The Ministry of Health let expire the validity of a stock of medicines, vaccines, diagnostic tests and other items that, in total, are valued at more than R$ 240 million. Now all these products must be incinerated.
The SUS input cemetery is in Guarulhos (SP), in the folder’s logistic distribution center. There are 3.7 million items that started to expire more than three years ago. Almost all expired during Jair Bolsonaro’s (non-party) administration.
All stock is kept confidential by the ministry. The folder uses an internal 2018 document to deny requests for access to data on stored or expired products, an argument already pointed out as inadequate by the CGU (Comptroller General of the Union).
But sheet had access to ministry tables with data on items, lot number, expiration date and amount paid by the government. The list of expired products includes, for example, 820,000 insulin pens, enough for 235,000 patients with diabetes for one month. Value: BRL 10 million.
The Bolsonaro government also lost vials for the application of 12 million vaccines for flu, BCG, hepatitis B (almost 6 million doses), chickenpox, among other diseases, as vaccine coverage rates in Brazil plummet. This lot alone is valued at R$50 million.
The expired products would also be intended for SUS patients with hepatitis C, cancer, Parkinson’s, Alzheimer’s, tuberculosis, rare diseases, schizophrenia, rheumatoid arthritis, transplants and kidney problems, among other situations.
Some items that will be incinerated are missing from health posts.
At the end of August, the government of Bahia complained about the delay in the delivery of medicines by the ministry, such as methotrexate, used for some types of cancer. There are 24,000 expired ampoule vials in the Bolsonaro government warehouse.
The Ministry of Health also keeps around R$ 345 thousand in lost items from STD/AIDS programs, mainly diagnostic tests, in addition to R$ 620,000 in supplies for the prevention of malaria.
Internal government data show that more than R$ 32 million in medicines purchased by court order must be incinerated. Most of these drugs are expensive and for treating patients with rare diseases, a government flag. Alongside the first lady, Michelle Bolsonaro, the minister Marcelo Queiroga (Health) launched on the last 31st the “Rarinha”, a new mascot of SUS.
In the middle of this stock there is a vial of nusinersena, valued at R$ 160,000, and 908 vials of eculizumab, which cost R$ 11.8 million. They are drugs used in two of the most expensive treatments available.
Vice-president of Instituto Vidas Raras, Amira Awada says there is a serious shortage and estimates that more than a thousand patients are waiting for medication.
“What we hear most is that we are to blame for the Ministry of Health’s budget deficit, but it is the ministry that loses millions by letting medicines expire. We have passed the revolt phase, we have no perspective,” said Awada.
The organization calculates that 15 million people live with rare diseases in Brazil. “I have never seen such a difficult situation in 12 years. We can’t even talk to them [representantes do ministério].”
Part of the rare disease drugs was returned to the ministry by patients who stopped using the products or died. Health did not respond if it carried out the relocation of the drugs.
Deputy Luis Miranda (DEM-DF), who also had access to the data, asked the Ministry of Health about the volume of wasted material. For the deputy, who denounced suspected irregularities in the purchase of the Covaxin vaccine to Covid’s CPI, expired drugs are even more worrying.
“The conduct is a mockery with the health of Brazil. Medicines and public resources that could save lives are rotting. What is the reason for purchasing these unused drugs? Why keep them stored after they expire? Enrich companies?”, he said.
In the midst of the pandemic, the Bolsonaro government also lost around 2 million RT-PCR exams to Covid, valued at more than R$77 million.
The manufacturer made a donation of new Covid exams to Health to replace the expired stock, but the interval and bureaucracy until the arrival of the product made the delivery of exams to SUS drop, as shown by sheet.
The ministry still keeps 2.2 million exams without validity for the diagnosis of dengue, zika and chikungunya, all sold by the public laboratory Bahiafarma. These lots cost around R$ 60 million and were banned in 2019 by order of Anvisa. Health did not inform whether it asked for reimbursement or replacement of these exams.
