Sunday, February 10, 2013

Iranian Medicine Shortage--Myths vs Facts

By: Jabbar Fazeli, MD


Medicine shortage is making headlines once again, everywhere except in Iran that is.

The headlines in Iran died out back on January 1st, 2013 when the supreme leader ended the discussion by saying "government officials should solve the medicine shortage issue" (see headline below). Apparently the Iranian media took that to mean that this issue is now off limit and the public does not need to read or hear anymore negative reporting on the subject.
Just before this unwritten gag order, the "Fars News" website posted an article titled "Medicine Languishing in Customs" (see photo below). In that article it was revealed that what little medicine that makes it to Iranian ports is not clearing customs because its been three months since the importers were given access to "hard currency" to pay for already imported medicine. That news article was published on December 29, 2012 (5, and photo below).
A couple of months ago, the health minister Marziyeh Vahid Dastjerdi, the only woman in Ahmadinejad's cabinet, was fired for being too outspoken in her criticism of the Government's lack of funding for medicine imports; She was never heard from again. Her last statement to the media was "I don't know what happened to the funds designated for the purchase of medicine". 

The now acting health minister was quoted on Jan 26 to say that "we have no shortage of medicine" (6, also see photo below)


It's been quiet in the Iranian media but the western media is picking this issue up as evidence of the unintentional ill effects of sanctions.

I would like to review a couple of reports currently making the rounds:

"Sanctions and Medical Supply Shortages in Iran" (1)
by Siamak Namazi, a Dubai based consultant and a former Public Policy Scholar at the Woodrow Wilson Center.

"There is no mistaking that the scarcity of medicine and medical equipment in Iran started with the tightening up of sanctions. Nearly every one of our interviewees—including senior officers of American and European companies that supply pharmaceutical and medical products to the country—attested to this fact."

The author assumes "cause and effect" based simply on the timing of the medicine shortage. The report does mention China and India as alternate sources of some drugs but claims that Iran has no way to purchase critical US and European made medicine from alternate sources.

Even if we erroneously assume that US and European made medicine can not be purchased in India or China using their local currency, a determined buyer would have considered alternate sources like Turkey and Iraq (as many individual Iranians do), both of whom have good commercial relations with Iran and would be more than happy to facilitate medicine purchases and make a commission in the process. 

Since medicine and medical supplies are officially off the sanction list, intermediaries in Turkey or Iraq would not face retaliations from the US or Europe for facilitating such transactions.

Most Iranians visiting Turkey know that one could walk into any pharmacy and obtain any drug without even a prescription, so long as you take your wallet along. I personally bought US made medicine in Istanbul and all I had to do is pay for it in Turkish liras. Incidentally, the cost was lower than what i would have paid in the USA.

There is no reason to believe that the Iranian government is not able to do what ordinary Iranians are already doing.

Iran has a significant Turkish lira account in Turkey as the Turks are paying Iran in local currency for their energy purchases. If the Iranian regime is as determined as it claims then there is nothing to stop it from using these funds to purchase US made medicine from Turkey. Instead, Iran has been converting its Turkish liras to Turkish Gold and taking it home (3,4) to use in lieu of hard currency within Iran to pay for its security forces and other more pressing budget items in order to stay in power and keep any future unrest in check.

This report goes on to point out that:
"Intuitive logic also supports the study’s findings. Remember, Iran had the same government and the same companies running the pharmaceutical and medical supplies business—all with the same deficiencies—prior to the ratcheting up of sanctions; yet Iranian patients did not lack in healthcare in the same way that they do today. Shortages began when the continuous tightening of sanctions eventually placed overwhelming obstacles in the way of humanitarian trade. There is no chicken and egg argument to be had in this instance since the timeline is clear."

This argument assumes that the Iranian officials are placing the same priority on medicine purchases as they did in the past. Available evidence indicates that they don't. They don't allocate enough funds for it, and when they do they are being caught red handed not providing the funds they promised to importers. Even Khamenei's last statement implies that the solution is in the hands of Iranian officials.

