Medicine crisis in Cuba. Timelines and prospects

Last week, the President of BioCubaFarma and other high-level representatives of the sector visited the Mesa Redonda TV show to report on the situation of pharmaceutical production in Cuba. Doctor of Science Eduardo Martínez Díaz, President of the above group of companies, explained that BioCubaFarma develops 996 products, including medicines, vaccines, diagnostic tools and medical devices. Of these, 757 are for the public health system, including 60% (369) of the 627 medicines and vaccines in the basic list, 10 more than last year.

The official explained that in 2021 “50% of the financial and material resources were dedicated to the production of protocol medicines COVID-19, as well as for the development of Cuban vaccines that have successfully brought the disease under control on the island. As a result, “we were unable to have the resources to manufacture the full range of drugs to ensure the baseline.” This situation “continued and worsened in 2022,” he said, explaining that 94% of medicines shortages are due to the country’s lack of the raw materials and materials needed to produce them.

The medical crisis in Cuba and the apparitions explained by officials from BioCubaFarma and the Ministry of Health in the evening programs of Cuban television are anything but new. This was confirmed by the fact that Dr. Emilio Delgado Iznaga, then Director of Drugs and Medical Technologies for MINSAP, attended the Mesa Redonda on June 7, 2019, where he explained that in 2016 around 100 drug shortages were reported due to financial problems, while in 2017 and 2018 there was a trend to a “gradual decline” in congestion and low drug coverage. With only 38 missing medicinal products in 2018, “the lowest amount in recent years” was reported. On this occasion the M.Sc. Rita María García Almaguer, BioCubaFarma Operations and Technology Director, pointed out that at the end of April 2019, “85 shortages were reported, including 16 controlled medicinal products with card”.

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A year later, on July 3, 2020, the current Cuban Minister of Health, Dr. José Ángel Portal Miranda and the President of BioCubaFarma appeared to get “up-to-date information on the drug situation in the country”. On that occasion, Portal Miranda explained that “at the end of June” “116 missing drugs (16% of the base table of drugs)” were reported. The situation Two years later it’s even worse. According to an EFE report in Havana on July 19, Tania Urquiza Rodríguez, Vice President of BioCubaFarma, stated that the group of companies “had an average monthly deficit of 142 products”. Note that this only applies to the medicines her group makes, so the shortages are certainly bigger.

During these years, the basic causes of the island’s lack of medicines were maintained. In the first place, “the lack of the necessary and timely financing to buy them,” as well as problems in paying suppliers due to the banks’ refusal to cooperate with Cuba,” officials said. All this coupled with the non-compliance of regular suppliers “who are suspending their deliveries due to measures related to the lockdown”. To the above reasons are added on this occasion: “World deficit of some raw materials and materials for pharmaceutical use, which has worsened during the pandemic” and “Impact on international logistics due to COVID-19”. These realities are compounded by the fact that the US government has included Cuba on the list of countries that support terrorism, according to the group’s president.

The impact of this crisis on the life of the country was enormous; especially as the significantly aging Cuban population requires more and more medicines and health services. To give an idea demand for blood pressure drugs like enalapril rose from 151 million tablets in 2010 to 400 million in 2019; amlodipine (10 mg), increased from 15 million to 87 million; Metformin 500 mg, a drug for diabetes, increased from 42 million tablets to 152 million over the same period, reflecting two of the population’s most common health problems. Another very popular drug, Dipirona 300 mg, also doubled its demand, in this case from 450 million in 2010 to 1 billion tablets in 2018, without the industry being able to meet demand.

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This became particularly sensitive in the summer of 2021, at the height of the COVID-19 pandemic, when the population’s need for medication became critical. With the intention of defusing the situation after the Social protests of July 11th the government authorized “Exceptionally and temporarily” imports of food, personal care products and medicines “without limit on import value and duty-free” until December 31 this year, a measure that has been extended twice. I remember that in those months the prices for a cycle of Rocephin and Azithromycin, two antibiotics with an auxiliary use in COVID-19, reached exorbitant prices on the island’s black market.

Although importing medicines is explicitly “non-commercial”, these products are sold freely on the informal market. The mechanism is very simple: just enter some of the sales groups that exist on Facebook, search for an offer, request a price list or a specific drug. The service sometimes includes home sales. In some cases these are ‘specialists’, while others market an assortment of products that may also include shoes, mobile phones, face masks, spices and so on.

Photo: Author’s screenshot on Facebook.

In this market, the offer can surpass that of many state pharmacies in terms of the variety of products, which, judging by the catalogues, include: antibiotics, anxiolytics, vitamins, antacids, analgesics, antihistamines, vitamins and antihypertensives. The problem, however, is the prices: A blister pack of ten loratadine tablets, a popular antihistamine that is widely used by allergy sufferers and also has virtually no side effects, is worth 170 pesos. Ten tablets of Sulfraprim, a very useful antibiotic for urinary tract infections, cost 220 pesos; a complete treatment would reach a value of 880 pesos. Keep in mind that this is happening in a context where the average pensioner’s pension is being paid areas between 1,528 and 1,733 pesos and can exceptionally reach 2,000 pesos. Under these circumstances, the family has to buy the medicines.

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Photo: Author’s screenshot on Facebook.

An additional risk is the commercialization of substandard, counterfeit or expired medicines. Those involved in this business are not persons with deep knowledge on the matter, nor is there any kind of regulation regarding it. Therefore, poisoning and other medical complications can occur from taking drugs without the necessary monitoring.

According to BioCubaFarma officials in the aforementioned Mesa Redonda, “by 2030, there is an import substitution program that includes medicines, raw materials…”. of the baseline table of national production and 77.8% of controlled drugs, at Mesa Redonda indicated that they work with “nationally produced cornstarch thanks to the import substitution program.”

It seems fanciful that the country’s financial situation will improve significantly in the coming months or that the US government will remove Cuba from the list of countries that support terrorism, hence the problems with the suppliers and the measures related to the blockade will last. Solutions will require new ideas and new strategies, otherwise shortages and poor coverage are likely to continue, and it’s possible national drug industry officials will be called to a new Mesa Redonda next year for “an update on the medical situation.” in the country.”

Carlos Alberto Gonzalez

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