The file of pharmaceuticals in Egypt cannot accommodate any tampering. Health is one of life’s most important elements and the lives of citizens is one of the pillars of national security everywhere across the world. In Egypt, many crises were related to pharmaceuticals, and the field is one of the most important fields for investment in Egypt. Last year, sales of pharmaceuticals reached EGP 60bn paid by Egyptians to maintain their health, and we all remember the insulin crisis and that of the children’s formula.
Daily News Egypt sat down for an interview witho Mohie Obeid, the head of Pharmacists Syndicate, one of the parties responsible for the issues of pharmaceuticals in Egypt, in order to further understand who monitors prices of pharmaceuticals and the role of the syndicate. We also spoke to him about the segment of pharmacists and other controversial issues, such as the shortage of pharmaceuticals, the reasons behind this shortage and fraudulent drugs. The transcript for which is below, lightly edited for clarity:
When does chaos of monitoring pharmaceuticals in Egypt in terms of manufacturing prices come to an end?
The system of selling and manufacturing drugs has been going through a real crisis over the past few years and the state has to play its role to save it from collapsing because this negatively affects the overall health in the country.
Egypt is falling behind the rest of the world regarding the step to establish a higher authority for pharmaceuticals. The countries of the world have these kinds of authorities working to supervise the pharmaceuticals manufacturing industry, starting from moment the product as a raw material, until it is a final product which reaches consumers. That authority existed in Saudi Arabia for 12 years and in Somalia for eight years.
The syndicate has proposed a project to establish that authority to the parliament and the state submitted another proposal to establish another body, which is responsible for medical supplies.
The legislative committee in the parliament is currently reformulating proposals and will be referring them to the Ministry of Health to take a final decision regarding them.
The new drug law stipulates that pharmaceuticals in Egypt must be subject to supervision by three authorities. One is specialised in unified purchasing, another in medical technology and the third would be the higher authority for pharmaceuticals. There will be no interference between the three bodies, and they will all be under the supervision of the presidency.
How do you see increase in prices of medicines, insulin?
The prices of drugs in Egypt are the cheapest in the world compared to various countries, being one of 30 of global prices, however, this can barely be felt given the poor economic situation of many citizens.
The majority of increases are due to the increase in prices of raw materials. There are efforts exerted by the syndicate to rationalise drug prices. One of the solutions includes reducing the value added on the price of pharmaceuticals to reduce their costs in accordance with incomes of citizens, especially, poorer and low-income segments.
Oftentimes, as is the case with insulin, the increase is actually in the best interest of citizens, because not changing prices will force production factories to halt their production, which would lead to the products’ disappearance from the market.
Does this mean there may be further price increases?
Of course not. Citizens cannot bear any more increases, and as a syndicate, we are keen on maintaining the stability of prices. We will intervene to solve company issues after studying the reasons for the substantial shortages persisting in some medications. We will not allow new increases to happen.
Until when will medication shortages continue in Egypt?
This is a global phenomenon, but it will continue in Egypt, as long as brand names are used in dealings. If Egypt used the scientific name of medicines, citizens would realize that about 12 companies produce the exact same products, but under different names.
Can you name main obstacles before developing pharmacy profession in Egypt?
There are many obstacles, including increasing the number of college students significantly each year until it reached 14,000 this year in 44 colleges across the country, even though the required numbers for the labour market is 2,000 graduates, hence, we find that there are 12,000 pharmacists which are unemployed.
Additionally, there is the obstacle of not developing government pharmaceutical companies and their products which account for 80% of the pharmaceuticals market in Egypt with a share of no more than 4%. The pharmaceuticals industry in a global business for commercial companies, which aim to achieve profit.
Other issues in the profession include the unprecedented phenomenon of opening pharmacy chains. These chains are a crime because they explicitly violate the law. Additionally, they are important outlets to sell smuggled medications, which do not meet the pre-set standards. They represent 10% of imported medications.
There are over 5,000 pharmacies, which are threatened to shutdown given the increase in labour wages, electricity, and water bills. We have communicated with the Ministry of Finance to reduce the financial burdens on pharmacists, including taxes and utilities.
Why no action took place against owners of these chains if they happen to be members of syndicate?
The state is against shutting them down, however, it has taken some actions against them before Eid Al-Adha. We have already suspended many members who own these chains and verdicts were executed against them. We also addressed the Ministry of Health and started acting. We are waiting for measures to be taken to include everyone involved.
What about city to be established for pharmacists by syndicate?
The syndicate has recently sought to reach the highest level of excellence for its members in terms of service provision.
Work is under way to establish an integrated city for pharmacists on an area of 50,000 sqm at a cost of EGP 700m.
Seven clubs were bought after the syndicate had no clubs at all. The first club will be opened next January on an area of 18,000 sqm in the Fifth Settlement and in the coming December in Port Said, in addition to other clubs in Gharbia, Beni Suef, Menoufia, the Red Sea, and Suez.