Iran maybe trying its best to overcome the sanctions in general, but it is clearly not trying hard enough when it comes to its humanitarian needs. I still believe that the IR of Iran is hoping to keep this humanitarian issue "alive" in order to better argue for easing of the sanctions, even if this inaction leads to the "death" of many Iranians.

A regime priding itself on managing to "almost" develop a "stealth jet" while under sanctions is surely capable of working around the obstacles involved in the purchasing of nonlethal items that are not subject to sanctions, like medicine.


Another interesting report in the news is the Reuters article of Feb 8, 2013 by Arshad Mohammed titled (2):
"U.S. pharmaceutical exports to Iran cut in half in 2012"

This article highlights the banking difficulties Iran is facing in paying for medicine purchased in the United States, despite treasury department assertions that medicine purchases are not restricted.

"Exports of U.S. pharmaceuticals to Iran were cut in half last year, according to data released on Friday, while overall U.S. exports to the Islamic republic rose about nine percent because of grain sales."

"Exports of pharmaceuticals fell to $14.8 million from $31.1 million in 2011, while sales of vitamins, medicinal and botanical drugs decreased to $4.9 million from $10.8 million."

"Exports of surgical appliances and supplies also declined to $2.4 million last year from $3.7 million the previous year."

"Sales of pulp mill products - which include the raw material for diapers - dropped to $26.3 million from $57.9 million, and exports of cattle fell to $5.3 million from $7.3 million."

Despite the title of this article, the data within is actually quite damning to the Iranian regime. Instead of purchasing hard to find chemotherapy and immunosuppressant agents the regime saw fit to spend $4.9 million on vitamins and botanical medicine, and $26.3 million on raw material for diapers. The well meaning anti-sanction camp should find it hard to justify such Iranian purchases in the US, while blaming the shortage of specialty medications on western sanctions. The Iranians could have bought their vitamins from India and China and used the millions of dollars in the USA to purchase harder to find medicine.

Make no mistake about, sanctions are no picnic for the Iranian public despite the intentions of the West to target the regime and not the people. 

Having said that, when it comes to the medicine shortage, it is becoming obvious that the regime is lacking the political will to resolve this humanitarian issue, and what little funds it allocates are falling victim to IR corruption or are being used to purchase US made diaper material.

References:
(1) http://www.wilsoncenter.org/sites/default/files/sanctions_medical_supply_shortages_in_iran.pdf
(2) http://www.reuters.com/article/2013/02/08/us-iran-usa-exports-idUSBRE91713120130208
(3) http://online.wsj.com/article/SB10001424127887324352004578136973602198776.html
(4) http://www.cnn.com/2012/11/29/world/meast/turkey-iran-gold-for-oil
(5) http://www.farsnews.com/newstext.php?nn=13911009000915
(6) http://isna.ir/fa/news/91110704204/از-آزادسازی-ارز-دارو-اطلاع-ندارم-کمبود

Photo credit: press tv, gulfnews, panorama.com, press TV


9 comments:

Anonymous said...

There are lots of fake and under-dosed medicines on the shelves of Indian, Chinese and Turkish drug stores...and those are meant for the local population! The owners of drug stores in those countries purchase medicines from any producer, even from so called "under-ground laboratories", cause of the profits that can be made. Meanwhile people in need of medicines get ripped-off. Now one can only wonder what Iran would be recieving if they ordered medication from those countries...or if they purposely seek-out and make deals for deliverance of medicines from dodgy/unreliable sources due to the "appropriate" price.

B.M.A said...

GOOD CRITICISM!!

ALTHOUGH i don't agree with your 'solutions' on the whole issue of drugs in the country ,at least you have come up with some serious objective criticism !HOPING THAT you will continue this trend -'opposing and giving suggestions' !.sadly your negative attitude on the regime makes you to overstep one serious effort the regime has undertaken!.

