drugs, the calculation of surplus or shortage is unpredictable, cannot be bid for on its own but must be included in the list of national strategic reserves.
Under current regulations, medical facilities cannot bid to purchase rare drugs for emergency situations. Because drugs for erratic, unstable diseases are expensive, medical facilities do not want to buy them; or pharmaceutical companies do little research, production, trading, distribution... Accordingly, prices can only be negotiated at the national level.
Speaking to reporters of CAND Newspaper, Deputy Minister of Health Do Xuan Tuyen said that, implementing the Prime Minister's direction, in the third quarter, the Ministry of Health will have to report on the mechanism to ensure rare drugs and drugs with limited supply. The Ministry is developing a plan, in which it assigns units to propose and collect opinions from health agencies, then collects and proposes solutions from the procurement mechanism, management of use and payment mechanism for rare drugs and drugs with limited supply. The Ministry of Health plans to deploy in 6 socio-economic regions and will research and select centrally-affiliated hospitals located in the area and assign management, instructions on use and drug coordination. According to Deputy Minister Do Xuan Tuyen, the Ministry of Health is currently reviewing all legal documents, and will soon establish a drafting committee and issue a guiding circular.
According to Mr. Le Viet Dung, it is expected that 3-6 centers will be established to reserve rare drugs nationwide. The number of drugs in the reserve list is from 15-20 types and botulinum is also one of the drugs in this list. The Drug Administration is also meeting with WHO to study the WHO's storage mechanism, to have a connection between the storage of rare drugs, drugs with low supply in Vietnam as well as neighboring countries in the region, as well as WHO's warehouses.
Currently, the legal basis for rare drugs is basically complete, therefore, the Drug Administration has issued documents requesting medical examination and treatment facilities nationwide to be proactive in building demand, forecasting the epidemic situation, as well as estimating the necessary quantity and purchasing drugs to ensure adequate response to treatment needs, especially for rare drugs.
It is thought that the deployment of a rare medicine reserve center needs to be quick and timely to prevent situations of poisoning or mass disasters, to have rare medicines for emergency treatment, saving the lives of patients.
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