Lebanon. Government recklessness in drug subsidy reform violates right to health and life


Lebanese authorities are failing to protect the rights to health and life of the country’s population amid the current crisis that prevents patients from purchasing or accessing essential medicines, Amnesty International said today.

Since the subsidies were lifted in November, drug prices in Lebanon have quadrupled compared to 2019, when the economic crisis began, and drugs remain in dire shortage. Although it has known for at least a year that the removal of subsidies may become necessary, the government has not put in place a social protection plan to ensure continued access to essential medicines. Amnesty International spoke to 13 pharmacists, doctors, hospital managers and patients with chronic diseases and others who regularly said that even when they were successful in obtaining funds, they regularly had difficulty obtaining essential medicines.

“Since 2019, the Lebanese people have been affected by a series of crises and today they find themselves in a health crisis created by the government. Removing drug subsidies without ensuring that a social protection framework is in place to guarantee their access to essential drugs is an act of profound recklessness, ”said Lynn Maalouf, Amnesty International’s deputy regional director for the Middle East. East and North Africa.

“The government’s inaction in the face of the drug crisis is inexcusable. The government has not met since mid-October at a time when it should rush to put in place urgent measures to deal with the drug crisis and its impact on the population. These could include the reintroduction of targeted essential medicines subsidies and working with pharmaceutical companies and international donors to ensure a reliable supply of essential medicines. “

Lifting subsidies on medicines without ensuring that there is a social protection framework to guarantee their access to essential medicines is an act of deep recklessness.

Lynn Maalouf, Amnesty International

On November 9, after months of statements by the Central Bank (BDL) announcing its inability to provide the US dollars needed to support the subsidy program that covers up to 95% of drug use in Lebanon, the government announced that it lifted price subsidies on most drugs. This led to a further rise in the price of essential medicines, even as shortages continued. While this decision was quite predictable since the BDL had warned it for months, the government did not accompany the removal of subsidies with a social protection plan that would allow people to access essential drugs. A government payment card program, which began registration on December 1, is not expected to issue payments until March 2022, and it is still unclear how the government plans to fund the program.

Residents saw their drug bills increase exponentially after the November decision, according to pharmacists and patients interviewed by Amnesty International. As a result, at least 70% of the population today cannot afford the drugs still available, according to Assem Araji, chairman of the parliamentary health committee.

Pharmacies began reporting a shortage of many essential drugs from June 2020. Several hospitals, including Rafic Hariri University Hospital (RHUH), Tripoli Government Hospital and Al-Makassed General Hospital, told Amnesty International that they could only function thanks to limited foreign donations.

The BDL, drug importers and the Ministry of Public Health (MoPH) blamed the shortage on the smuggling of subsidized products, storage and accumulation of chronic drugs and delays in processing import requests. Yet the government has taken little action to overcome these obstacles. In June, BDL largely stopped providing dollars to banks to extend lines of credit to importers of infant formula and drugs, saying it could no longer afford to draw on its reserves, and in November the Ministry of Health announced the lifting of subsidies on pharmaceuticals for chronic diseases. , while subsidies on drugs used in cancer treatment, dialysis and mental illness management would remain in place. Yet even maintaining the subsidies on these categories of drugs, patients and hospitals are struggling to find them on the market.

Drugs unavailable or unaffordable

According to hospital workers in Beirut, Tripoli and Nabatiyeh with whom Amnesty International spoke, the lack of available medicines is having a severe and potentially fatal impact on patients. The RHUH pharmacy manager told Amnesty International, for example, that the impact is clear in emergency rooms: “A patient came in with a failing heartbeat because he couldn’t find the medicine that organizes his heartbeat. And another patient had a seizure because he couldn’t find the blood pressure medication… […] Even my husband’s brother, he couldn’t find his blood pressure medication for two days, he was rushed here to the emergency room, but he died.

Amnesty International spoke to patients with cancer, diabetes and mental health problems who said they could not find the drugs prescribed for them, although some searched as many as 12 pharmacies different across Lebanon. They were also rarely able to find suitable alternatives. A patient with bipolar disorder who could not find her medicine in Lebanon explained, “I asked friends to get me a medicine called Manicarb from overseas. It is a very delicate drug. Something was different in its makeup, so I had a serious manic episode. My doctor then checked the composition and ordered me to stop it.

Meanwhile, hospitals are running out of supplies, including donations they have received from international organizations. Doctors and patients told Amnesty International that they could barely get enough medicine to cover their treatments for the rest of December. These shortages particularly affect those suffering from diseases such as cancer, heart disease or mental health, as they are likely to suffer extremely serious health consequences if they do not have access to medicines.

The government’s inaction in the face of the drug crisis is inexcusable.

Lynn Maalouf, Amnesty International

Dr Issam Chehade, head of the hematology-oncology department at RHUH, said several of his patients had been denied medication and chemotherapy treatments for a period of three or four months, with potentially serious impact on their patients. health and their chances of recovery. “The psychological state of our patients is very bad, especially [those] who are diagnosed early with curable cancers and certain types of blood cancers. Then all of a sudden you tell them their medication is not available, ”he said.

“Mahmoud,” a 60-year-old man with heart, blood pressure and central nervous system problems, says he can barely find drugs and those he can find he cannot afford. “How much can things get worse?” And again they [the state] are not even planning any sort of rescue, ”he said.

To support patients, staff at Al Makassed Hospital have launched a fund. “We cannot see our patients unable to buy their life-saving medicine and do nothing. But we are aware that the situation is too bad for our initiative to have an impact, ”said Dr Mohammed Badr, director of Al Makassed.

Although some doctors say the pressure has eased somewhat in recent weeks after some companies resumed importing drugs, limited and expensive supplies mean only a small number of patients can access the drugs.

Dr Rania Sultan, who heads the pharmacy at the government hospital in Tripoli, says they lack the essentials a hospital needs to function. “I do not have the shots needed to resuscitate a patient who has had a heart attack … And I only have 10 shots of adrenaline, whereas a patient in intensive care needs 30 shots!” I can’t talk about sustainable planning when I don’t even have the essentials needed to save lives today. And as fears grow over a new outbreak of Covid-19, Dr Raida Bitar, director of RHUH pharmacy, told Amnesty International that “we do not have the drugs to treat the symptoms of the disease” .

Fund

According to the International Trade Organization, Lebanon imports around 95% of its pharmaceuticals, spending more than $ 1 billion a year.

In November 2019, BDL reduced its drug import subsidies to 85% of the foreign exchange required for pharmaceuticals at the official rate of LBP 1,507.50. This meant that importers were forced to buy the remaining 15% of foreign currency on the black market at the unofficial exchange rate, thus pushing up drug prices. However, with the Lebanese pound losing more than 95% of its value and the depletion of foreign exchange reserves, the BDL warned it must remove subsidies on most drugs. MP Araji explained on Nov. 22 that medical subsidies had risen from $ 120 million per month to around $ 35 million.


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