Grim Prognosis

By Ahmed Mansour

I’ve been trying to get hold of hypertension medication for quite some time now, and I simply cannot find it anywhere. I’ve tried going to all the pharmacies that I can think of and still no luck. Finally, I decided that I would have to turn to an alternative, which costs LE500 a course, instead of the LE150 I used to pay,” Hassan
Mansour, an engineer, tells us. He can afford to pay the difference, but many others cannot, and Mansour believes that if this issue persists, the medication shortage crisis will come to a head between the government and pharmaceutical companies in Egypt.

Egypt has been struggling to maintain the basic needs of its people, such as sugar, affordable fuel, and pharmaceuticals for several months now. And while the government says it is doing its best to control the situation, most people believe more effort needs to be made.

Since the flotation of the Egyptian pound on November 3, 2016, key drugs have disappeared from the market, among them basic meds like insulin, tetanus shots and contraceptive pills. The shortage has hit patients with chronic diseases such as hypertension and diabetes especially hard.

The crisis began to turn into a public concern a few months back when patients suffering chronic illnesses started complaining via media outlets of a massive shortage of medicine in all pharmacies. The only recourse was to buy imported medications—costing almost four times the price of local brands.

A few months earlier, in September 2016, hundreds of Egyptian mothers marched through the streets because\ they couldn’t find formula milk which was essential for babies with genetic chronic blood disorders such as sickle cell anemia. They protested by raising empty baby bottles and blocking a street in Eastern Cairo.

The issue was resolved by the Egyptian Armed Forces in collaboration with the Ministry of Health, exactly two days after the march. The army began to distribute baby formula through military-owned grocery centers for LE30 instead of LE60. The official spokesman of the Armed Forces explained that they felt they had to take matters into their own hands to “counter monopoly and greedy traders or companies.”

“That incident with the baby formula is a very clear indication that the military has a solution for every problem that this country faces, but sadly they only fix them when it’s a bit too late. I wouldn’t want to go as far as saying that the military themselves are the ones who created the demand so that they would be the supplier, but we are grateful that they took it into their own hands. I seriously do hope that they find a solution to providing the other medications many rely on,” says Reham El-Ezaby, managing director of El-Ezaby pharmacies, to Egypt Today. The shortage in essential needs spread from pharmacies to hospitals, who started complaining that they could not procure much-needed medical supplies such as syringes and alcohol wipes.

“There’s a shortage in medical supplies here at the hospital. We are having a hard time finding essential supplies such as alcohol wipes, syringes, basic operation room tools, and we are even finding it hard to find some new scrubs,” explains Dr. Murad Ismael, neurosurgeon at Saudi German Hospital in Cairo. “We urge the Doctors Syndicate to take action to put an end to this nonsense.”
But when Dr. Mona Mina, the general secretary of the Doctors Syndicate, brought up the shortages during a TV interview, she was slammed with a lawsuit by the Ministry of Health claiming she was spreading false claims.

Mina reported she had received a “cry for help in the form of a text message” from a young doctor at one of the public hospitals stating the doctors had been informed by the Minister of Health to reuse syringes as they were in low supply. “He said doctors had received orders to use half the medical supplies they require, including syringes and kidney dialysis machinery, because there is a chronic shortage in supplies. A patient who may need two sacks of saline solution will get only one and each syringe will be reused for the same patient,” she claimed.

The Ministry later denied that the minister, or any other official, had ever stated anything related to Mina’s claims. “We stand strong in this situation, and we are sure that the judicial system will be fair in their ruling on this matter,” Dr. Saeed Mokhtar, official spokesman of the Ministry of Health, told Egypt Today.

Flotation Ripples


Some 40 percent of Egypt’s pharmaceuticals market is dominated by multinationals such as Pfizer, Novartis, GlaxoSmithKline and Sanofi, while the remaining 60 percent comprises local drugs, albeit mostly private sector players. Before the float, annual sales of pharmaceuticals were estimated at a reported LE 40 billion but are expected to fall dramatically.

“Many do not understand that all local pharmaceutical factories depend on active ingredients that have to be imported. We’ve been in constant contact with local factories but they tell us that production of certain medications has been halted due to lack of materials,” El-Ezaby told Egypt Today. The Ministry of Health admits it has a situation on its hands. “The Ministry is fully aware of the fact that there are a lot of medications becoming scarce in Egypt, but I would like to assure you that the problem is not a consequence of the flotation, negligence of the Ministry of Health, or any restrictions applied by the government on the pharmaceutical companies.”

Instead he puts it down to pure market panic. “The only problem is that the international and national pharmaceutical companies panicked when the government decided to float the pound, thus halting the production or selling of any medications until the Egyptian pound stabilizes against the US dollar, for fear of losing profit.” As for public companies, Mokhtar stresses that they are providing their line productions to consumers and under the Ministry’s supervision. “I need to assure the public that we are doing everything that we can to stabilize the drugs market in Egypt. Many meetings are being conducted with both the international and national pharmaceutical companies to find a solution to their problems so that they would steadily provide their products for the consumer,” Mokhtar adds.

At the end of last year, President Abdel-Fattah Al-Sisi urged the government to create a new and modified plan to tackle the drug shortage in the country. On January 12 of this year the Ministry of Health released a press statement announcing a price hike on medications, explaining that “medicines subject to the increase will not exceed 15 percent of local medicines and 20 percent of imported medicines. [The increase is] divided into three segments, with a minimum increase of 30 percent and a maximum of 50 percent.”

However, the release noted that the increases will not be applied to vital medications such as those for hypertension and diabetes. According to the Ministry, the higher prices would help alleviate the shortage by fixing the imbalance in the market. But many criticize the strategy as misguided. “These increases are not acceptable. The tens of millions of poor people in this country found it hard to afford the old prices to begin with and with the price increase of everyday essentials, that is way more than what the Egyptian citizen can handle,” Hassan Maamon, a human rights lawyer and activist, tells Egypt Today.

“The government needs to understand that what they consider acceptable might not actually be acceptable for the average-income citizen, let alone people below the poverty line. With such a decision, they are literally condemning millions of Egyptians to death.”

El-Ezaby agrees and puts much of the onus on pharmaceutical companies. “Pharmaceutical companies need to understand that losing money is least important when it comes to the well-being and the needs of the Egyptian people. I urge them to take the risk. People are dying because they either cannot find their medications or they simply cannot afford them.”

But pharmaceutical companies take a different stand. Said Ibrahim, factory manager at EIPICO, one of the largest pharmaceutical companies in the country, says that about 1,600 types of drugs have disappeared from the
Egyptian market in the months since the floating of the Egyptian pound. Among them are 35 medications that have no alternatives and would disappear if the price caps were not eased.

“We aren’t a charity,” Said told Reuters. “We have expenses and production costs, and if a company isn’t making profit it will have to halt production.”