COVID-19 is now a major global health challenge. Are we ready to fight a medical emergency of the magnitude seen in Europe and USA? One of the biggest challenges that Pakistan may face is an extreme shortage of essential medicines.
China and India are better off than many developed countries when it comes to the capability to produce medicines; why not Pakistan?
Pakistan is blessed with a pharmaceutical hub which already produces medicines. However, we lack the capability to produce raw materials needed to make medicines. For raw materials we mainly rely on imports.
In response to a global health emergency like Covid-19, do we know our total national pharmaceutical reserve for essential medicines? Do we know how long our reserve could last during a health emergency? Can we continue producing medicines if our raw material supply is interrupted from overseas?
The answer to most of these questions unfortunately is in the negative. The bitter truth is that over-reliance on imported raw materials have put the entire industry and public health in danger.
China and India supply most of the pharmaceutical raw material to the entire world; they are struggling to meet the surge in demand amid the present pandemic. Moreover, the global lockdown has not spared even the pharmaceutical supply chain.
To understand our capability of producing medicines, let’s take as an example paracetamol and ibuprofen tablets — a common baseline treatment for Covid-19 and a number of minor ailments like the common cold and flu.
Pakistan produces these medicines at a very low cost, but many would be surprised to know that we do not manufacture the active ingredients present in these products. We cannot continue producing these medicines if other countries stop the supply of these active ingredients.
Have we thought about how much reserve do we have nationally for the materials used to produce these medicines and the implications of the shortage of essential medicines like paracetamol and ibuprofen in the country?
There are two types of materials generally needed to produce any medicine. The first is the active ingredient which has the medicinal property to produce a therapeutic effect. The other ingredients, commonly referred to as “excipients”, are the materials needed to convert the active ingredient into a suitable dosage form, for instance a tablet, so that quality is maintained in medicine production and a drug is administered safely.
Pakistan does not have the capability to produce the active ingredients of most medicines, including life-saving drugs. Over-reliance on cheaper imports has ruined the country’s capacity to produce medicines.
The irony here is that massive quantities of inactive ingredients used to formulate active ingredients into dosage form are also imported.
Many pharmaceutical and food additives that we currently import are plant-derived carbohydrate polymers extracted from vegetables and fruits.
We do not produce them locally, even though Pakistan is among the top 10 producers of agricultural commodities.
Have we always been so incapable and handicapped? Well, a few decades ago, the situation was not so bad and our country used to manufacture drugs. Aspirin, penicillin, nicotinamide and ephedrine are a few examples.
While most of these drugs were produced by chemical synthesis, drugs like penicillin were produced in a biological production facility using microorganisms. The country was then on the road to achieving self-reliance in producing life-saving medicines.
Cheap imports kill local production
But we stopped manufacturing medicinal substances decades ago. The cheaper imports gradually killed the local produce over time. Consequently, we cannot make a single medicine without using an imported ingredient.
Covid-19 has not only shaken the world but also challenged public health organisations over the state of their preparedness in preventing a pandemic.
It is a wakeup call for Pakistan to realise the importance of self-reliance during a national emergency.
Recently, a pharmaceutical firm obtained a licence to locally produce remdesivir, the anti-viral drug approved to treat Covid-19 patients.
The medicine failed badly against Ebola and other viral outbreaks and its effectiveness against coronavirus is questionable. But all said and done, it is encouraging to see a local company come forward to establish the infrastructure for an anti-viral drug.
Even if remdesivir does not prove effective, the technology to make it will help us manufacture other anti-viral drugs of proven efficacy against other infections.
These drugs are widely prescribed and for their production, like others, we currently rely on imported ingredients.
Pakistan needs a holistic strategy to move forward and enhance the capacity of its pharmaceutical sector. The policy on pricing, equitable access to medicine, reforms in imports, tax relief and rebates for local manufacturers are a few examples.
Institutions like non-government organisations, not-for-profit bodies and universities can play their role in fostering the knowledge exchange and technology transfer from academia to industry.
Another example is Pakistan’s National Institute of Health. It was conceived in the 1960s to facilitate infectious disease control programmes, production of biological medicines such as anti-venoms, and vaccines.
The institute still collaborates with the World Health Organisation in the field of viral diagnostics and serves as a regional reference laboratory for viruses like polio and flu.
It is unfortunate that the institute’s capability has deteriorated over the years, mainly due to a lack of vision, strategic direction, government support and funding.
Revival of pharma industry
There is no reason that our national capability cannot be revitalised.
But it requires an honest attempt to set a strategic direction and priorities in the interest of the nation.
Millions of people across the world have been infected with coronavirus and it is highly likely that it will stay with us forever. Mutations are inevitable and future contagions are not impossible in the global village that we live in today.
Covid-19 is a global health emergency and all developed nations are struggling to cope with it. Hence overseas support is difficult.
If we do not act now, a severe medical crisis may hit the nation and more people will die due to emergencies and shortage of essential medicines than by the virus itself.
The lessons learned from the pandemic will even go beyond Covid-19 and can potentially protect Pakistan in the event of another pandemic. Together we can!
Dr Hamid A. Merchant is a Subject Lead in Pharmacy at the University of Huddersfield, UK, and Dr Izhar M. Hussain is the Director of the Institute of Business & Health Management at the Dow University of Health Sciences, Karachi. The authors have extensive experience both in the pharmaceutical industry and academia, and have worked for various organisations
Published in Dawn, May 30th, 2020