Thus, in all, the invalid diagnostic tests account for about 60% (R$ 140 million) of the value of expired inputs.
The director of Dlog (Department of Logistics) of Health, retired general Ridauto Fernandes, told the sheet that the loss of shelf life of products “is always undesirable” but occurs “in almost every branch of human activity”. He stated that he “cannot comment” on the stock.
“In supermarkets, every day, material is discarded for this reason,” said the general. “We strive for this not to happen”, he added.
An area that operates at the end of the line of input management, the Dlog was under the command of Roberto Dias, appointed from the center, during most of the Bolsonaro government. He was only dismissed on June 29, after Corporal Luiz Paulo Dominghetti told the sheet who received a bribe from Dias to unlock the sale of vaccines.
In some cases, such as product failure or when it is supplied with a short expiration date, the government is able to replace part of the inventory expired by contractual agreements with manufacturers, but the operation can delay treatments.
But there are situations of total damage to public coffers and patients, as in the case of insulin pens. Despite the high demand, Saúde did not deliver and will incinerate about 20% of the purchase of this product’s debut in the SUS, made in 2018.
Endocrinologist Fadlo Fraige Filho, president of Anad (National Association for Diabetes Care), stated that mistakes made even in administrations prior to Queiroga’s led to delays in delivering pens to patients.
He said that, in addition to taking a long time to buy needles for the pens, the government demanded that the products be released in specialized centers and after the presentation of complex reports. “They should be distributed as regular (insulins) are, in the basic units, eventually in the Popular Pharmacy,” he said.
Sought, Health did not explain why the products have expired and what is the size and value of the stock that it managed to replenish in negotiations with manufacturers. It also did not present data from the historical series of stocks, nor did it say what amount was paid to store and dispose of expired inputs.
In a statement, Bahiafarma said that the board of Anvisa has not yet judged an appeal on the interdiction of lots. He also stated that expired tests have already started to be collected and that they are stored in state warehouses. Ministry data obtained by sheet, however, point out that exams have expired from this laboratory at the federal government’s distribution center in Guarulhos.
For the president of Conass (National Council of Health Secretaries), Carlos Lula, the stock is disproportionate. “The situation is very serious and needs to be resolved. It may not only result from mismanagement, but also be an act of improbity.”
Representative of Abrasco (Brazilian Association of Collective Health), Wagner Gastão says that the volume of expired supplies is a sign of “degradation and dismantling” of the ministry.
“It is a complex machine, but the story of the ministry is not that. There are always expired products, but it has to be something residual, otherwise it is a serious indicator of inefficiency”, says Gastão. He is also a professor of medicine at Unicamp and former Executive Secretary of Health (2003 to 2005).
Ministry of Health hides SUS input cemetery
Data obtained by sheet show expired stock of medicines, tests and vaccines valued at more than R$240 million. There are about 3.69 million items, which can serve a much larger number of people in the SUS, as each vial of vaccine, for example, has up to dozens of doses.
CGLAB (General Coordination of Laboratories): BRL 140.73 million
Over 2 million Covid RT-PCR tests, plus dengue, zyka, chikungunya, leishmaniasis, and various reagents.
Vaccines: BRL 49.59 million
About 12 million immunizers for BCG, flu, polio, hepatitis B, tetra viral, serums for various diseases, in addition to diluents
Medicines purchased by court order: BRL 32.99 million
Mainly expensive drugs for rare diseases such as eculizumab (HPN) and ataluren (Duchenne Muscular Dystrophy).
Exceptional medications: BRL 17.72 million
Insulin pen and treatments for hepatitis C, multiple sclerosis, Alzheimer, Parkinson, among other diseases
Others: BRL 1.93 million
Blood products, rabies treatments, tuberculosis and malaria prevention products
STD/AIDS Programs: BRL 420 thousand
Mainly HIV and HCV diagnostic kits
Source: Ministry of Health internal documents