Pharmacists are calling on President Mubarak to cancel a Health Ministry decree on the sale of pharmaceutical products, writes Reem Leila In what was described as an attempt to reform the pharmaceutical sector and to put an end to abuses committed by pharmacists and protect people's health, the Minister of Health, Hatem El-Gabali, recently issued a decree banning Egypt's 35,000 pharmacies from selling medical supplies including sterile cotton, gauze, disposable syringes and unlicensed medicines, violators being subject to a fine of between LE20,000 and LE50,000 and the one-year closure of their businesses. According to Abdel-Rahman Shahin, spokesman at the Ministry of Health, more than 10 per cent of the 6,000 different drugs on sale in the country are currently either unlicensed or smuggled. Since turnover in the pharmaceutical industry is estimated at more than LE10 billion, this means that more than LE1 billion worth of illegal drugs are on the market, he said. "Pharmacists should not be upset by this decree, since although we do not have accurate statistics, as most violators escape the ministry's attention, the violation rate does not exceed 10 per cent. However, this is increasing, and we need to reform the system as well as enforce the decree," Shahin said. In response, the Egyptian Pharmacists Syndicate (EPS) held an extraordinary meeting attended by some 4,000 members on 8 February and threatened to shut down the country's pharmacies. The pharmacists describe the ministry's actions as unfair, since in their view they endanger the future of Egypt's pharmacists by considering them as all potential violators of the law. The decree could also harm patients by depriving them of vital medicines that could save their lives, the pharmacists said. According to Mahmoud Abdel-Maqsoud, EPS secretary-general, pharmacists have agreed to send a memorandum to President Hosni Mubarak, personally requesting his swift interference in halting the actions of the Ministry of Health and correcting what they see as the minister's mistaken actions. According to Abdel-Maqsoud, a former health minister, Ismail Salam, also issued a similar decree in the 1990s, which was annulled by the president in order to preserve the pharmacists' welfare. A decree was then issued allowing pharmacists to sell all registered drugs at pharmacies, as well as all drugs that had a traceable source. The Ministry of Health's current problems with the country's pharmacists come against a background of more general problems in the health sector, including demands by doctors for salary increases and for changes in their professional status. Doctors demonstrated in front of the People's Assembly in Cairo on Sunday, as well as in front of the Ministry of Health, and the presence of dozens of security police failed to halt their determination to make their voices heard. As far as the ministry's new pharmaceuticals decree is concerned, the current objections to it may well impede its application. According to Mohamed Abdel-Gawad, deputy secretary-general of the EPS, the new decree annuls the previous regulations without any prior notice being given to the syndicate. A delegation from the EPS had agreed with the minister to draw up a list of drugs and other materials that should not be sold at pharmacies six months ago, Abdel-Gawad said, and "a list of 60 drugs was submitted two months ago." "After presenting the list we agreed that the ministry would determine the drugs on the final list and the drugs that should not be circulated by pharmacies. We were therefore surprised at the issuing of the present decree without further consultation. How will we stop selling these 'unlicensed drugs' and medical supplies now, without knowing which ones they are," he asked. Abdel-Maqsoud also raised a further issue regarding unlicensed drugs, since these form only one per cent, not 10 per cent as claimed, of those available on the market, he said. Most of them are imported, and companies usually avoid registering the drugs as their distribution is limited, and they are often aimed at patients suffering from cancer or kidney or liver failure. "In such cases, these drugs, imported through the Ministry of Health, are considered sourced drugs, not smuggled drugs," he explained. "Patients with serious illnesses will ultimately be the losers, since the drugs are life-savers," Abdel-Maqsoud added, saying that the procedures for registering drugs were slow and complicated. Shahin, disagreeing with Abdel-Maqsoud, said that the procedure for registering drugs has became easier, and any imported drug does not take more than four months to be licensed. Several, he said, would be licensed over the coming few days. "The ministry has granted pharmacists six months as a grace period to adjust their situation. Until then, no pharmacist will be sanctioned," he said. More than 35 pharmacies have recently been closed across the country, Shahin said, on charges of selling unlicensed medicines and medical supplies. However, according to Abdel-Maqsoud, "the closure of these pharmacies is unjustified," and the ministry has simply decided to make examples of them as the percentage of violators is increasing. In an attempt to undermine the ministry, the EPS is also making efforts to create a Supreme Drug Authority that would be under the control of President Mubarak directly. "This would enable us to act more freely for the sake of Egypt's patients, and to provide them with the drugs they need," said Abdel-Maqsoud. He also claimed that unlicensed drugs were being sold at the minister's own hospital, Dar Al-Fouad. "I have proof of this and intend to send it to the prosecutor-general's office so that the case may be investigated," he added. For his part, Shahin refused to comment on the claims, saying only that, "if it turns out to be true, all those responsible will be punished, since no one is above the law."
