Materia Medica Malaysiana

Open letter to Health Minister Chua Jui Meng

Dear Datuk Chua,

Citizens' Health Initiative (CHI) wishes to thank you for the reply from officers of the Health Ministry to our email of June 6, 2002 regarding the alleged dumping of HIV-contaminated Factor VIII in Malaysia in 1984/1985 by Cutter-Bayer.

Dr Abdul Rasid Kasri very kindly faxed me a copy of the letter by Dr Yasmin Ayob (dated July 25, 2003) in which she reported that:

Setelah mencari rekod-rekod lama Pusat Perkhidmatan Darah Hospital KL (PPDHKL), didapati memang PPDHKL membeli produk Factor VIII concentrate (Koate) dan Factor IX (Konyne) dari Sykt Cutter/Bayer sejak Julai 1984. Rekod-rekod sebelum ini belum dapat dikesan. Walau bagaimanapun, tidak ada rekod yang mencatitkan samada proses ‘heat treatment’ sebagai langkah mematikan virus dijalankan atau tidak ke atas produk ini, Koata (FVIII Concentrate) dibeli hingga Disember 1989 dan Konyne dibeli sehingga 1997...Melaui perbualan saya dengan Dr G Lopes dan Prof Datin G Duraisamy, FVIII Concentrate dari Cutter memang dibeli sejak 1982. Mengikut Dr Lopes, setelah ‘heat treated’ concentrate dibuat oleh syarikat ini, produk-produk yang telah dibeli ditukar dengan produk yang telah di ‘heat treated’. Memang ada pesakit hemophilia yang menggunakan Factor VIII dan Factor IX yang tidak di ‘heat treated’ sebelum ini.

If we juxtapose what Dr Yasmin reported in her letter to Dr Faisal Hj Ibrahim, against the New York Times article (May 22, 2003) by Walt Bogdanich and Eric Koli:

...At the November [1984] meeting [of Cutter officials], the minutes show, Cutter said it planned to "review international markets again to determine if more of this product [non-heat treated Factor VIII] can be sold."

And in the months that followed, it had some success, exporting more than 5 million units (a typical vial might contain 250 units) in the first three months of 1985, documents show. [heat-treated Factor VIII was being distributed by Cutter in N. American and European markets beginning February 1984].

"Argentina has been sold 300,000 units and will possibly order more, and the Far East has ordered 400,000 units," according to a March 1985 Cutter report. Two months later [ie May 1985], the company reported that "in Taiwan, Singapore, Malaysia and Indonesia, doctors are primarily dispensing non-heated ‘Cutter’ concentrate."

By then, while there were still a small number of buyers in the United States, nearly all of the unheated concentrate was being sold abroad, available records show.

All told, Cutter appears to have exported more than 100,000 vials of unheated concentrate, worth more than US$4 million (approximately RM15.2 million), after it began selling its safer product...

The question that immediately arises is whether Cutter/Bayer withheld information on the availability of heat-treated Factor VIII from its buyers (or used various strategems to induce its buyers to continue purchasing old stocks of non-heated Factor VIII, which appears to have been the case in Hong Kong and Taiwan).

Was this also the case in Malaysia? CHI hopes Dr Yasmin's searches will uncover some documents which can throw light on this.

We appreciate that it may be difficult to establish whether the 11 reported HIV-infected hemophiliacs in Malaysia were infected through contaminated Factor VIII (before or after February 1984), or were infected via cryoprecipitates produced (locally?), or indeed through some other mode of transmission.

What is most important at this juncture, in the context of World Trade Organisation-mandated reductions in ‘trade barriers’, is that we retain adequate national discretion and jurisdiction over imports of potentially hazardous products - and manufacturing processes - as well as tightening up our own internal monitoring and surveillance of products and practices in the international marketplace.

May I also take this opportunity to raise a couple of concerns as a follow-up from last year’s Ministerial Dialogue with NGOs (June 2002):

1) At that dialogue, CHI and the Federation of Consumers’ Association of Malaysia (Fomca) enquired about the representation of organised labour on the Health Ministry sub-committee that was drawing up a fees reimbursement schedule for the National Health Security Fund.

Since salaried workers (and their employers) would be largely bearing the financial burden of national healthcare expenditures under this scheme via payroll deductions, you agreed that it was an oversight that labour was not represented, whilst the Malaysian Medical Association, Association of Private Hospitals of Malaysia, Malaysian Employers Federation, consumerists, and other stakeholders were represented.

It has been more than a year, and my recent enquiries with the Malaysia Trades Union Congress and Cuepacs lead me to understand that neither labour confederation has been invited to send representatives onto that sub-committee.

2) At a national conference on ‘Facing the Challenges of Globalisation and the New Trade Agenda’ (October 10-12, 2002, Penang) organised by the Health Ministry, a consultant from Ernst & Young reported on a survey of health tourism prospects for Malaysia, mentioning that cardiological and cardiothoracic services at that time constituted the largest clinical category (by value) of Malaysia's health tourism earnings. Institut Jantung Negara, according to this consultant, was a key player in this.

CHI believes that the Malaysian public is not against foreign nationals benefiting from our national healthcare capabilities, indeed we can take pride in this.

CHI however is much concerned when more and more of our local health resources are diverted to serving regional (and national) healthcare priorities as dictated by economic (market) demand, rather than on the basis of need.

Reportedly, the queuing time for a stress test at our public heart centres is currently in the region of three months.

At the 2003 Malaysian Health Conference ‘Partners in Health’ (June 23-24, 2003, Kuala Lumpur), organised by the Asian Strategy and Leadership Institute (Asli) I asked Health Ministry Director of Medical Practice Division Dr Ong Chee Leng for some statistics on health tourism services provided by our public hospitals. She said she would get back to me, and we look forward to her further communication.

May I end by thanking you again for your kind responses to our current concerns with the Malaysian healthcare system.

We deeply appreciate these dialogues and exchanges, and we sincerely believe that they can only enhance the performance of our healthcare system and its governance.

Chan Chee Khoon
Co-ordinator
Citizens’ Health Initiative