Concerns about recent bird flu outbreaks and public health issues in China are drawing scrutiny from Congress and interest
in bolstering FDA oversight of soaring food and drug imports from that country. Shipments of FDA-regulated products from China
increased from 1.3 million entry lines in 2007 to 4.5 million in 2012, reported Steven Solomon, FDA associate director for
global operations and policy, at a May hearing by the Congressional-Executive Commission on China. Solomon noted that FDA
now has 74 active import alerts for Chinese food and drug products, which allow detention or refusal of entry into the US,
and that the agency is collaborating more with the Chinese FDA (CFDA) to address concerns. FDA staffers meet regularly (by
video conference) with Chinese counterparts to discuss economically motivated adulteration of products and have worked jointly
to shutdown websites illegally selling unapproved drugs. CFDA has provided FDA's China office with a list of domestic pharmaceutical
firms that failed to comply with GMPs, enabling FDA to target 61 violative firms shipping products to the US.
ARV supply chain
The President's Emergency Plan for AIDS Relief (PEPFAR) marked its 10th anniversary in May 2013, amid kudos for success in
providing antiretroviral therapy to millions of stricken individuals in Africa and other nations, as well as calls for more
effective and efficient treatment and care programs. So far PEPFAR has provided $1.2 billion in ARV drugs to some 5 million
people, promoting the use of combination therapy and transforming the deadly disease into a manageable epidemic in some places.
An April 2013 report from the Government Accountability Office notes the need for better controls and recordkeeping to ensure
that ARV supply chains are secure and establish appropriate inventory controls and records to avoid shortages, waste and loss
of inventory. The aim is to expand the program to serve 23 million eligible people, and further improvements in drug supply
chains are "critical," the study concludes (2).
Shortages in TB treatments
Efforts to control and treat tuberculosis have been hampered by a shortage of first-line treatment isoniazid (INH), according
to reports from the Centers for Disease Control and Prevention (CDC). Manufacturers have had problems obtaining active ingredient
supplies, prompting production delays. Shortages in all TB drugs are even more severe in India and other regions, fueling
a spread of multi-drug resistant TB strains as patients are forced to stop taking medicines. Manufacturers Sandoz and Teva
have moved to ramp up production in response to a temporary shutdown at VersaPharm. A lack of clear procurement projections
by government health programs, as well as low prices for these widely used drugs, have discouraged additional manufacturers
to move into the TB drug market.
1. Avalere Health, An Analysis of Access to Anticonvulsants in Medicare Part D and Commercial Health Insurance PlanS, June
2. GAO, President's Emergency Plan For AIDS Relief: Drug Supply Chains Are Stronger, but More Steps Are Needed to Reduce Risks, GAO-13-483, Apr. 26, 2013,