Ashraf Mohamed, a 51-year-old diabetic patient, is experiencing severe anxiety as the drug shortage crisis deepens, with medications disappearing from the markets. He confirmed that the crisis has also infiltrated the black market in the Al-Gomhoriya district, Sohag, where he resides. Expressing his distress, Ashraf said, “I have been undergoing a severe psychological crisis since the onset of the drug shortage, and I am terrified of falling into a diabetic coma due to the rising drug prices and persistent insulin shortage.”
Local Production
The crisis affecting Ashraf and thousands of individuals with chronic illnesses first emerged at the end of 2023 but significantly worsened mid-year. This escalation is attributed to the Central Bank's decisions on February 1st and March 6th to adjust the currency exchange rate, which triggered a dollar liquidity crisis for local pharmaceutical companies. These companies produce approximately 91% of the locally required medications, according to data from the Egyptian Drug Authority.
Black Market Crisis
According to statements made by Ali Al-Ghamrawi, head of the Drug Authority, last August, there are 81 types of medications for diseases such as blood pressure and diabetes that are currently in short supply in Egyptian markets.
The black market has become a refuge for Ashraf and many other patients as a solution to the shortage of diabetes and nerve medications. Ashraf remarked, "I bought Plavix from the black market for 120 EGP, while its official price was 67 EGP. At the beginning of the crisis, I also purchased insulin for 100 EGP instead of 65 EGP. The same applies to Milga, which diabetics use to treat nerve conditions."
Statements, and more Statement
Amid the ongoing drug shortage crisis, with medications vanishing even from the black market, Minister of Health Khaled Abdel Ghaffar announced at a press conference in late September that the crisis would be resolved within weeks, assuring that medications would soon be available in the Egyptian market. However, Ahmed Mohamed, a 35-year-old pharmacy employee at Maragha Town, reported that the crisis had worsened since July, impacting thousands of medications, particularly those for blood pressure, heart conditions, diabetes, and some antibiotics, thereby affecting pharmacy sales.
Pharmacy Challenges
Despite repeated promises that the crisis would be resolved shortly, Ra’fat Hamdi, a pharmacy worker at Maragha Town, lamented the unavailability of several essential medications. These include Urosolvine effervescent tablets for gout and high salts, Minalax for constipation, Ursofalk for gallstones, Streptoquin for diarrhea, Predsol for respiratory infections, Profen and Cafsid, Contafever for high body temperature, growth hormone medications, treatments for epilepsy and depression, thyroid hyperactivity medications, as well as some antibiotics, and medications for heart conditions, blood pressure, and psychosis.
Regarding the plight of diabetes patients, Ra’fat confirmed a significant crisis among those with chronic conditions due to the disappearance of critical medications since May, such as Diavance and Lantus Mixtard.
Exporting Insulin
Addressing the crisis faced by Ra’fat and diabetic patients, Khaled Abdulghaffar, the Egyptian Minister of Health, announced on March 9th that Egypt had taken a crucial step in providing life-saving treatment for diabetics globally. He emphasized Egypt's unwavering commitment to ensuring the availability of "insulin," an essential medicine, for patients in need, regardless of their geographic location.
Abdulghaffar’s statements were made during the signing of an agreement between the Ministry of Health and the United Pharmaceutical Company to export Egyptian-made insulin "Insulinagypt" to Cuba, in the presence of the Cuban Minister of Health. The Minister of Health also confirmed that Egypt would export insulin to 11 African countries as well.
Cuban Patients’ Needs
In late May, amid the worsening diabetes crisis in Egypt, the Egyptian Drug Authority confirmed the export of 18 million packages of Egyptian insulin. This initiative aimed to meet the needs of Cuban citizens for insulin, as outlined in a press release by the Authority on May 29th, following the signing of a memorandum of understanding with the Cuban State Control Center for Drugs, Equipment and Medical Devices.
Sohag Patients’ Needs
10,725 kilometers away from the Egyptian insulin shipments in Cuba, Ahmed Ali, a pseudonym for a pharmacy owner in Tahta Town, is grappling with a crisis that has slashed his sales by 40%. The absence of medications for kidney, diabetes, and blood pressure patients has exacerbated the situation. Ali reported that the crisis began three months ago, leaving patients bewildered, as many rely on daily medication, such as insulin for diabetics and Concor for blood pressure patients.
Aliya Mohamed, a 47-year-old hypertension patient from Akhmim, Sohag, confirmed this dire situation. “I cannot do without Concor, and my husband has kidney disease. He struggles to find Cystone capsules and resorts to buying them from the black market for 172 EGP instead of 27 EGP,” she said.
Despite the success of Ahmed Gaber's open-heart surgery, the 54-year-old resident of the eastern district of Sohag now faces a significant risk due to the scarcity of Concor and Milga medicines. Consequently, he has turned to the alternatives available at the pharmacies of the Health Insurance Authority.
Ceramic Powder
Souad, a 39-year-old resident of Tahta Town, turned to an alternative blood pressure medication that proved ineffective, causing her to suffer from continuous hypotension.
Souad remarked, "this is better than what happened to my brother. After experiencing a toothache, he struggled to find an antibiotic. After an extensive search, he managed to obtain a box, but it caused him to bleed for three hours. Tests at the hospital revealed that the antibiotic was a ceramic powder, produced by some 'under the table' manufacturers to exploit its scarcity."
Monopoly and Storage
Mahmoud Thabet, a pharmacist at Akhmim Town in Sohag, highlighted that the crisis is exacerbated by monopolistic practices and stockpiling. Patients tend to hoard medications during crises, fearing shortages.
Solutions
Mahmoud suggested several solutions: “first, implementing laws to regulate the import of raw materials, ensuring guarantees for manufacturing companies, and fair drug pricing to maintain production continuity. Secondly, oversight of distribution companies to prevent monopolistic practices and improper storage of medications.”
He emphasized the necessity for equitable distribution of medications across sectors, including public and private hospitals and health insurance. Additionally, prescribing medications by their scientific name in electronic prescriptions should be mandatory, and doctors should adhere to this practice.
Mahmoud noted that pharmacies are on the brink of collapse due to the crisis and the rapid daily fluctuations in drug prices. He stressed the need to stabilize prices and raise patient awareness about alternative medications, as “patient's confidence in their treatment is crucial to its effectiveness.”
