The political instability that spread across various countries in the Middle East has an adverse effect on so many aspects of people’s daily lives, but healthcare, in particular, has been severely affected. The economic pressure that resulted from the political instability, in addition to other reasons, also has helped worsen the problem. Severely declining oil prices affected major exporters, such Libya and Algeria, and the reduction in the flow of tourists to countries like Egypt and Tunisia has severely affected the flow of foreign currency, urgently needed to maintain the flow of essential imports, including medicines.

Surge in demand, import reduction contribute to shortages

The affected countries have started to decrease medical imports by using announced and unannounced policies, sometimes by not providing foreign currency needed by importers and in other occasions by delaying the release of import licences. New and expansion plans for local manufacturing projects have also suffered because of a noticeable decrease in the flow of foreign investment, triggered by uncertainty, and the currency-related hike in the price of raw materials.

Markets heavily dependent on imports, such as Algeria, have been severely affected, And the impact also affects consumption patterns in neighbouring companies, such as Tunisia, leading to shortages and the appearance of the so-called black market for imported products.

Countries receiving large numbers of refuges, such as Lebanon, Jordan and Turkey, have also experienced drug shortages triggered by a hike in consumption. To get an idea of the pressure that such a problem could have on the healthcare system of a country, one should consider that Lebanon now hosts a number of refuges equivalent to a quarter of its original population.

Shortages drive rise incounterfeit drugs production

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Drug shortages and the insufficient control systems in many Middle East countries have also allowed illegal mega-manufacturing factories to work freely, flooding the local market with counterfeit medicines.

A few days ago, Egypt announced the discovery of ‘thousands’ of packages of counterfeit copies of hepatitis C virus (HCV) medicine Harvoni (ledipasvir 90 mg/sofosbuvir 400 mg; Gilead Sciences, US), produced at ‘five’ illegal manufacturing facilities. The drug is available free of charge to Egyptian patients, suggesting that counterfeit copies made in Egypt are most likely destined for export to other countries. The inability to fully control the borders between neighbouring countries, such as Tunisia, Algeria, Libya, Egypt, Sudan, Lebanon, Syria, Iraq, Yemen and Jordan, can certainly facilitate the flow of counterfeit products between countries in the region.

Long-awaited positive changes and future opportunities

Despite this chaotic landscape, a positive change is starting to appear as a result of the spreading of counterfeit pharmaceuticals. Governments are increasingly realising the importance of using technology and introducing legislation to help control and monitor products on the market. For instance, the UAE announced a new strategy to combat counterfeit drugs, including preventing their shipment to the UAE for domestic use and stopping their import and re-export to other countries. Egypt started developing a digital tracking system to control and track pharmaceutical products in the market. More countries are starting to tackle the problem in a serious manner as well! And legislative changes in this area are happening much quicker than would have been thought possible in these markets.

The dilemma of drug shortages has also pressured health authorities to take more steps to accelerate the process of drug approval, with a strong regard for internationally approved drugs, which can present an opportunity for new players to access those markets, especially after the economic recovery and the regaining of purchasing power!

Having said that, it seems that the drug shortages problem in many of the countries in the region, particularly in North Africa, is inevitable, and only a true economic recovery can help bring the market back to normal. For the time being patients in those countries will sadly continue to face the risk of counterfeit medicines, until the issue of drug shortages of legitimate products is addressed.