Plans to increase syndicate’s budget?
We are preparing to establish a pharmaceutical distribution company with a capital of about EGP 500m. It will help us end the shortage of medicines and stop the monopolisation of certain types of medicines by some companies. The future company will also help us get rid of expired medications.
The company will also provide professional services to its members, and if successful, we will expand its business so that it can manufacture more medications.
Spurious medications among local market?
In the past year, companies withdrew medicines worth EGP 260m to EGP 270m, but they would typically withdraw only about 2% of their medications, worth about EGP 120m. This increase came following the implementation of the ‘Washout’ agreement. The syndicate addressed the ministry of health and the cabinet to take the necessary legal action against those who abstain from implementing the resolution, but nothing happened. We want to negotiate, not to escalate with sit-ins and strikes because the state will not tolerate this, though we must emphasise that the expired medications problem is the state’s responsibility. Online websites are the biggest source of trading in spurious medications, along with clinics and medical centres, which sell medications in full view of the ministry of health.
Appropriate way to deal with abstaining companies?
There are about 48 companies, which have refrained from withdrawing their expired medications from pharmacies, and I call on pharmacists to boycott these companies. Meanwhile, we called for the extension of the Washout agreement for another six months to free Egypt from expired medications.
Role of pharmacological inspection?
The pharmaceutical inspection is limited to licensed pharmacies only. There are about 15,000 to 20,000 pharmacies owned by non-pharmacists. They obtained permits through exploiting the names of some pharmacists. There are several rulings for the closure of many pharmacies but they were not implemented. The pharmaceutical inspection suffers from some problems, and they came under tough pressure due to the growing increase of pharmacies and toll companies.
Your opinion over death of one-year-old child, Remas, after taking injection at pharmacy?
It is the problem of pharmacists, as he was not authorised to give injections to citizens, though there are about 2 million citizens who take injections daily in pharmacies.
Egyptians got used to taking injections in pharmacies, and we have two options: either preventing injections in pharmacies or offering training courses to pharmacists to give injections.
After examining the body of Remas, we found that she was allergic to the medication, and this is a rare incident which occurs in only one person out of 1,000 cases, but the problem is that the girl did not undergo an allergy test.
Actually, pharmacists do not want to continue giving injections, as it is not worth it.
In Remas’s incident, the pharmacist was the one who diagnosed her case. This brought up this problematic issue. When you suffer from headaches and high temperatures, or when you get sick, the first person we usually resort to in our community is the pharmacist.
Pharmacists play a major role in providing health care. They are experts in medicine and use their clinical expertise to prescribe a specific medication for common problems, such as coughs, colds, pains, as well as advising us on healthy food, and quitting smoking.
They are highly trained and study health care and pharmacology at university for five years. They are also trained on diagnosis and treatment of general diseases and undergo special training on dealing with patients and medications under the supervision of qualified and experienced pharmacists and specialists usually in a hospital or public pharmacy.
The pharmacist provides several services, including choosing the appropriate physician, giving prescriptions and advice for treatment of minor cases, using over-the-counter medications, giving influenza vaccinations, blood pressure tests, diabetes and pregnancy testing, and providing information about medications, and their contraindications or side-effects.
There are large scientific institutions, which have published researches on pharmacists’ successful diagnoses of many diseases.
Diagnostic training courses for pharmacists objected by Egyptian Medical Syndicate?
We have already received a letter of objection from the Egyptian Medical Syndicate, but we replied that these courses come in line the objectives for which the Pharmacists Syndicate was established, in accordance with Article 2 of Law No 47 of 1969 concerning the establishment of the Pharmacists Syndicate. The Pharmacists Syndicate in Fayoum offered training courses with the aim of introducing pharmacists to the side effects of medications, pharmacological reactions and the pharmacist’s role in advising patients when dealing with different medications. The course was called ‘The Pharmacist’s Role As A Prescriber.’
Syndicate recent conflicts?
There were no conflicts. A very small group of individuals tried to seize the syndicate and the general assembly dismissed them in a meeting several months ago.
Reforms demanded by pharmacists?
We have accomplished a number of them. We raised the profit margin of the pharmacist in accordance with the ministerial decision No 499. We also called for a mechanism for withdrawing expired medicines and prevented sequestration of the syndicate’s assets.
We achieved a budget surplus of about EGP 36m and opened six new headquarters. The pharmacists’ pension was raised from EGP 500 to EGP 800 in three years. The syndicate offers compensation for pharmacists who are fire victims worth EGP 40,000. The syndicate formed a committee to reformulate taxation on pharmacies. We also finished drafting a law on practicing the pharmacist’s profession, but it was halted as a result of opposition from a number of sub-unions.