Malaria-stricken Tripura has been buying the wrong malaria drugs for two years prior to an outbreak that has earned it the unenviable distinction of having lost more people to the disease in the past month and a half than it did in the last four years.
On Friday, an FIR was filed against Tripura’s health secretary M Nagaraju, additional health secretary Dr Satya Ranjan Debbarma and mission director of the National Health Mission’s state unit Dr Sandip Namdeo Mahatme in connection with the malaria outbreak, which has claimed almost 70 lives and infected more than 30,000 in the state.
Congress leader Ashok Sinha alleged in the FIR, lodged with the West Agartala police station, that the “negligence” of these three officials resulted in the deaths. The deceased include almost 50 children less than 10 years of age.
“The mission director…floated a short notice inviting tender…for purchase of anti-malarial drugs nearly a month after the outbreak. All such drugs ought to have been purchased much earlier as there was no dearth of funds,” the FIR said.
“These criminal acts by the three accused which led to the loss of lives of innocent people, mostly children… should be investigated and punished in accordance with the provisions of IPC and Drugs And Cosmetics Act,” the FIR added.
Tenders floated for the purchase of medicines by the state’s Directorate of Health Services (DHS) for 2013-14 and 2014-15, accessed by the The Indian Express, show orders were placed for malaria drugs that are supposed to be used neither in Tripura nor in other Northeastern states, while the main drug prescribed for these states was entirely absent from the two tenders.
Doctors who asked not to be named for fear of the government said the toll — the official number of deaths is inching towards 70 and the official number of confirmed cases has already surpassed 30,000 since the outbreak in June — may have been much less had the right medicines been available.
The Directorate of National Vector Borne Disease Control Program under the Union Health Ministry had last year issued national guidelines for the treatment of malaria. Those guidelines specify that Northeastern states should use a drug combination called ACT-AL (Artemisinin-based Combination Therapy of Artemether and Lumefantrine) followed by doses of primaquine to treat malaria cases because of resistance developed against other drugs. For other states, the guidelines recommend the use of ACT-SP (Artemisinin-based Combination Therapy of Artesunate, Sulfadoxine and Pyrimethamine) and doses of chloroquine.
The 2014-15 and 2013-14 tenders floated by the Tripura government’s DHS, however, asked for a total of 1,000 tablets plus 500 combi-packs of ACT-SP and 20 lakh chloroquine tablets, and 30,000 60 mg bottles of chloroquine syrup, while completely omitting ACT-AL, and placed orders for just four lakh tablets of primaquine but no syrups.
“Officials responsible for drug purchases have made a terrible mistake that has cost the lives of scores of people, many of them young children. If the right medicines were available surely most of the victims would have recovered,” a senior government doctor said.
Others said the actual number of deaths and infections was likely higher than the official figures. “The area where the outbreak has taken place is tribal-dominated and connectivity is a major issue,” another doctor said. Indeed, the state government has roped in paramilitary forces for transportation.
Errors in the government’s drug purchases over the past two years in fact led to the state having to turn to Orissa for drugs, and the state unit of the National Health Mission, which was earlier not involved in drug purchases, was forced to float a tender for medicines towards the end of June when it had already been several weeks into the outbreak.
The emergency move has helped ease the drug supply, and NHM mission director Dr Sandeep Mahatme said fresh supplies have come in. “We have distributed 60,000 tablets and 20,000 tablets are in stock as back-up,” he said.
Tripura Health Minister Badal Choudhury, who took over a week before the malaria outbreak erupted in June, has said “allegations” of erroneous drug tenders were “utterly false”, and had been propagated by “the opposition, particularly the Congress”.