Canada is facing outbreak levels of syphilis across the country and a national shortage of the medication used to treat the disease is forcing the federal government to order hundreds of drugs from Australia.
The only Canadian manufacturer of Bicillin, the most effective antibiotic in the treatment of all different phases of syphilis, said it is facing an “out-of-stock situation” and won’t be able to reach normal production of the medication until July.
Pfizer Canada said the national shortage is due to a “production issue” at its manufacturing plant, adding that it is currently investigating the situation and “are working around the clock to ensure that Canadian patients have access to this important medication.”
The medication shortage could also lead to more cases of infectious syphilis, according to Dr. Allison McGeer, director of infectious disease control at Mount Sinai Hospital in Toronto.
“Syphilis is a communicable disease that’s passed from one person to the next and in that setting if you fail to prevent the disease in some people you increase the risk to other people,” she said, adding that treating syphilis is in itself part of the “control program” for keeping incidences of the disease down.
“So the syphilis example is one of the few examples where you actually worry about more disease because you don’t have as good treatment.”
Dr. Supriya Sharma, senior medical adviser at Health Canada, said Canada is facing “outbreaks” of syphilis across the country that are pushing demand for the drug amid the national shortage.
“We’ve had a manufacturer who has had some manufacturing issues and so is working to try to restore the usual supply and that won’t happen until the beginning of July,” she said.
“So then we might be faced with a situation where we have limited supply in the system and a potential shortage of a critical medication to treat a communicable disease.”
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Health Canada’s latest numbers for syphilis rates across Canada show a dramatic spike, rising from 475 cases in 1998 to 3,266 cases in 2013 — a 687 per cent increase in 15 years.
In Ontario, syphilis rates rose from 0.8 cases per 100,000 in 1998 to 6.3 cases per 100,000 in 2014 — an increase of 678 per cent during the same time period. New data from Public Health Ontario shows 1,044 reported cases in 2015 in the province.
Alberta has seen a similarly startling growth, rising from 2.6 cases per 100,000 people in 2011 throughout the province to 8.5 cases per 100,000 in 2015 — a 326 per cent increase in just four years.
And in B.C., syphilis rates hit a 30 year high in February prompting Vancouver Coastal Health (VCH) to initiate a “formal outbreak response.”
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Bicillin is given as a single-dose injection that makes a standard syphilis patient non-infectious within a 24-hour period. Alternatively, oral antibiotics must be taken twice a day for between 14 and 28 days in order to be similarly effective.
“So you can imagine that if you had to take something twice a day for 14 or 28 days that the issue is around making sure that you’re taking all of those doses,” she said.
“It’s effective in terms of treatment but it also takes a longer time for someone to not be infectious and be contagious.”
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Sharma said concerns over the Bicillin shortage have prompted the federal government to work with the Public Health Agency of Canada and provincial health ministries to alter prescribing practices in order to reserve what little the country has left of the drug for the people who need it most.
The “priority cases” include patients who are pregnant with suspected or confirmed syphilis and patients with infectious syphilis and HIV infection, who are at high risk of developing the dangerous condition known as neurosyphilis.
“Bicillin has this tremendous advantage of being single dose therapy, and effective single dose therapy for syphilis, so it’s much easier than taking antibiotics for two weeks,” said McGeer.
“It’s not that there aren’t alternatives for treating syphilis, it’s that we are for a short time losing one of the best ones. Hopefully for a short time.”
McGeer said medication shortages such as with Bicillin have become a “chronic issue” in Canada that the federal government needs to work harder to address.
“It’s Bicillin today, but it’s another antibiotic three weeks from now,” she said. “It’s an ongoing issue with the way we’re managing global supply of drugs and how dependent we’ve become on both just-in-time supply and single source products.”
For its part, Health Canada is taking a three-pronged approach to the drug shortage; first locating where the supply is throughout the country so it can be shared, then rationing that supply and finally looking overseas to meet the expected demand for the drug.
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“We have secured a supply from Australia that is actually the same as the supply that we have here in Canada,” said Sharma, with Pfizer Canada adding that it has requested 800 units of the medication to be delivered.
“So we are making efforts to bring that in to Canada so that it can be basically distributed to get us through this period of time until the supplier can go back to usual production.”
McGeer said she is hopeful the medication shortage will be addressed sooner than the July estimate, but it’s too early to tell.
“If we’re lucky, it will get actually fixed earlier than that,” she said. “It’s also theoretically possible that it could go on longer, so there’s always a lot of uncertainty around what is happening.”
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