PAKISTAN has the second highest prevalence rate of hepatitis C in the world. Yet, more than 18 months since the UN-backed Medicines Patent Pool announced an agreement enabling the generic manufacture of the new hepatitis C drug daclatasvir in developing countries, the Drug Regulatory Authority of Pakistan has yet to confirm local tenders. Used in combination with sofosbuvir, daclatasvir reduces the course of treatment to three months, and has better cure rates and fewer side effects than intravenous therapy. Sofosbuvir suffered from a similar fate of delays and controversy before it was approved last year. Over the past few years, there have been severe shortages of many essential, live-saving drugs — thyroxine, folic acid, TB medication, to name a few — owing to discontinued local production, each representing a major health emergency that threatens the lives of millions and adds to spiralling healthcare costs. Medicine accounts for the largest expenditure item after food for most families, a cost that is driven up by lack of government support in providing free medicines and a market flooded with expensive imported and smuggled drugs in the absence of local alternatives.

At the heart of the issue lies a weak Ministry of National Health Services, headed by a state minister lacking the executive powers to effectively administer it; its ancillary Drap is frequently at loggerheads with pharmaceutical firms over what they deem prohibitive regulations; and a dysfunctional pricing policy that seems to benefit neither the industry nor consumers. The Drugs Act, 1976, entitles the federal government to fix maximum sales prices on medicines, a necessary provision that requires the private sector to carry some of the health burden by accepting lower margins. But the government seems to desire all the accolades of securing affordable drug prices — in appearance at least — without any policy or financial investment on its part. Prioritising positive optics, it ignores the consequences of fixing prices lower than regional reference prices in a country where 90pc of active pharmaceutical ingredients are imported, even as our product list continues to shrink. We need to analyse and adopt best practices from the regional pharmaceutical industry model, develop our nascent API manufacturing industry and guarantee the independence of Drap in adopting a transparent price control regime. The cost of this lengthy pricing dispute has been paid in too many lives lost to preventable, treatable health conditions.

Published in Dawn, July 24th, 2017