The disappearance of essential medicine from Egyptian pharmacies because of a shortage of foreign currency to import them is causing panic among people with chronic illnesses.
Medications for diabetes – a condition that affects about 11 million people in Egypt – blood pressure, cancer and a number of psychiatric conditions are no longer available, according to pharmacists and patients.
Others have soared in price because of a supply shortage,, leading to a surge in sales of black-market, unverified versions of medicines that could be dangerous for patients.
“I have been on medication to treat my bipolar disorder for over six years. I am entirely dependent on it. A few months ago, I would have to search several pharmacies around me to find it," said one Egyptian woman, 33.
"Now I am lucky if I can find one strip of 10 pills per month," she said, well short of the 30 to 60 Lamictal pills she needs each month.
"I was told that because it’s not deemed as essential as other medicine, pharmacies aren’t supplying it. It has been a month since I have had to reduce my dose. I can’t imagine what it’s like for someone who has more than psychological symptoms to deal with."
Lamictal now costs five times what it did at the end of 2023, just a month and a half ago.
The drug is one of many that have soared in price because of supply shortages.
Historically, the Egyptian government has heavily regulated medicine prices to prevent this scenario and ensure that even the poorest people have access to the drugs they need.
However, these regulations have lapsed in the past two years since the country has been hit hard by a currency crisis and economic downturn. Suppliers and manufacturers have raised prices to account for the increase in costs of importing the necessary drugs and ingredients due to the diminishing value of the Egyptian currency against the US dollar.
The shortages have been getting worse since early last year and are now at a "critical level", Dr Noha El Sayed, who runs a pharmacy in Cairo's Heliopolis district, told The National.
“About 80 per cent of our listed medications are not available," she said.
A number of broad-spectrum antibiotics, including Augmentin and Zithromax, have also disappeared from Egyptian pharmacy shelves, according to Dr El Sayed, in addition to tablet-form cancer medications.
Intravenous cancer medications are still provided at specialised hospitals, according to Dr El Sayed. However, some patients who need the medicine in pill form have begun to buy them via unofficial channels.
Black-market varieties of well-known brands, which may be expired or cut with additional substances, are circulating. Some Egyptians are resorting to unofficial versions of insulin, thyroid treatments and blood pressure disorder medications as the verified versions of these crucial medicines become less available.
Aside from being 10 times their listed prices in some cases, according to Dr El Sayed, black-market products are unregulated.
“The problem with buying medications on the black market is that much of the time they are not regulated, so they might include more or less of the listed dosage," she said. "And some are just sugar or mineral pills which can be dangerous for cancer and diabetes, because patients who don’t take their daily dose can take a turn for the worse very easily."
Local manufacturers have been unable to fill the growing gap between demand and supply due to increasing operation costs and a heavy reliance on imported components, Dr El Sayed said, emphasising that the availability of dollars and the high price paid to acquire them are the root of the problem.
She said that many of her patients who switched to local alternatives have reported adverse side effects that have made them question the efficacy of the medicine.
The doubts over local alternatives have led some patients to hoard the imported varieties, driving their prices up further.
The Egyptian chamber of commerce's pharmaceuticals division said this month that the main problem was a shortage of US dollars to pay for imports of medications and for raw materials for local manufacturers.
However, the division's head downplayed the shortage during a televised phone-in to Al Hekaya, a popular talk show, on Monday during which he gave assurances that "the public sector has enough".
While local alternatives to the imported drugs are available for some of the medicines in short supply, many patients refuse to take them and insist on purchasing only the medication with the brand name prescribed by their doctor.
“A lot of patients will choose to go back to their doctor to check that the local alternative is viable before taking it, they don’t trust that it will work as well,” Dr El Sayed said.
“I think this is a symptom of a larger problem in Egypt, where imported goods are typically preferred or deemed superior. In some cases, though, they’re not wrong. Some of the local alternatives for diabetes have caused some of my customers a range of new side effects.”
The continuing shortages have reduced pharmacies’ profits, hitting cash flow and further reducing their ability to buy stock from importers and large-scale manufacturers.
Pharmacies have also suffered from continued price caps on medications, despite suppliers selling their medicines to pharmacies at higher prices.
The Egyptian health ministry issues price lists on medications in Egypt and regulates pharmacies to ensure they do not charge customers more than what they paid to suppliers, Dr El Sayed said.
“Most of our profits are made on cosmetics and beauty products, which have tripled in price in most cases. But people aren’t buying as many beauty products at the moment, which has brought down our profits, at the same time that pharmacies are being asked to pay more by importers and manufacturers because there is heated competition over what little wares they can provide.”
Hospitals, state-owned and private sector, have likewise been suffering a severe shortage of many medications, including basic antibiotics and painkillers, the head of a pharmacy division at a general hospital in Egypt's northern province of Beheira told The National.
He said that all hospitals deal with the same importers that supply medicines to pharmacies and clinics in Egypt and have consequently suffered shortages, albeit less than smaller operations because of existing laws that support hospitals.
Dr Mohamed Moharrem, an osteopath and former director of a general hospital in Beheira province, told The National that importers and manufacturers were formerly mandated by law to supply hospitals with a percentage of their wares. The exact amount varied between 20 per cent and 40 per cent, depending on the province.
"Today a lot of the old laws aren't quite operational any more because of the instability in the markets and the exchange rate. Suppliers are now selling to the highest bidder and they are not favouring public hospitals," Dr Moharrem said.
Officials have repeatedly addressed the crisis on television over the past week to try to alleviate concerns, promising that Egypt has stockpiled enough insulin and cancer medicines for six months.
However, with the country going through some of the toughest economic conditions in its history, pharmacists like Dr El Sayed are not optimistic that the situation will get better this year.
