“One of my cousins went to hospital and we had a hard time finding glucose for him,” says Sayed Mohamed, a resident in Giza. “I suffer from hypertension so I bought extra boxes of my medicine in case it goes missing in the pharmacies,” says Naglaa Mahmoud, a housewife living in Cairo. A rumour spread that the Egyptian Company for Medical Trade collected all the insulin supplies in pharmacies after the government recently decided to float the Egyptian pound. “There is a problem in the availability of some types of imported vital medicine. Egyptian medicine is there but not the amount needed for the needs of our hospitals,” says a member of the Pharmacists Syndicate in Giza Shaimaa Rabea who runs a pharmacy at Warraq Public Hospital. Rabea said governmental hospitals in general have medicine that will last for about three to six months, but if private companies do not start working, there will be a shortage soon. “We need vital medicine in which imported components are used. There has been a problem in the glucose and saline containers which started about five months ago. Factories have not opened yet. These companies closed because they wanted to increase prices. However, they are profiting anyway given the current situation. “First, the syndicate sought to distribute a limited amount of containers by communicating with factories. Then the Ministry of Health decided to address the problem by providing hospitals and pharmacies with quotas, meaning limited amounts for each hospital, which naturally was not as much as it was. The syndicate wants these factories to make more medicine and this will make prices cheaper,” Rabea said. Karim Abdel-Latif, a pharmacist, voices the fears of his colleagues that either the ministry will increase the price or companies will stop importing medicine. “We have problems with imported medicine. Companies are now working with the quota system. That is, they provide each pharmacy with only six to 10 boxes of medicine, for example. As a result, pharmacies have been buying more medicine to build a stock to face a possible increase in prices or a lack of medicine. “The problem could be caused by one of two things: Either companies don't have certain types of medicine or they locked it up while private pharmacies bought their medicine. They see that there will be a problem with imported medicine around three to six months from now. This is because the medicine stored until now was imported with the old price of the dollar and when it is imported again it will be more expensive,” says Abdel-Latif. However, the impact of the increase of the price of the dollar is not so great on manufactured Egyptian medicine since only the raw materials in it are imported. “Still there are essential products which are not subsidised like milk powder which went up from LE69 to LE99. There is some medicine that is not available like Deprivan, an anaesthesia for hospitals and cortisone alternatives. Insulin has been distributed to each pharmacy in limited numbers which could be less than the needs of the public,” he adds. The Egyptian Cabinet Information and Decision Support Centre (IDSC) issued a press release rejecting what it called rumours in social media and media concerning the lack of insulin in pharmacies and hospitals. The statement also quoted the Ministry of Health as saying that such news is neither true nor precise, insisting that the drug was available in pharmacies and hospitals and that there is a strategic supply of the drug in its storehouses to ensure its fair distribution to all patients. The ministry said it has been staging a campaign to ensure that pharmacies, storehouses and the Egyptian Company for Medical Trade have ample amounts of insulin. In addition, the ministry stated that there is no lack of blood bags nor any blood type in hospitals and that anything published to the contrary was false. The statement added that the ministry “constantly protects the patients' interests and monitors the market to prevent any cheating, smuggling or hoarding of medicine in unlicensed storehouses”. In a statement issued last week, the ministry denied any increase in the price of medicine and said that anyone caught selling medicine at higher prices will be punished.In addition, it said the Central Bank will provide hard currency to help provide the medicine. However, problems faced by the medicinal production sector die hard. “Due to the high price of the dollar compared to the Egyptian pound many people have started to buy medicine which resulted in high demand on medicinal companies and pharmacies to provide the medicine. Until now most companies are still providing medicine unless it is medicine that is missing,” says the commercial director of a well known Egyptian-based pharmaceutical company, Hisham Murad. Murad forecasts the medicine market six months ahead. “I believe that the real problem will appear in a month or a month and a half especially in imported medicine as the dollar is high compared to the Egyptian pound. The difference will not be made up unless medicine is re-priced to suit the producer without harming the consumer. This will be essential in determining that the medicine is available; medicine will not be available if the