Forty days into the winding up of GlaxoSmithKline’s 60-year-old pharmaceutical unit’s operation in Bangladesh, some of the vital vaccines marketed by this London-based healthcare giant seem to be out of stock even in places across capital Dhaka and the port city of Chattogram. The Independent found out that vaccine for chicken pox--Varilrix-- is not available almost anywhere in the two cities and elsewhere in the country. The vaccine Cervarix, used for cervical cancer too is not available in the market. Another vaccine, ‘Engerix-B’, used for preventing hepatitis B is only available in some places in Dhaka, but not in Chattogram.

These vaccines do not have any generic alternative and no other pharmaceutical company is manufacturing or marketing those as of now, posing threat to healthcare services.

Despite the fact that Varilrix had been marketed solely by GSK and that the government authorities concerned knew that there has been a vacuum in the market following the GSK departure, they decided to sit on this information.

They failed to foresee any possible crisis in the market and did not even take any preemptive measure to replenish the market with ample supply or commission any local manufacturer for prompt production of chicken pox vaccine.   

When contacted, Md Serajul Huq Khan, Secretary to the Health Services Division under Ministry of Health and Family Welfare, said he was not aware of the matter.

“I have no information in this regard. I have to check into the matter. For any specific information in this matter, you better contact the director general of the Directorate General of Drug Administration (DGDA),” the secretary told this correspondent.

As the DG of the DGDA, Major General Md Mustafizur Rahman, is currently out of the country, The Independent talked to the spokesperson of the DGDA.

The spokesperson, Mohammad Ruhul Amin, also a director of the DGDA, admitted that there was a scarcity of those vaccines in the market.

Amin admitted GSK was the sole manufacturer and marketer of Varilrix and there is only one local company—

Incepta—that has applied to the DGDA for the license to manufacture a generic alternative to the medicine.

“So, at present, there is no alternative available in the market.”

The GSK took the decision of shutting down its pharmaceutical unit in the country in July this year, as the pharmaceutical unit was incurring losses for years and pulling down the profits made in its consumer healthcare unit.

GSK, while announcing its proposed shut-down, however, had assured that “all of its medicines have generic alternatives” and said GSK vaccines, which are purchased via Unicef and funded by Gavi, the Vaccine Alliance, “will continue to be available in Bangladesh.”

Renowned paediatrician Prof Dr MAK Azad Chowdhury told The Independent that though Varilrix does not fall under the category of essential vaccines, many parents prefer vaccinating their children with Varilrix to prevent chicken pox.

“This is an important vaccine and, in the last one month, the market seems to be out of stock of this,” said Chowdhury, who heads of Department of Neonatology at Dhaka Shishu Hospital.

Dr Mahadi Abdur Rauf, a doctor of the Northern Medical College and Hospital, told The Independent that he couldn’t give any vaccine of chicken pox to the patients as there “was no vaccine available”.

“As far as I know, the vaccine of chicken pox was only produced by GSK, but for the last one month I don’t see the vaccine Varilrix. I have to say no to the parents who were seeking vaccination against chicken pox for their children,” he said.

Talking with The Independent, Munur Uz Zaman, a pharmacist in Laaz Pharma’s Mirpur branch, said no vaccine of GSK is available for the past one month.

“They have shut down their factories. In the last one month, we had no vaccine of GSK available in our pharmacy,” said Zaman, who works in the country’s largest pharmacy chain shop.

In Chattogram, Shafiqul Islam, owner of Shafiq Pharmacy near the Chittagong Medical College, told The Independent that none of the vaccines including Varilrix, Cervarix, and Engerix-B were available anywhere in the port city.

“I had to say no to a number of customers who were looking for vaccines, especially for chicken pox,” he said. The Independent sent a set of queries to GSK and the company sent the answers through its designated public relations agency Forethought PR.  GSK said it does not produce or manufacture any vaccines in Bangladesh.

The company markets a total of eight vaccines—Cervarix, Rotarix, Infanrix Hexa, Engerix-B, Varilrix, Rabipu, Havrix, and Synflorix—and these vaccines are imported from GSK’s global manufacturing sites.

 These vaccine solutions are used for hepatitis A and B, cervical cancer, chicken pox, measles, mumps and rubella, rotaviral diarrhoea, pneumonia etc.

 However, due to the recent announcement of the proposed closure of the pharmaceutical business unit of GSK Bangladesh, availability of all GSK medicines and vaccines will be phased out in the private market by the end of this year.

 When asked, the GSK spokesperson admitted that because of the proposed closure, there was a disruption in the supply chain and “some vaccines might not be available in some places”.

The company said, “All GSK medicines are substitutable with alternate generic brands and, therefore, patients will be able to access a range of suitable options.” But it was found out by The Independent that no generic alternative to the chicken pox vaccine Varilrix was available in the market.

When asked, the GSK said, “This vaccine does not fall under the list of essential vaccines in the Bangladesh government’s Expanded Program for Immunisation (EPI). Moreover, this is extremely low in demand. We sell only a few hundred chicken pox vaccines every month. It was mostly unavailable over the last few years due to both global manufacturing constraints and low market demand. However, we still have some stock available.”

The company, however, said, patients’ access to vaccines and medicines remains a priority for GSK. The company will continue to supply vaccines purchased via UNICEF and funded through Gavi for the ministry of health to the EPI.

When asked about the vaccine of cervical cancer Cervarix, the company said, “Cervarix has an alternative brand available in the market from another multinational company. And we also have stock of Cervarix that can cater for at least 6 months. Early next week, we will introduce a hotline to facilitate access of such vaccines and medicines in case of emergency to Healthcare Personnel (HCPs) and patients.”

The company said, “All of our essential vaccines have alternatives available from local and global companies in Bangladesh. We have requested HCPs not to enroll any new GSK vaccines.”

 The company added, “To facilitate access to GSK medicines and vaccines, next week onwards we will operate through a hotline number that will be advertised on newspapers early next week. Also, patients with prescriptions can collect such products from our sole distributor Zuellig Pharma’s branch offices across the country.”

 “However, to enable subsequent 2nd/3rd doses of any GSK vaccine and to complete vaccination (for those who have already taken the 1st/2nd doses of GSK vaccines) as per schedule, we have maintained reasonable stock with our sole distributors branch offices to be available for a limited period on prescription,” it added.

 GSK Bangladesh, in early 2018, started a process of reviewing its business in Bangladesh as part of its parent company’s decision of March last year to combine operation in emerging markets. In the review, the company found that it was making losses in the pharmaceutical segment of its businesses. The board later decided to close the segment and continue with consumer healthcare segment running well in profit.