Lives at risk as antifungal medicines are either unavailable or costly: study

The study carried in the Journal of Antimicrobial Chemotherapy is based on results of the largest survey ever conducted in 159 countries by the Global Action Fund for Fungal Infections

Karachi

The world is in the grip of a global crisis that kills the equivalent of the populations of Philadelphia, Kampala or Prague – around 1.6 million each year.

Fungal infections attack the skin, hair or nails, can cause serious infections in the lungs and may spread through the body and, without the drugs to fight back, claim the lives of over 3,500 people every day.

A new study has found that two critical antifungal medicines that are used to treat life-threatening infections are either unavailable or unaffordable in over 95 countries, including Pakistan.

The study in the Journal of Antimicrobial Chemotherapy is based on results of the largest survey ever in 159 countries by the Global Action Fund for Fungal Infections (GAFFI), said a statement issued by the Aga Khan University.

Dr Kauser Jabeen, associate professor of pathology and laboratory medicine at the Aga Khan University and Pakistan ambassador for GAFFI, commented that it was becoming increasingly difficult in Pakistan to treat fungal infections as life-saving and safer antifungal medicines were often not available, were available in limited amounts or were expensive and unaffordable.  In Pakistan, a nationwide population-based survey of fungal infections has never been carried out and so the public health burden they represent is unknown.

Only limited data available is from laboratory and hospital-based reports. Yet the population at high risk from life-threatening fungal infections that are a consequence of other health problems such TB, diabetes, chronic respiratory diseases, asthma, cancer, organ transplant and HIV is growing.

Professor David Denning of the University of Manchester, president of GAFFI and the paper’s lead author, says it beggars belief that hundreds of millions of people cannot access the optimal therapy for fungal meningitis and fungal lung infections.  “It is doubly tragic that these antifungals have been used since the late 1950s in the case of amphotericin B. Yet the systems for delivering these drugs to the most needy are still not in place.”

The report says that one of the critical drugs for fungal meningitis in AIDS -- amphotericin B-- is not available in 42 countries. The other key drug, flucytosine, is unavailable in at least 95 countries.

Yet both have been available in Europe and the US for over 40 years. The World Health Organisation recommends they are used together to bring down mortality from 100 to 25 percent.  The 25-year-old drug fluconazole is available in all countries and itraconazole is unavailable in just five countries. However, being available is not enough – price also matters as patients pay for their care in many countries. The daily cost of fluconazole varied from $1 to $31, and itraconazole from $1 to $102. In South Africa, which has the largest AIDS burden in the world and a massive TB problem, itraconazole costs about £11.60 per day – unaffordable for most people there.

“Last year GAFFI called on governments to provide fungal diagnostics and antifungal drugs to all their citizens yet there has been a deafening silence. There is clearly a long way to go, but the tragedy is that every day thousands of people die needlessly while the world turns a blind eye,” says Professor Denning.