producer loses. The same goes for the consumer who will not be able to find most of his medicine. I know that the government is doing its best to provide medicine for citizens, but maybe this is a problem faced by the whole country and in many fields which affect medicine and medicine providers. During the recent re-pricing of medicine, despite a slight increase, medicine was available. This is a win-win situation for both producers as they are profiting, and for consumers who find their medicine,” Murad said. Professor of Pharmaceuticals at October University and Deputy Chairman of the Pharmacists Syndicate Giza branch Tareq Saad points to the causes of the problem. “The citadel of medicine manufacturing was built on a wrong foundation from the beginning because they were not concerned with what goes into the medicine they make. The dollar which was in the past worth LE3 at the beginning of the medicine industry in Egypt, is now LE18. So they cannot adjust a profit margin. This was reflected in most medicine factories, government as well as private. It is unable to determine the path it is going and how it will be distributed.” In addition, people focussed on the outer appearance of medicine without focusing on the components. For example, for our supply of children's milk we depend on factories abroad while we have many factories that produce antibiotics and vitamins which exceed the needs of the market. That makes it about more than 600 factories which sell identical medicine. There is no development or creation of new formulas, just the same ideas. In the current circumstances, this problem is clear. We are unable to export our medicine because the price is too low to be credible. For example, a box of medicine could cost LE3 which is not even worth 50 cents in the US,” he adds. “There is no vital medicine missing, only products that are repeatedly produced in companies. There may be some entities that spread rumours because their profit margin decreased. I think everything is fine up until now. The problem is that the patient does not want to adapt and some doctors, because of certain interests, insist on prescribing a certain kind of medicine,” Saad said. “As for glucose, it has been a problem for a long time. There are only about three factories of glucose or salt solution containers that serve millions of patients. There should have been more factories to produce such vital products instead of suffering from shortages. It is only a matter of re-organising priorities. We also do not have factories like the army to make up for missing medicine. However, we did our best to try to avoid a lack of a certain type of medicine at the beginning of the crisis,” says Saad, adding that there should have been a process to study the needs of the market before rushing to build overlapping medicine factories. “A medicine factory costs less than a saline container factory.” “The Ministry of Health should move quickly to find a solution to this problem. Up until now there is no problem as every company has what is called a buffer stock which lasts from 45 days to two months. I see that consumers are buying large quantities. This means that this stock may not last that long. The biggest problem is with imported medicine due to the high price of the dollar. We call on the government to subsidise the price of the dollar for medicinal imports or at least reserve dollars for medicine so that medicine for cancer and heart disease patients is available,” Murad said. “Stocks of medicine and chemicals needed for medicine are there for three to six months. If we unite and share our ideas and stop looking for excess profit, there will surely be a solution. If we start by subsidising the price of the dollar for medical imports we will also need to do that on wheat imports, for example. I believe that the profit margin for private companies is appropriate and that they should sacrifice some of their profits for the sake of the stability of the country. Even if the profit is low in one type of medicine, it can be compensated in others,” Saad said. “We in the syndicate are starting to ask doctors to write the scientific name of a medicine -- the compound or the active substance -- so that a patient does not look for a certain type or name of a medicine. This will decrease the amount of medicine missing in the market. We are also training pharmacists to be able to understand the scientific names of medicines. This is all for the benefit of the patient,” Rabea said. “We hope such an initiative is launched but there is a fear that pharmaceutical companies will try to stop it. This initiative will remove the burden from the public and will solve some 70 per cent of the problem of the lack of some types of medicine. Giving medicine an obligatory price is not a successful policy and which has been tried in many countries in many fields, but it didn't work with medicine. The government should free the cost of medicine according to the market demand while monitoring the market, and subsidise the medicine for those in need,” said Abdel-Latif, adding that international pharmaceutical companies should be invited to open branches in Egypt to make prices affordable rather than importing medicine.
