ISLAMABAD, June 25: The Pakistan government’s draft new pharmaceutical policy, if adopted, will erode the safety, affordability and equity of medicines and badly affect the poor, says a World Bank document.
The proposed policy, the document says, aims at promoting the goals of the local and multinational drug manufacturing companies.
The document, prepared by the senior health economist, (pharmaceuticals) of the World Bank, Juan Rovira, in response to the ministry of industries’ draft pharmaceutical policy, sent to the Bank for “quick review”, says that the proposed deregulation and tariff reduction is likely to increase profits rather than reduce the prices.
The expert has asked the WB to influence Pakistan towards a more health-oriented drug policy as it is not in line with the Bank’s policy stated in the Millennium Goals.
It stresses on promotion of generics production and generics substitution, setting up or reforming the IPR policy, designing an integral drug policy as part of a broader health policy, which carefully balances the health needs of the population, especially the poorest group, and the development of an industry of INN generics and active ingredients, setting up a regulatory framework that allows market forces to operate but the public authorities must retain and manage a set of core functions to eliminate/minimize the negative effects of some market failures and attain any defined equity goals.
The draft of the new policy was scheduled to be discussed and approved at a high-level meeting at the chief executive secretariat to be attended by ministers of health, commerce and finance on Tuesday but the meeting was postponed for an indefinite period.
The Bank document, made available to Dawn, has pointed out several flaws, discrepancies and contradictions in the proposed policy and warned that it is likely to erode the efficacy, safety, affordability and equity of drugs as a consequence of the overwhelming focus on industrial goals. It gives no consideration to health or equity-related effects.
The most likely scenario deriving from the proposed policy is a certain increase in production and a parallel increase in prices.
In the absence of an actual pro-competition policy based on the promotion of INN, generic substitution and rational drug use policies and incentives to the demand, the proposed deregulation and tariff reduction is more likely to increase profits than to reduce prices.
This assumed outcome is certainly not in line with the declared pro-poor commitment of the Bank. Unless appropriate financing for the poor is ensured, these are going to be main losers of the new policy, it says.
The document says that the World Bank should try to influence Pakistan towards a more health-oriented drug policy or, at least, let the authorities know that this policy is not in line with the Bank’s broad policy as stated in the Millennium Goals and other formal policy statements.
It also goes in line with the increasingly shared view that the Bank should move away from lending of drugs and become involved in policy dialogue, capacity building and institutional development. This seems a good chance to do so.
As indicated above, without a more detailed analysis of the present situation it is not possible to outline an appropriate drug policy for Pakistan.
A pharmaceutical policy document should be expected to start with an analysis and diagnosis of the present situation, identify the problems and state the main goals of the proposed change or reform. The draft of the proposed policy, or at least the version that has been provided for review, does not have any of these elements, but immediately addresses the specific issues such as pricing, registration, import and export. As no global reasons and objectives for the reforms are explicitly stated, they must be implicitly derived from the proposals.
The Bank expert while pointing out the contradictions in the draft policy says, on the one hand it states that drugs for diseases most prevalent in Pakistan will be maintained in the list, but on the other hand it states that drugs containing active substances produced in the country will be excluded; this could include the majority of the former groups of drugs.”
Commenting on price control, it says competition in the drug market requires more than just removing price control. In fact price control is established in many countries precisely because there usually is not competition in the drug markets.
“Removing fixed margins in the distribution sector has usually been a policy response to the lack of competition, not its cause. If the conditions that are responsible for the lack of competition do not change, removing margin control will not restore competition, but allow prices to rise.
In fact, this is probably why many market economies apply fixed margins to pharmacists and wholesalers. It is less than likely that the appropriate conditions for competition exist in Pakistan and justify the removal of price and margin control in most drug sub-markets.