Jalal Saber, a 50 year-old employee at Egypt Post in Asyut, has struggled to buy a solution bottle his wife needs for the thrice-a-week dialysis to treat her kidney failure. She is one of 52,000 other Egyptian patients who need dialysis treatment on a weekly basis, according to statistics published by the Egyptian Society of Nephrology & Transplantation (ESNT).
Jalal Saber, a 50 year-old employee at Egypt Post in Asyut, has struggled to buy a solution bottle his wife needs for the thrice-a-week dialysis to treat her kidney failure. She is one of 52,000 other Egyptian patients who need dialysis treatment on a weekly basis, according to statistics published by the Egyptian Society of Nephrology & Transplantation (ESNT). Yet in the last weeks, Saber has had to secure the solution on the black market for $3.5, more than ten times the government set price.
For the past several months, Egypt has experienced a chronic shortage of imported and locally-produced medicines – with imported inputs, in particular: insulin, heart and cancer medications. The crisis was further aggravated when the Central Bank of Egypt (CBE) decided on 1 November, 2016, to liberalize the exchange rate of the Egyptian Pound, causing a depreciation in the currency of around 40 percent.
Half of all medicines missing
The Egyptian Pharmaceuticals Trading Company, one of the largest companies for import and distribution of medicines in Egypt, has, according to its spokesman Karim Karam, decided to issue each pharmacy with only one pack of each imported item, in addition to 5 ampoules of insulin, used by diabetic patients, per day. Most distributers have implemented the decision. The reason provided for such restrictive rationing was the depreciation in the currency, described by some pharmacies as a disaster.
Mohammed Waliudin, 45, a pharmacist from Minya, says pharmaceutical companies have informed pharmacies that their quota of imported medicines will be limited. “More than 50 percent of the medicines patients need are not available,” Waliudin told Correspondents. “Imported medicines account for 60 percent of all medications used in Egypt.”
Fabricated crisis?
Health Minister Dr. Ahmad Imad insists the crisis is a fabricated one. Minister Imad says only domestic pharmaceutical companies have complained or raised their prices, suggesting there is an effort to profit from the currency devaluation. “The government will not allow others to trade at the expense of Egyptian patients,” says Imad.
According the the minister, there are 10,000 types of medicines in circulation in Egypt, of which the holding pharmaceutical company produces 1,000 types. Another 1,000 are produced by international companies, while local companies produce 8,000 different medicines. So far only 200 domestic companies have complaned, says Imam.
Placebo negotiations
Meetings with pharmaceutical stakeholders have failed to prevent a further hike in prices, however. The companies have maintained their decision to raise prices immediately, otherwise threatening to cease all pharmaceutical production. The Egyptian pound meanwhile has jumped from 8 to 16 pounds to the dollar, doubling the price of imports.
Some are still not convinced the price hike is necessary. “Companies are trying to continue to make more profits by selling the products at double the actual price. They are using the shortage of medicines to reach their aim of raising prices,” adds Ministry of Health (MoH) spokeman, Khalid Mujahid.
Mohidin Hafez, a member of the Chamber of Pharmaceutical Industries, an independent association comprising pharmaceutical companies, flatly denies these allegations and says that 90 percent of the components of medicines manufactured in Egypt are imported. Hafez believes the country will experience a severe medical crisis if the government does not draw up a list to stabilize prices immediately.
Dr. Ahmad Rami, former treasurer at the Egypt Pharmacists Syndicate, confirms that the root cause of the crisis is the floating of the Egyptian currency and the increased cost of imports. “Ninety per cent of the components of locally manufactured medicines are imported against a binding pricing procedure imposed by the government,” says Rami, stressing why pharmaceutical companies have been forced to raise prices in response to the market.
University hospitals close
University medical facilities have been hit hardest by the medicine shortage. The university and central hospitals in Egypt provide medical services to about 80 percent of the Egyptian population, based on the statistics published by the Central Agency for Public Mobilization and Statistics (CAMPAS) in 2014. In addition, these hospitals perform 55 percent of major surgical operations and provide treatment to 70 percent of cancer, heart and brain patients.
The pharmaceutical companies have literally stopped supplying important medicines to the university hospitals in Asyut province, including solutions, according to a statement made by Dr. Osama Farouk, vice-chairman of Asyut University Hospitals, which receive more than 2 million outpatients every year from the different Upper Egypt governorates. Despite Farouk’s assurance that the supply of medicines has not affected medical services, hospitals have stopped services for over ten days. Many were compelled to buy their supply of medications on the black market.
“The crisis led to a halt of major surgeries and we have been compelled to accept in-kind donations (solution bottles and anesthesia boxes) to facilitate work inside hospitals,” says Dr. Zia Abdul Hamid, professor of urology at Asyut University Hospital.
Fatima Abdul Samie, a housewife from Sohag province, had to wait for 15 days at Asyut University Hospital to have a joint replaced for her 12 year-old son who was injured in a car accident, due to a shortage of anesthetic drugs needed for the surgery.
Black market remedies
Zainab, a housewife from Sohag province, has so far failed to find insulin for her diabetic husband. Even the black market has no supplies left. “I should have listened to the doctor’s advice to store the largest possible quantity,” Zainab told Correspondents.
Twenty-year old pharmacist Mariam Ezzat believes pharmaceutical companies are merely profiting from the crisis and people’s needs. “All the imported medicines, including insulin, heart and cancer drugs, and blood components such as Anti RH, antibiotics, like Albumin and more than 146 types of vital medicines are not available,” Ezzat says of her pharmacy. “Patients will pay any price to get a particular medicine, and that is exactly what producers want,” added Ezzat.
Experts have warned pharmacies and hospitals not to make recourse to expired medicines to fill the gap in medication. The Chairman of the Pharmacists’ Association Dr. Mohidin Obeid warned against use of expired medicines at a number of public and private hospitals and pharmacies. No guidelines were provided as to how patients can distinguish.
Adel Abdul Maqsoud, head of the Pharmacies Section at the Cairo Chamber of Commerce, has warned that clandestine factories could try to fill the void in production of medicines, regardless of quality standards, and subsequently supply these medicines to medical centers at low prices, threatening patients’ health.
Medicating the crisis
MP and health undersecretary Dr. Magdi Morshed says there are a number of measures that can be taken to solve the crisis, including subsidizing the pharmaceutical companies to offset the price difference. “Although this action burdens the government’s coffers, it is the quickest solution to the current crisis,” Morshed told Correspondents. Pharmaceutical companies could also be given tax breaks, adds Dr Morshed.
Dr. Ahmad al-Sawah, chairman of the Board of Trustees of the Egyptian Center for the Right of Medicine, says the government should source the same medicines cheaper internationally, as “the prices vary to source these medicines all over the world.”
Jalal Saber, who is still searching for insulin for his diabetic wife, says the government must find a solution because it’s prime responsibility should be focused on provision of medicines.
