SANJA RADOJEVIĆ ŠKODRIĆ, STATE HEALTH FUND DIRECTOR: 'Corona has led to tenfold increase in antibiotic use'

"The consumption of some antibiotics in Serbia has increased up to tenfold due to the coronavirus. When it comes to antibiotics dispensed at pharmacies, the consumption of some of them in December increased between five- and sevenfold compared to the average monthly consumption in 2019. As regards antibiotics administered by injection or through IV at hospitals, the consumption of some of them rose five- to tenfold compared to the average monthly consumption in 2019," Acting Director of the State Health Insurance Fund (RFZO) said in her interview with Kurir.

Antibiotics are taken left, right, and centre, when they are needed as well as when they are not …

"It is incredibly important to follow the protocols and specialist guidelines in prescribing antibiotic medications. The protocols specify that antibiotics are not administered as a matter of routine but only when necessary, especially for fear of developing potential resistance. Further, these medications can be dispensed at pharmacies only with a prescription or a medical specialist report."

We are also facing the shortage of the antibiotic Levofloxacin.

"As regards Levofloxacin, a number of manufacturers make it. Although all products are never available in the market at the same time, there are always some, so patients can get this antibiotic. The State Health Insurance Fund's website publishes the list of pharmacies to which it has been delivered."

What is the situation with Fraxiparin, which is used to prevent blood clotting?

"The temporary interruption in the supply of Fraxiparin to pharmacies early this year was due in part to a multiple increase in consumption in the treatment of Covid patients. When these patients are released from the hospital, some of them need to take this medication at home for several more weeks due to elevated D-dimer levels. The other reason was the change of the company responsible for this medication. Fraxiparin had for years had a major share in the consumption of the low-molecular-weight heparin class of medications, which is why it is in highest demand at pharmacies. Since then, there have been no problem with the supply. The State Health Insurance Fund website publishes the list of pharmacies to which the medication has been delivered."

We have also recently procured the US medication Bamlanivimab.

"We have secured Bamlanivimab, which is a new neutralizing antibody class medication, for 5,800 patients. Obtaining these medications was very difficult, given that the production capacity is limited. They are not used on a mass scale even in the country where the manufacturer is based, as antibody production is very expensive."

It is great that we have got hold of it, but the quantities are insufficient to meet all our needs.

"New deliveries of the medication will be made in April and May. Serbia is the fourth country in Europe – alongside Germany, Hungary, and the Czech Republic – to have Bamlanivimab. It is administered as a one-time IV dose in the first ten days following the onset of symptoms, with patients older than 12 years of age and weighing in at over 40 kg. It is used when patients have a mild and moderate form of the disease and are at a high risk (due to obesity, diabetes, or a cardiovascular condition) of developing a severe form and ending up hospitalized. Treating patients in this way in the early stage of the disease prevents hospitalization and eases the Covid hospitals' workload."

'Third Covid hospital to be built'

Are the wait lists exceedingly long due to the coronavirus?

"Diagnostic procedures, surgical interventions, and medical check-ups are slower or delayed. There is also the psychological aspect with patients who do not see a doctor due to fear of infection. Building two new Covid hospitals – with the third one in the works – has helped a lot to increase the capacity of the medical facilities treating Covid patients, aimed as it is at reducing the pressure on other institutions and freeing up the capacity to treat chronic patients. The current wait lists are not very different from pre-Covid ones. The State Health Insurance Fund monitors the wait lists and redirects patients in line with the available capacity at a given time."

Are there more Covid medications in the pipeline?

"The coronavirus situation has demonstrated the importance of innovation and its rapid deployment, as we have seen with the vaccines. At present, all the Covid-specific medications are available – Favipiravir, Remdesivir, Tocilizumab, and the monoclonal neutralizing antibodies – and they are included in the official Covid treatment protocol in Serbia. We will continue to follow the recommendations of expert professionals in procuring all the required medications, expanding thus the range of instruments in the fight against this epidemic."

Will 2021 see a significant expansion of the Innovative Medications List?

"Due to the coronavirus situation, a new list was not adopted as planned last year. However, it was adopted at the start of this year, containing 16 innovative medications. During the Covid crisis, there has not been a single interruption in the process of innovative therapy approval. That said, what has happened is the slowing down of the diagnostic procedures necessary for the application of an innovative therapy. Innovative therapies are very expensive and including all these medications in 2020 wouldn't have been possible had not additional budget funds – in the amount of five billion dinars – been secured. However, as Covid impacted on the Medications List scheduling, app. 2.3 billion dinars were carried over from 2020. Given that the 2021 budget sets aside 3.5 billion dinars, 5.8 billion dinars are earmarked for new innovative medications. This is the largest sum ever set aside for innovative medications. The State Health Insurance Fund is preparing a new Medications List, and we hope to have it very soon. The Fund has made tremendous progress in the past two years, with as many as 54 innovative breast and lung cancer, and multiple sclerosis medications included in the list. The importance of innovative therapy lies in the fact that patients receive a more efficient treatment, increasing their lifespan and boosting the quality of their lives. The added effects on the health system and the society at large are seen in shorter hospital stays and sick leaves, as well as in preventing early retirement."

There is no hope from COVAX?

"Vaccine negotiations aren't at all easy, even for bigger and economically stronger countries than Serbia. However, we have already managed to obtain vaccines from multiple manufacturers, offering our citizens a choice of which vaccine to take. Serbia is also a signatory to the COVAX programme, which assigns vaccine quotas to individual countries. However, we have not relied solely on COVAX, through which we have not yet received any vaccines. Instead, we negotiated directly with the companies, and in this way we have received the Pfizer and AstraZeneca vaccines. We also had negotiations with the partners from Russia and China, in which the President of Serbia played an important role. The vaccine is one of the most important gains of medical science. In order to bring the pandemic under control and eventually win in the fight against it, vaccination and adherence to the epidemiological measures are the only way. This is why it is very important to make sure that as many people as possible get the jab as soon as possible."

(Kurir.rs - J.S. Spasic)