The Kyrgyz government's failure to pay its bills has left the country's diabetics fearing they may soon be unable to obtain insulin. Western drug makers have cut off shipments to the Central Asian republic pending payment of a $750,000 debt, leaving the country with less than a five-week supply of the life-saving hormone. The coming shortage has reportedly forced Bishkek to consider purchasing cheaper insulin from Ukraine -- a plan some critics say poses health hazards of its own.
Prague, 6 October 2003 (RFE/RL) -- The clock is ticking for Kyrgyzstan's diabetics. Unable to pay its Western pharmaceutical bills, Bishkek has less than five weeks' worth of insulin supplies. For the country's 4,000 sufferers of Type-1 diabetes -- including 155 children -- it is a terrifying prospect.
Pascal Onraed of the International Diabetes Federation in Brussels explained to RFE/RL: "Without insulin, Type-1 diabetics die very quickly. So there are many countries where they are still dying [of the disease]. Also, some individuals react badly to certain types of insulin. But this is periodic and marginal."
In Type-1 diabetics, the pancreas fails to produce insulin, the hormone needed to convert sugar into energy. The resulting deficiency can cause increased glucose in the blood, which in turn can cause severe damage to blood vessels and nerve endings. People with the disease need to have injections of insulin every day in order to control their glucose levels.
The Kyrgyz Health Ministry has appealed to the government, Finance Ministry, and central treasury to settle the debts with Western insulin suppliers. Part of the debt is reportedly being paid off. The Finance Ministry said Switzerland has also pledged to grant funds for the purchase of insulin. The Health Ministry is due tomorrow to hold a tender to buy some $740,000 worth of insulin.
But it is still unclear if new supplies will arrive before current stockpiles are used up. The delivery and registration of new drugs can take up to three months -- far longer than current supplies will last.
There are also concerns that the government will proceed with the purchase of low-cost insulin from Ukraine. Kyrgyz Prime Minister Nikolai Tanaev last month reportedly ordered the state procurement office to buy insulin supplies from the Ukrainian company Indar.
Tatyana Gulyamova is vice president of the Kyrgyz Diabetics Association and the mother of an insulin-dependent son. She is concerned that switching to cheap insulin might affect the health of her child.
"Officials approached the insulin issue incompetently," she told RFE/RL. "They didn't consult any specialists -- they just made decisions from a bureaucrat's perspective and chose what was cheaper and decided to offer us Ukrainian insulin."
Svetlana Mamutova, chief doctor at Bishkek's endocrinology hospital, told reporters that the Ukrainian insulin preparations could cause "serious complications." Treating such complications, she stressed, might cost more than buying good-quality insulin.
Safina, an insulin-dependent diabetic in Bishkek who has taken Ukrainian insulin, agreed. "The insulin which is produced in Ukraine has a lot of side effects on your health," Safina said. "For the state it is more expensive, because, for example, I now have some problem with my kidneys [caused by the Ukrainian insulin]. [As a result], I now need insulin for my diabetes, plus I have to buy medicine for my kidneys. The American insulin, Humulin, doesn't have any side effects."
A Kyrgyz government official told RFE/RL that a decision on the Ukrainian insulin has not been made, and that options are still being considered. But Nikolai Ranko, the director of the Kyiv Institute of Endocrinology and Metabolism, said Indar's products meet international standards, and are not inferior to the insulin made by Western companies.
"The insulin produced by [Indar] complies with all European and American pharmacology standards. Moreover it complies with all World Health Organization requirements. We have been conducting a clinical study and research for several years. We have registered more than 60,000 cases to see whether there are any side effects with Indar-produced insulin. The rate is 2.5-2.8 percent. It is pretty similar to the [rate of side effects seen in insulin made by Western] companies Novo Nordisk, Eli Lilly, and Aventis," Ranko said.
Ranko noted that Ukrainian-produced insulin, which was recently fully licensed in Russia, will participate in a number of tenders in several Russian regions. It is also being licensed in eight other countries.
But some still offer a word of caution. Valentina Ocheretenko is head of the Ukrainian Diabetic Federation and vice president of the International Diabetes Federation. "In our country, we [don't have] any independent office or laboratory checking the quality of any kind of insulin," she said. "So we have to believe official data."
Ocheretenko said 60 percent of insulin-dependent diabetics in Ukraine use locally produced insulin. But children and pregnant woman, she said, use insulin made in the United States and Western Europe.
(RFE/RL correspondent Sergei Danilochkin and Ainura Asankojoeva of RFE/RL's Kyrgyz Service contributed to this report.)