As the political hoopla continues across the country one industry silently breathes its last on the brink of collapse threatening devastating consequences for the vulnerable, especially children in Pakistan.
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In a letter addressed to Pakistan’s leading investigative journalist and talkshow host Mr. Mubasher Lucman the pharmaceutical community makes its case, stressing urgency, in an effort to prioritize health for the many children fighting for their lives. The pharmaceutical community which has been working in Pakistan since 1951, is currently being crushed by inflation, a lack of support from governmental and non-governmental agencies, and an ongoing global healthcare crisis. Making its argument in support of Pakistan’s healthcare and pharmaceutical industry, through the letter, the community stressed the need to develop a locally produced drug to combat the rising threat of TB (Tuberculosis).
As stated in the letter, TB is a disease that kills thousands every day yet authorities remain “oblivious” to the fact that “generations are being destroyed” resulting in the collapse of the healthcare system in the country. According to recent statistics, Pakistan is rated the 5th burden country in the world with “no drug in the market” for sale. It is essential to understand why this is leading to disastrous consequences for a country already shackled to a shaky economy. According to WHO (World Health Organization) statistics, approximately 1.3 million lives were lost due to TB in 2022 alone, of which 167,000 were HIV positive. This means that while it is curable, TB is the “second leading infectious killer” worldwide, after COVID-19 and followed by HIV and AIDS, respectively.
Although ending the TB epidemic by 2030 is an essential health target of the United Nations (UN) Sustainable Development Goals (SDGs), Pakistan is falling deeper into it with no end in sight. In the last few years alone, the country has jumped from the 7th to the 5th ranking in the burden countries. But why is that? As rightfully argued in the letter, producing TB medication in the country is costly: its raw material needs to be imported in dollars, the production cost is very high, and the quality cost needs to be ensured per WHO formulations which are even higher. Apart from that, a tablet manufacturing line needs to be set up the cost of which was 580 million dollars three years ago. A price that has since risen to between 800-900 million dollars, respectively.
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But why are these production facilities costing so much resulting in the collapse of an entire industry? The letter argues that this is because the cost of production is rising despite no increase in the prices of the medicines. Despite a policy and a system focused on the pricing of lifesaving drugs, the implementation remains lacking especially in the last couple of years. As suggested, in January-February of 2022, the industries submitted a case for price consideration of essential products to no avail. At the time, the dollar was at 176 PKR, and lawyers and regulatory departments spent hours outside of courts with no progress. The first committee meeting convened in December 2022, a year later when the dollar had risen to 226 PKR. This resulted in the case being deferred to the cabinet. Since then, the pharmaceutical community has been waiting for a step in the right direction.
On 14th November 2023, a judge acted in favour of the industry and passed an official ruling that stated: “The constitution of Pakistan does not envisage that losses inflicted on citizens and entities operating in Pakistan will lie where they fall, merely because of delinquency on part of the Federal Government, its employees and those in service of Pakistan.” A second meeting of the ECC (Economic Coordination Committee) on the 15th of November, dismissed the agenda. At the time, news outlets like The Nation and The News reported: “The ECC, after detailed discussion and deliberation, asked the Ministry of National Health Services, Regulations & Coordination to come up by Tuesday next, with well-informed and well-considered recommendations involving a proper and judicious analysis of the pricing mechanism.”
The ECC’s rejection makes it another deferral to DRAP (Drug Regulatory Authority of Pakistan) for review with no progress. In the process, the dollar has risen to 308 PKR and back to 282 PKR yet there is no relief to the national pharmaceutical industry which is consistently looking to the government for relief to ensure better production of essential healthcare and medicines across the country.
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The only solution they argue, is to meet the challenges of annual inflation and the fluctuating rates of the US dollar because fixing the price increase based on the PKR is no longer feasible for the industry.
According to the letter, not only is the collapse and closure of manufacturing lines and associated industries inevitable, but this may further result in “exponential” collateral damage through health-related catastrophes including deaths of patients, a decline in the health of patients undergoing treatment, development of Multi-Drug Resistant TB, children being born with TB, increase in TB mortality rates in the elderly, or no access to drugs to affording patients who support Pakistan’s healthcare system.
This, in turn, will give way to the black market drugs and their consequences such as patients and caregivers being blackmailed into paying double for medicinal items, markets selling fake or counterfeit products with no guarantee of cure, side effects and adverse drug reactions which may even result in loss of life, the livelihood of skilled labour being at risk, and the collapse of the healthcare industry. All this, with political leaders and people fighting for power amidst their political hoopla of who gets the “king seat” while millions of lives are at risk because of the “inadequate supply of health care products and industries shut down”.
As the conundrum continues, the letter reads on testimonies from patients, their loved ones, and the healthcare professionals treating them. One such case is that of Uzair, the father of an infant fighting TB. Uzair is allegedly forced to seek India’s support in order to receive a pack of chewable tablets which can be sent to Pakistan via UAE after paying an exorbitant amount of money to save his child’s life.
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On the other hand, is Aasiya, a patient whose life hangs in the balance because she is unable to find the single drug formula which remains unavailable because the industry is on the brink of a shutdown. Aasiya was close to being cured when her sputum showed traces of TB once again. Likewise, is Dr. Ashraf an infectious disease specialist in Pakistan. Dr. Ashraf is calling on every industry that once made anti-TB products to help save the life of his patient Zainab, a young girl with an auto-immune disorder who contracted TB during surgery for a broken nose.
This then begs the question, who is responsible for the lives that could be saved but will be lost because of the failings of the pharmaceutical industry? Who then will be responsible for the millions who do not have either the resources or the access to those resources? Such people will have no choice but to die without treatment argues the pharmaceutical community. They stress, “One doesn’t need to go to Palestine to be answerable for the loss of precious lives of children. Pediatric TB in Pakistan will kill enough children this year if things go on this way.”
Pakistan’s pharmaceutical community urges, “Countless industries of Pakistan, with the capability of producing international quality drugs, with registered products are begging for respite. We are ready to take the burden of the healthcare system if only the government would support our price handicap.”
“We have been silent for many years but refuse to take responsibility for the murder of innocent children. We beg for attention. The media is our last resort”, concludes the letter.
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