Egyptians face illness amid a serious scarcity of medicines

According to pharmacist Mohamed Zaki, “Not a day goes by without a verbal altercation or a physical fight.” He was commenting on the atmosphere in the Egyptian pharmaceutical market, which has been hit by severe shortages that continue to exacerbate the suffering of patients and put pharmacists in an embarrassing position.

Fellow pharmacist Iman Sayed says that the types of drugs needed for chronic diseases such as diabetes, high blood pressure, liver, heart, kidney failure and asthma attacks are not available. “But I have cosmetics.”

The crisis affects about a thousand types of drugs, out of a total of 17,000 which are officially registered for use in Egypt. The shortages mean major losses for about 80,000 pharmacies in the country, which have been unable to provide the medication needed in the market for more than a year, even as most are in increasing demand.

Despite the worsening crisis, government responses have been slow and ineffective.

They have been dominated by official conflict and vague promises. Egyptian Prime Minister Mostafa Madbouly said that the state is working to overcome the pharmaceutical crisis within a month. During a press conference in New Alamein in the north of Egypt last Wednesday, though, that dateline was amended to between two and three months. However, the head of the Medicines Division at the Federation of Egyptian Chambers of Commerce, Ali Auf, said that the medicine shortage will end almost completely within a period of between 45 and 60 days at most.

Ninety billion Egyptian pounds ($1.9bn) was spent on medicines in the first half of this year, with expectations that sales will rise to 200 billion pounds ($4bn +) by the end of 2024.

“Hashish is available, but medicine is not,” said one sixty-year-old man as he explained the difficulties of searching for pharmacies in different residential areas to find missing medicines. The alternative is the black market. This is active outside pharmacies, and is managed by drug store owners online and on social media. It has seen record levels in the prices of some drugs.

I looked at the prices of some important medicines. The price of Ozempic injections, for example, which are used to treat diabetes and reduce weight, varied from 1,400 pounds ($29) in the regular market to 5,000 pounds ($103) on the black market. The price of Prolia, a drug used to treat arthritis, rose from 1,350 pounds ($28) to 4,500 pounds ($93), while the price of Tresiba insulin was as much as 1,000 pounds ($21) on the black market, up from 380 pounds ($8) in pharmacies. The price of Mixtard, a drug used for diabetes patients, also rose from 55 pounds ($1.10) to 400 pounds ($8 minimum) on the black market.

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What is strange is that in Egypt, you may have to ask for help from someone to obtain a missing medicine if you have a diabetes patient or someone with other chronic and serious diseases. I was asked by a friend to help find some insulin for his wife, who is a diabetic, after he had searched in vain in a number of pharmacies in the neighbourhoods of Haram, Faisal and Giza near the capital. Only after contacting one of the owners of major pharmacies in downtown Cairo was one box provided for him.

A tour of pharmacies in Cairo and various governorates reveals the extent of the severe shortage of medicine, which has also affected nutritional supplements and baby milk, most notably Nactalia, Hero Baby, Bebelac and Similac, in addition to a significant increase in their prices, and the absence of alternatives. This means that a child could receive more than one type of baby milk in any short period of time, which may affect the child’s health.

The most prominent shortages include the medicines Concor, Blokium Duo, Capoten and Capozide, which are used by patients with high blood pressure, from which more than 30 million Egyptians suffer, according to data from the Egyptian Hypertension Society. The shortage also extends to antibiotics such as Curam and Megamox, painkillers and fever-reducing medications such as Brufen, Cataflam and Megafen, as well as the alternatives that doctors are able to prescribe.

The suffering of patients is increasing significantly, with the continued disappearance of medicines for gout, liver, kidney and gallbladder issues, intravenous solutions, IV injections, sea fever and muscle atrophy. Even anaesthetics are in short supply.

Pharmacist AA told me that he sells angina and asthma tablets such as Minophylline and the bronchodilator Kipron by the tablet system, while other shortage drugs are sold by the strip and not a full box. He justified this as an attempt to meet the needs of patients in light of the severe shortages in the market.

Arguably most dangerous of all is that the crisis has extended to the operating theatres in government hospitals.

They suffer from a shortage of surgical equipment, cannulas, solution devices, plates and screws for fractures, and prosthetic limbs. A doctor in a government hospital, who requested anonymity, said that quarrels occur frequently between patients’ families and medical staff due to the hospital’s inability to provide surgical and pharmaceutical supplies. The hospital asks patients to buy their needs from abroad, which represents an extra financial burden on them.

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Patients are often blamed for exacerbating the crisis by stockpiling medicines, which puts additional pressure on the supply chain. There are those who hold pharmacies and store owners partly responsible, arguing that they hold back stocks while awaiting details of price rises which are passed on to patients. However, according to the head of the NGO Right to Medicine Association, Mahmoud Fouad, the crisis is due to the lack of dollars in Egypt to import raw materials from abroad, and the high prices of raw materials and manufacturing supplies.

In light of the liberalisation of the local currency exchange rate in March, from 31 pounds to 48 pounds per dollar, pharmaceutical companies are in a difficult position due to the high cost of production. This prompts them to demand the raising of the prices of nearly 3,000 types of medicine, according to the Medicine Division of the Federation of Chambers of Commerce.

There are 191 licensed pharmaceutical factories in Egypt, which together own 799 product lines, according to data issued by the government’s Egyptian Drug Authority, but the market relies on imported raw materials for 90 per cent of what is needed.

A businessman in the pharmaceutical market, who declined to be named, attributed the crisis to the dilemma of “forced pricing”, as medicines are products that are priced by force in Egypt, similar to petroleum products and bread. Unlike fuel, though, the prices have not been raised. Fuel has seen more than 10 price increases under President Abdel Fattah Al-Sisi.

It was announced in May that a permanent committee would be formed, headed by Minister of Health Khaled Abdel Ghaffar, to review drug pricing every six months, similar to the Petroleum Products Pricing Committee. The announcement came after many companies submitted requests to re-price pharmaceutical items, in light of the increasing manufacturing costs.

Shareholders in pharmaceutical companies told me that they are demanding serious negotiations with the government to resolve the crisis. The hope is that the parties will agree to set fair prices that achieve a balance in the market between medicine supplies for patients and company profits while covering the gap in production costs after floating the local currency against the dollar.

For its part, the government is proposing solutions that require approval for a limited increase in chronic disease medications, in exchange for compensating the manufacturing companies with larger increases in other non-vital products, such as nutritional supplements.

Nevertheless, Egyptians still fear a new wave of inflation hitting the medicine market, similar to the increase in fuel prices a few days ago, and the rise in transportation and food prices, which will burden patients with greater suffering, combining the pain of illness and the harshness of being unable to afford to treat it.

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