Major price hikes and the unavailability of certain medicines in Egypt has caused an issue for many in recent months.
Anecdotal evidence of the shortages abound, from the reports of the absence of headache and flu medication, to anti-depressants, antibiotics and anti-coagulants. Many pharmacies are also struggling to find a steady supply of saline solutions and cancer medication.
While the pound devaluation in November directly contributed to the rising costs of existing medication, it also affected imported brands and the import of components for local production, resulting in a longer-term issue.
Ahmed Aboudeif runs a pharmacy with his father in Cairo. He reports shortages in oral contraceptives, RhoGAM, baby formula, Duragesic and lens solutions, among others. RhoGAM is a solution made from human blood plasma that is administered via injection to pregnant women whose blood does not contain the Rhesus factor protein (Rh-negative). Rh-negative blood that is exposed to Rh-positive blood produces antibodies that attack Rh-positive blood cells, potentially leading to fetal anemia and other life-threatening complications during pregnancy. “This drug is a lifesaver,” Aboudeif explains.
Doctor Ahmed Nagy works at Cairo University hospital and runs his own private clinic. Many of his patients suffer from liver failure and other conditions that require several doses of human Albumin a day. Albumin, at roughly LE350 per vial, cannot be synthesized and therefore has no viable alternative on the market, according to Nagy. Many of his patients need up to six vials of the serum a day, but due to shortages, public hospitals do not provide more than two per patient, regardless of whether or not they need more.
According to Amgad Maher, a medical representative for GlaxoSmithKline, the dollar shortage in Egypt hasn’t only affected the import of medication, but also that of many active ingredients used in the production of local medicines.
The cost of importing medication has risen by 100 percent, and production costs by 50 percent in recent months, according to Ahmed al-Ezaby, head of the Federation of Egyptian Industries’ Pharmaceuticals Division.
While Egypt’s Central Bank prioritized making currency available for pharmaceuticals and raw materials, as well as basic commodities, during its regular foreign currency auctions, this process stopped when the pound was floated and the supply of dollars to drugs importers is now at the discretion of individual banks.
The government’s insistence on keeping prices low through medical subsidies and price ceilings has hurt pharmaceutical companies, who say production costs for many medicines exceed their official sale price.
Maher says the government has kept prices static for more than three decades, which some people perceive to have contributed to the current crisis more than the devaluation of the pound and issues with imports. As a result, a number of companies are shutting down their production of drugs such as aspirin, because they cannot market them, says Nagy.
Alaa Ghannam, a pharmaceutical policy expert and head of the Right to Health Program at the Egyptian Initiative for Personal Rights (EIPR), had called for a rise in prices to save the local industry, suggesting third parties or the state should bear the brunt of insurance schemes. Adel Abdel Maqsoud, head of the Pharmacists Division at the Cairo Chamber of Commerce, told the privately owned Al-Watan newspaper that a health fund could be created from the interest on transactions across various public sectors, as a gesture of social responsibility.
In May, the Cabinet approved a 20 percent increase in the cost of medicines sold at or below LE30, in an attempt to ease the burden on pharmacies and pharmaceuticals and spur the production of many medicines in short supply. The 20 percent increase only amounts to a maximum of LE6, but coupled with an increase in the price of many basic commodities, this could spell trouble for many. “For middle and upper class Egyptians these aren’t really problems,” Maher says. “It should not be a problem for them to overcome, but people living in lower socio-economic situations will find it difficult to overcome. This will certainly contribute to more black market activity.”
These price increases didn’t just affect medication below LE30. “Many medications are sold in strips,” Maher explained. “One pack of Genufil that contains five strips sold at LE65 before May, and has now increased to LE71, because if sold separately each strip is worth less than LE30. Because of this, many people have begun buying single strips or even daily doses of medication because they cannot afford to buy a full pack.”
Despite expectations of more price rises by the government, Health Minister Ahmed Rady told the press in mid-November that the cost of medicines would remain fixed.
On November 29, the privately owned Youm7 newspaper said that the Ministry of Health announced a price increase of a particular drug, Ketosteril, used by kidney failure patients, from LE220 to LE540. The imported drug has been missing from pharmacies for over a month, stirring a crisis amid kidney patients.
Many agree that a key role in controlling the price of pharmaceuticals, particularly through imports, should come from encouraging local production. “We must encourage local industries to make generic versions of imported drugs, especially lifesaving ones,” Aboudeif says. “We have local companies with high-tech capabilities that can make biological drugs, and we have to start manufacturing the raw materials instead of importing them. This is not rocket science.”
The cost of shortages
Many unethical and dangerous practices have emerged due to the shortages of drugs, says Nagy.
The shortage of Albumin on the market has led to instances in which fake serums that look like Albumin are sold in pharmacies. “Three years ago I was working in a public hospital in Cairo and one of my patients died because her son bought a vial of fake Albumin from a pharmacy off the street,” Nagy says. “Immediately after taking the dose she had a fatal hypersensitivity reaction and was rushed to the intensive care department, where she died. The shortage of similar medication and high prices has created an environment for such unethical behavior, it is very nasty.”
Aboudeif agrees that there are many counterfeit medicines currently on the market, including RhoGAM. “You can buy them from unregistered drug suppliers,” he says, “but as far as I know most pharmacies refuse to deal with them.” Despite this, he admits that pharmacists can be manipulated into buying counterfeit medication, particularly if there is an acute shortage or if they are looking to increase their profits.
Another practice has been the storage of medications in order to pressure the government into raising prices. As a result, medicines are often close to the expiry date because they have sat in storage for years.” An example, according to Nagy, is penicillin injections and aspirins, which are also becoming more and more scarce.
According to Maher, many large pharmacy chains also contribute to the shortage by purchasing large quantities of medication, making it harder for smaller pharmacies to restock. “I deal with many pharmacies,” he says. “Large pharmacies hoard medication and refuse to sell them to other pharmacies, so that when people go looking for their medication they are forced to go to specific pharmacies for them.”
The shortage has led to a black market of medication. Maher says that a lot of drugs in Egypt, from vitamins such as Centrum to Panadol Extra, are illegally imported and sold under the counter. Many alternatives to medicines currently in shortage are sold this way because the government has not authorized their sale.
Other people have tried to call for a crowdsourcing process for missing drugs by sharing their unused medication.
Parliament agreed to form a fact-finding mission on November 28 to look into Egypt’s drugs crisis, but its ability to find immediate solutions for the critical shortages remains to be seen.