President Appeals for Free Treatment

President Joko “Jokowi” Widodo has appealed for public protection from drugs that trigger acute kidney injury in children.

KOMPAS/MAWAR KUSUMA WULAN

Some Indonesian ministers and high ranks officers at Bogor Presidencial Palace to attend limited meeting related to acute kidney injury cases in Children, on Monday (24/10/2022).

BOGOR, KOMPAS — The President’s priority is to ascertain that the entire population is protected. Now, the treatment of two pharmaceutical companies will lead to the criminal domain.

At a limited meeting related to acute kidney injury cases in children on Monday (24/10/2022) at the Bogor Presidential Palace, the President demanded that public safety be given priority. “Don’t consider it a trivial matter. This is a big issue and I instructed the Health Minister on Sunday to temporarily withdraw the alleged medicines, although still alleged,” said the President.

The Health Ministry has to delve into all risk factors that give rise to kidney failure cases

Meanwhile, the Food and Drug Monitoring Agency (BPOM) has been asked to withdraw and halt the distribution of syrup medicines already proven to contain medicinal substances causing kidney injury. The Health Ministry has to delve into all risk factors that give rise to kidney failure cases, from the medical drug sources as well as other potential causes.

The President also instructed his ranks to prepare health services, including the procurement of medicines that can overcome and cope with kidney failure. “I want free therapy for patients being treated. I think this is very important,” he said.

Until yesterday, the Health Ministry recorded 245 children with atypical progressive acute kidney injury in 26 provinces with 141 fatalities or 57.6 percent of the total cases. Eight provinces contributed 80 percent of the cases: Jakarta, West Java, Aceh, East Java, West Sumatra, Bali, Banten and North Sumatra. According to Health Ministry spokesman Mohammad Syahril, Jakarta topped the list with 55 cases and 27 deaths.

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Several regions reported cases of acute kidney injury in children and deaths due to this disease, including Southeast Sulawesi, Lampung and Riau Islands. In West Sumatra, for instance, the number of deaths caused by acute kidney injury increased by one, making the total 13. West Sumatra Health Office Chief Lila Yanwar said kidney cases were found in 11 of 19 regencies/cities in the province.

In order to prevent a rising number of acute kidney failure cases, the appeal to provisionally stop the use of syrup medicines is being expanded in Jambi. In Palembang, the withdrawal of five syrup drugs contaminated by ethylene glycol and diethylene glycol has taken two weeks. In Jakarta, a number of dispensaries no longer sell medicinal syrups to comply with the Health Ministry’s instruction.

KOMPAS/IWAN SETIYAWAN

Health Minister Budi Gunadi Sadikin

Since the Health Ministry temporarily banned the use of liquid and syrup medicines, there has been a drastic decline in cases. “We notice now that patients with clinical symptoms after the ban have drastically decreased in number from dozens to less than 10,” said Health Minister Budi Gunadi Sadikin following the limited meeting.

Since August

The number of cases began to increase in August 2022 and most of them have affected children under five. The government conducted pathological analyses as the causes were originally presumed to be viruses, bacteria or parasites. The other presumption was its connection with the Covid-19 pandemic, which was not proven either.

After the World Health Organization (WHO) issued a circular on 5 October 2022 related to the same case in Gambia as a result of the chemicals in drug solvents, the Indonesian government communicated with the WHO and the Gambian government. “We made a toxicological analysis,” he said.

Out of 10 patients’ blood and urine sample tests, seven of them contained dangerous chemical substances. “So, 70 percent of those affected were due to the chemicals. We made the second confirmation by a biopsy of dead victims to find traces of kidney damage caused by the chemicals. We checked that 100 percent kidney damage conformed to the traces produced by the chemicals,” said Budi.

Then the government visited patients’ houses and collected the medicine they had consumed. In their houses, most of the medicine discovered contained dangerous compounds. “Thus, the chemicals that become contaminants of medical solvents constitute the cause,” added Budi.

The government is preparing an antidote with highest efficacy based on pharmacologists’ research in Indonesia, which is Fomepizole.

The harmful compounds are ethylene glycol (EG) and diethylene glycol (DEG) as additional solvents of syrup medicines. Syrup medicines can be given to treat critical diseases with a doctor’s prescription. The BPOM will release a list of 150 medicines with solvents containing no dangerous substances.

In the meantime, the government is preparing an antidote with highest efficacy based on pharmacologists’ research in Indonesia, which is Fomepizole. The government has received 20 vials of Fomepizole from Singapore. Sixteen vials will be delivered from Australia. The government is preparing 200-500 vials of antidotes. “Later we will distribute the medicines to hospitals where there are patients with acute kidney injury symptoms,” said Budi.

The National Police has begun investigating the criminal allegation linked with atypical progressive acute kidney failure in children. The police will be looking into the likelihood of negligence in the production of syrup medicines that have caused the death of 141 patients.

National Police spokesman Insp. Gen. Dedi Prasetyo said the investigation was conducted by a team of the Police Criminal Detective Agency chaired by Specific Crime Director Brig. Gen. Pipit Rismanto. “They are studying laboratory test results conveyed to investigators,” said Dedi, adding that the team had obtained samples from the Health Ministry in the form of patients’ urine and blood and drug specimens, which will be tested at the forensic laboratory of the police.

SEKAR GANDHAWANGI

BPOM Penny K Lukito di Jakarta, Rabu (25/9/2019).

BPOM Chief Penny K Lukito affirmed that two pharmaceutical industries would be led to the criminal domain. “The BPOM Deputy IV for Prosecution enters the pharmaceutical industries in cooperation with the police and will soon make an inquiry that leads to a criminal case. It’s because there is an indication that the EG and DEG contents of their products are not only in concentrations as contaminants, but are also very high and toxic,” she said.

The incidents of acute kidney failure, said Chairman of the Indonesian Public Health Experts Association, Ede Surya Darmawan, should be declared an extraordinary event. (DEA/ WKM/ SKA/ Z03/ Z13/ Z14/ IKI/ RAM/JAL/ ITA/ CHE/JOL/ VIO/ NSA/ NDU)

This article was translated by Aris Prawira.