@WHY not highlight the effort of the REGIME in making sure the Nation becomes self reliant in medicinal drugs a fact acknowledged even by the enemies!!.

Mark Pyruz said...

Jabbar, you've an MD. You know what procurement is like, as well as the rudiments of logistics, supply and distribution. When supply is disrupted, the entire system is disrupted. Serious disruptions aren't solved overnight. Think back at how here in the United States shortages of immunization drugs have taken place, and the time it took to remedy the situation.

Perhaps a hospital administrator would know better.

You're well placed as a medical observer for Iran. But simply posting headlines from Iran media isn't enough. You need a contact with a MD counterpart in Iran. (Unfortunately my Iranian cousins that are MDs practice in France, otherwise I'd refer you.)

Jabbar Fazeli, MD said...

Thank you Mark:
I appreciate that you think I am qualified to speak on "this" issue because I am a doctor, although it seems that I would have to talk to one of your cusions first.

In all seriousness, if we followed your logic then there would be no thinkers or philosophers in the world as everyone would have to earn the right to express an opinion by first obtaining the appropriate degrees and having the right pedigree. Perhaps this kind of thinking is whats keeping the Middle East a hundred years behind the rest of the civilized world.

Almost half of this piece is about logistics and procurement. I am happy to discuss any specific part or fact mentioned in here. When you talk about vaccination shortage in the US you forget that flu vaccine shortage is not as predictable as medicine shortage resulting from a predictable set of sanctions that took years to implement.

Instead of discussing qualifications you could have asked me about some of the details not covered in this article, like the difficulty in convincing a company like Pfizer to sell drugs in India, Turkey, or China at their local prices (not the higher prices they can obtain in the US) intended for export to third countries (There are way to overcome that which I would have been happy to discuss)

In the meantime, I hope the regime in Iran would let the simple merchants with no high school education solve this procurement issue as they have done throughout Iranian history. All the regime has to do is give them the resources and keep the educated pencil pushers out of their way.

Jabbar Fazeli, MD said...

@anon 9:08
There is no doubt that fake drugs are an issue in many countries, including the US believe it or not, but I didn't think its a major component of the issue being covered here. But now that you mention it, I would say that when countries or companies make a multimillion dollar purchase of drugs they have ways to ensure that bills of sales are traced to a reputable source (not some obscure lab in Calcutta). Experienced procurement officers also do random sampling of their purchased drugs to verify their point of origin and authenticity.

With regard to prices, the prices of US made drugs are cheaper in India or Turkey than they are in the United States, not because they are fake but because the pricing is decided based on cost of living in each country to make the drugs within reach of a large number of people. It's just the way multinationals do business.

allochtonie said...

One could wonder if Iran had made the same efforts in trying to obtain certain medicines as it finds all kinds of holes and tunnels to smuggle rockets to Gaza, there wouldn't be any shortage.

B.M.A said...

indedd THE REGIME has done a lot positively in that area BY INVESTING heavily in research projects in human medicine .the end result is what we see today IRAN BEING SOMEWHERE NERE self sufficienct in that field-OUR HUMBLE MD is just sitting on this succes story from the REGIME somehow practicing dishonesty,YET HE KNOWS WELL and is in a better position to make fact known-BUT once again 'an archievement ' from the "rapist regime"is a taboo here ,otherewise this is the open secret-

HAD IRAN not invested heavily in reserch and technology thereby coming up with an indeginous framework to satisfy all needs of the NATION in different sectors,[HEALTH INCLUDED]then the NATION would have been subdued long ago!.

Anonymous said...

good essay, Dr Fazeli....and an excellent answer to the fanboy questioning your cometence to speak about supply chain problems and saying that a hospital administrator would be more qualified.

I worked for years as a hospital admin with oversight of purchasing and distributing supplies. he's not offering any valid criticism and hasn't anything other than gall in questioning your competence.

Jabbar Fazeli, MD said...

Thanks