Feeling blue

Three years after the Viagra explosion, Egyptian men are still resorting to backroom deals for a crack at the little blue pill that packs a serious punch. Sahar El-Bahr investigates why the drug remains banned in Egypt
It was in 1998 that the multinational pharmaceutical company Pfizer launched the product that would spur a revolution in the way people look at sexual drive. Viagra, the little turquoise diamond-shaped pill prescribed for male impotence can be credited with the dubious honour of making the term "erectile dysfunction" a household word rather than a whispered malady and putting the thrill back in more than a few marriages.
The world over, men both impotent and virile were test-driving the new wonder-drug with giddy anticipation. Few people were celebrating in Egypt, however, when the Ministry of Health (MOH) put a damper on the festivities and banned the drug. To date, the MOH has denied licensing rights for local pharmaceutical companies to manufacture Viagra -- a position that has baffled specialists and frustrated drug companies.
Critics of the ban say that the MOH's position has done nothing but drive a flourishing black market and aggravate a lot of unhappy men paying exorbitant prices for the drug under the table. A recent story splashed across local papers tells of a stash of some two million pills confiscated by customs that was set aside, its fate undecided. Reporters investigating the find realised that the only lucky recipients of the drug were in fact the mice which roam the customs storage rooms.
For Viagra users the story added insult to injury. "Why are millions of Viagra pills kept in storage for mice and rats to spoil, while there are thousands of couples who suffer the effects of impotence?" demands Said, a 38-year-old Viagra user.
Said explains that in order to get his weekly fix of Viagra, he is a slave to the black market. "Viagra has a huge black market. Sellers exploit people by either selling the pill at very expensive prices or providing pills that were not manufactured under licence, or have expired," he said. Men with a problem already stigmatised by society are forced to feel like criminals or drug addicts.
Why Viagra continues to be banned in Egypt is unclear. In 1998 the Ministry of Health announced that specific medical studies verifying the drug's effectiveness and safety had to be undertaken before it could be approved in Egypt. Today, ministry officials are unwilling to give any public statements regarding Viagra.
Galal Ghorab, who heads the Holding Company for Pharmaceuticals (a division of the Ministry of Public Business that serves as the umbrella company for public sector drug companies), argues that studies on the drug should never take so long. Claiming that the ministry's position is unjustifiable, Ghorab told Al-Ahram Weekly that Viagra is "safe", noting that it is "covered by European health insurance systems and is even dispensed to some patients for free." Speculating on why the MOH might be insisting on the ban, Ghorab suggests officials might think that widespread use of Viagra could lead to an unwanted increase in the population. He noted, however, that even if this were the case, smuggled Viagra is available everywhere.
One major concern announced by the ministry in 1998 is that Viagra is known to bring on heart attacks in patients who suffer coronary problems. According to Zakariya Gad, head of the Pharmacists Syndicate, there are fears that Viagra will be misused. But this argument fails to satisfy specialists such as Dr Yasser Sami, a dermatologist and andrologist, who explained that the risks posed by Viagra are no different from those of 90 per cent of the drugs available worldwide. "Even aspirin has side effects," says Dr Sami. "We know that about 80 per cent of impotence sufferers have improved by using Viagra without suffering any side effects. Viagra is only dangerous for heart disease patients."
Even Gad qualifies his reservations by adding that possible misuse does not constitute an adequate reason for the ministry to persist in holding off manufacture of the drug. In 1998 the Holding Company submitted three requests to the Ministry of Health for three national companies to manufacture Viagra locally. Another 14 national and international companies have submitted the same request, but not one has received an answer from the MOH.
The Holding Company's Ghorab is at his wits end on the issue of Viagra. "Officials have stopped making statements on Viagra completely," he says. "We are appealing to the Ministry of Health to reply [to our requests], but if they don't, we will resort to higher authorities, or take legal procedures. We are living in a democratic country -- the MOH has no right to stand against the people's will and interest."
On the matter of the MOH's recalcitrance, pharmacists can only resort to sarcasm. "Perhaps MOH officials think that what is suitable for men all over the world is not good enough for Egyptian men, because Egyptian men are different," suggests pharmacist Mohamed Zahran wryly. "Are they trying to convince us that their tests are more accurate than those conducted in America and Europe?"
While manufacturers await approval of the drug by the MOH, the black market is doing brisk business. For those who are willing to pay, Viagra is available at pharmacies, popular markets like that of Al-Musky, near Khan El-Khalili, and even in some supermarkets. According to one pharmacist, who spoke to the Weekly on condition of anonymity, Viagra manufactured in India, China, Syria and Jordan can be found in Egypt for LE30-40 per pill (American Viagra runs for LE55-60 per pill). The number of Viagra pills being sold on the market, however, is far larger than what is indicated by confiscated stashes, the pharmacist noted.
As for the cost, Ghorab stresses that locally-manufactured Viagra would sell at a mere 10 per cent of the imported variety. "Local drug companies have already imported raw materials and manufactured samples," Ghorab says, noting that tests proved the samples to be very effective. "As soon as the MOH approves Viagra, we are ready."
Manufacturers are especially keen to get their versions of Viagra out and on the market as a draft law on Intellectual Property Rights currently being discussed in parliament looms on the horizon. If passed, the law would protect so-called trade secrets and in the case of an enormously profitable drug like Viagra, Pfizer would have the right to stop the local manufacture of Viagra. "The Egyptian economy could lose billions of pounds due to the delay in approving Viagra," notes Ghorab.
Obtaining accurate figures on how much Egyptians spend on Viagra remains difficult so long as the drug remains illegal. Ghorab floats three figures. Some people suggest a preposterous LE7.5 billion is spent on illegal Viagra per year, while the MOH offers a remarkably modest figure of LE600 million. Ghorab suggests the figure is probably closer to LE2 billion.
Dr Sami points out that regular use of Viagra in quite moderate amounts can often provide an alternative to a costly surgical procedure. It also discreetly treats a problem that is particularly sensitive. Sami notes that Egyptian culture is not forgiving of male impotence and that men who suffer from it are willing to pay anything to make the problem go away. Dr Sami takes issue with the claim that Viagra is not an "essential" drug. He maintains that while impotence is hardly a life-threatening affliction, it is "psychologically devastating." As proof, Sami says that couples come to his clinic on the verge of divorce because of the husband's impotence. "Impotence can lead a man to severe depression."
Sami suggests that with virility being so strongly tied to manhood, Viagra not only addresses medical and economic issues, but also social and psychological ones. He even ties the need for Viagra to the country's increasing unemployment rate -- a somewhat tenuous, but credible argument. Sami argues that men are getting married much later in life because they must wait longer for job opportunities to bear fruit. Older men are the predominant users of Viagra, but Sami even includes younger men depressed by their poor economic situation as potential sufferers.
"Men who suffer from impotence should be encouraged to try and save their marriages and improve their lives through legal means," Sami asserts. But until the MOH breaks its vow of silence on the matter, the wonder pill will remain a black-market item.
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