KARACHI: The Pakistan Medical Association (PMA) has issued an urgent national alarm over a severe shortage of essential pediatric tuberculosis (TB) medicines across the country, warning that the situation could trigger a serious public health crisis if immediate action is not taken.
In a statement, PMA Secretary General Dr. Abdul Ghafoor Shoro said the disruption in the supply of TB medicines for children reflects a serious breakdown in the National Tuberculosis Control Program (NTP) supply chain. He warned that the shortage is no longer a routine administrative issue but a full-blown medical emergency that could lead to a rise in drug-resistant TB cases.
Pakistan currently ranks among the countries with the highest TB burden in the world, and the shortage of life-saving medicines could worsen the situation, particularly for children who are among the most vulnerable patients.
Dr. Shoro said reports from healthcare facilities across the country indicate a near-complete depletion of first-line pediatric TB medicines. He warned that interruptions in TB treatment are extremely dangerous and significantly increase the risk of Multi-Drug Resistant TB (MDR-TB).
“When TB treatment is interrupted, the bacteria can survive and mutate, leading to drug resistance. This forces families to undergo longer, more toxic, and expensive treatments,” he said.
According to PMA, Pakistan already faces a high burden of drug-resistant TB. Among previously treated patients, MDR-TB prevalence is estimated to be around 40 percent, and treatment interruptions could lead to further escalation toward Extensively Drug-Resistant TB (XDR-TB), which carries a mortality rate of up to 31 percent.
The association also warned that children are particularly vulnerable to severe forms of TB. Without consistent medication, infections can spread to the brain or bloodstream, leading to conditions such as TB meningitis and miliary TB, which can be life-threatening.
If first-line medicines are unavailable, children may be forced to undergo second-line treatment regimens that can last up to 24 months and may cause serious side effects including liver toxicity, anemia, and permanent hearing loss.
The PMA also clarified that the issue is not due to a lack of manufacturing capacity in Pakistan. Several local pharmaceutical companies, including Remington Pharmaceuticals and Schazoo Zaka, have previously produced TB medicines. In 2023, Remington Pharmaceuticals became the first Pakistani company to receive WHO prequalification for an anti-TB medicine used in drug-resistant TB treatment.
However, many companies previously stopped producing TB medicines due to pricing disputes, as rising raw material costs and fixed retail price caps made production financially unviable. This led to increased dependence on imported medicines.
Although some medicines have returned to the market after pharmaceutical deregulation in late 2024, PMA said pediatric TB formulations remain in critical shortage due to procurement and distribution problems within the NTP and Central Medical Units.
The PMA has urged the federal and provincial governments to take immediate action to prevent a health emergency. The association demanded emergency imports of pediatric TB medicines to address the current shortage and called for accountability within the National TB Control Program.
It also urged the Drug Regulatory Authority of Pakistan (DRAP) to ensure that the benefits of recent deregulation reach the pediatric sector and recommended an immediate and transparent audit of TB medicine stocks across the country to ensure equitable distribution.
PMA warned that failure to address the shortage could lead to a major public health crisis that the healthcare system may struggle to manage.
