There are at least three reasons for this: (i) phages possess different biological, physical, and pharmacological properties compared to conventional antibiotics. To date, no whole phage or phage derived products are approved for human therapeutic use in the EU or USA. The long clinical history of phage therapy in Eastern Europe, combined with more recent in vitro and in vivo success, demonstrates the potential for whole phage or phage based antibacterial agents. This has led to a number of well publicized calls for global funding initiatives to develop new antibacterial agents. The global rise of multi-drug resistant bacteria has resulted in the notion that an " antibiotic apocalypse " is fast approaching. Many low- and middle-income countries need to: (i) strengthen public systems for medicines’ management, to improve inventory control and the reliability of procurement forecasts (ii) reduce stress on central medical stores, through liberalization and reimbursement schemes (iii) strengthen the regulation of drug donations (iv) explore the salvage of officially expired pharmaceuticals, through re-analysis and possible shelf-life extension (v) strengthen the enforcement of regulations on safe drug disposal (vi) invest in an infrastructure for such disposal, perhaps based on ultra-high-temperature incinerators and (vii) include user accountability for expired pharmaceuticals within the routine accountability regimes followed by the public health sector. The rates of pharmaceutical expiry in the supply chain need to be reduced and the disposal of expired pharmaceuticals needs to be made both timely and safe. If not adequately monitored or regulated, expired pharmaceuticals may be repackaged and sold as counterfeits or be dumped without any thought of the potential environmental damage. In low-income countries like Uganda, many such stockpiles are the result of donations. In some low- and middle-income countries, the national stores and public-sector health facilities contain large stocks of pharmaceuticals that are past their expiry dates. Facilities may need to invest in infrastructure to maintain stockpiled materials after purchase to ensure viability. This not only represents wasted resources, but it could also hinder disaster response, leading to increased morbidity and mortality. Although almost all sites claimed to assess the stockpile annually, results from this study indicate that almost half of the supplies are either missing or in an unusable condition. Decontamination equipment and pediatric supplies had the lowest percentages of deployability (29.0% and 37.7%, respectively). The best-maintained supplies included personal protective equipment (79.4% deployable) and general medical supplies (73.5% deployable). On average, 60.1% of each site's cache materials were present and deployable (range: 22.1%-87.5%). Almost all sites (93.3%, n = 14) reported that they inventory their cache at least once a year.
The percent of deployable materials was calculated for each item, each category of supplies, and for the entire cache.
Stockpiled materials were categorized by the type of supply or equipment for analysis. Each supply was assessed to determine whether the correct amount was present, if it was in a safe and usable condition (ie, deployable), and whether it had expired. An assessment was performed in the summer and fall of 2016 on a regionally funded stockpile that was decentralized through a regional network of 15 local hospitals. The purpose of this study was to assess a regional stockpile to determine its viability and readiness. Stockpiles can aid with healthcare surge that occurs after a disaster, and experts recommend that these caches be assessed at least annually to ensure supply integrity.
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