Brazil stands accused of neglecting thousands of people with Chagas disease due to a lack of action that will led to a shortage of the only first-line drug used in most endemic countries.

Medicins Sans Frontieres (MSF – Doctors Without Borders) says people suffering Chagas, also known as American trypanosomiasis, will go untreated in coming months due to a shortage of benznidazole. The drug  was initially developed more than 40 years ago by Roche but in July 2003, it signed an agreement to subcontract manufacturing and marketing to a public Brazilian agency, the Laboratorio Farmaceutico do Estado de Pernambuco (LAFEPE).

This means, according to MSF,  that "Chagas treatment currently depends wholly on a single pharmaceutical company to produce benznidazole". In October 2010, the last batches of the drug produced by Roche expired.

It notes that responsibility for producing the active pharmaceutical ingredient used by LAFEPE was recently transferred to one private company, Nortec Química, but "there is not enough API at present to produce the tablets needed, and Nortec has yet to validate production".

Already, MSF’s programme in Paraguay has been forced to suspend diagnosis of new patients in a bid to mitigate the effects of the shortage, while in Bolivia, stocks will run out early 2012. All plans for new projects have been put on hold and the charity claims that "this crisis could have been prevented but the major player involved, the Brazilian Ministry of Health, has shirked its responsibilities and is evidently unwilling to overcome the various challenges".

Parties blame each other for shortage

Indeed, MSF says it "firmly places the onus" on the Ministry of Health for the problem, as it is responsible for LAFEPE, though it adds that "resolution of this crisis will only be possible if the different parties involved stop blaming each other". In successive communications with MSF, LAFEPE has blamed Nortec for failing to deliver the API, while the latter has claimed the firm failed to make precise orders. "Both companies have blamed the Ministry of Health for not unblocking the funds in a timely fashion", notes MSF, adding that the government has again shifted the blame onto LAFEPE.

Henry Rodriguez, MSF’s head of mission in Bolivia and Paraguay, said that "for decades, Chagas was a completely neglected disease and just when diagnosis and treatment were finally being made a priority, we’ve run out of medication. We must not allow this to continue".

MSF has called on Brazil to "spearhead a regional contingency plan for the rational use of the benznidazole stocks among the most vulnerable groups in endemic countries". It is also urging the ministries of health in those countries to demand this contingency plan "to be put in place as soon as possible, while finding a definitive solution for the long term".

Endemic in several Latin American countries, Chagas causes 12,500 deaths per year and it is estimated that 8-10 million people have the disease. Case numbers are rising in the USA, Europe, Australia and Japan as a result of greater international travel.

Picture © MSF