Responsible use of rifampin in Canada is threatened by irresponsible shortages

We agree wholeheartedly with Drs. Batt and Khan’s description of rifampin as “unequivocally the most important drug in the global fight against [tuberculosis] TB.”¹ However, using a drug effectively requires that it be available in the first place. Disturbingly, rifampin is becoming increasingly difficult to acquire in Canada; both companies that sell it (Sanofi and Bausch Health) are facing long-term shortages and the imminent potential for indefinite total stockouts.²

Rifampin is the cornerstone of care for active TB disease, forming part of all first-line treatment regimens,³ as well as a valuable treatment for latent TB infection. These shortages of rifampin pose a real threat to TB care⁴ in Canada, including the prevention and treatment of active TB in the Indigenous communities most affected by the disease.⁵

The Government of Canada has consistently failed to offer adequate long-term solutions and short-term fixes for frequent drug shortages.⁶ For past shortages of other basic TB drugs like ethambutol, existing mechanisms like Health Canada’s Special Access Programme have not proven to be effective stopgap measures. Although the new Access to Drugs in Exceptional Circumstances mechanism, which allows temporary access to drugs without market authorization in Canada in response to an urgent public health need, has proven helpful in accessing rifapentine,⁷ another drug for latent TB infection, its usefulness in addressing shortages of drugs that are already authorized in Canada remains unclear.

Canada has already recognized the vital importance of sustainable access to crucial TB drugs in lower-income countries, becoming the largest single-country donor for first-line drugs like rifampin to the Global Drug Facility, a global bulk procurer of TB medicines.⁸ Given the looming threat to both public health and patient care, we call on the Canadian government to devote similar effort and resources to ensuring continuous access at home, both through stronger regulatory measures to prevent domestic drug shortages and the authorization of alternative sources for TB drugs such as the Global Drug Facility.