No need for drug battles

LAHORE: Our government regulates the pharmaceutical industry to ensure supply of quality drugs at the lowest possible commercially viable rates. Yet it has banned the cheapest source from which even the developed world imports finished medicines or pharmaceutical raw materials.

There is no clarity on decisions taken by this regime. When India slapped prohibitive duties on imports from Pakistan, we very rightly retaliated.

However, Indian action was calculated, as it was directed towards items that India could arrange from alternate sources. There was no enhancement of duty for instance on rock salt that only Pakistan could supply.

India exports the cheap salt it imports from Pakistan through established brands at a thousand times higher price. When we imposed blank curbs on Indian products in July last year, the hardest hit sector was the pharmaceutical industry. Our pharmaceuticals depend heavily on India both for active pharmaceutical products and excipient material.

Alarmed by the ban, all three pharmaceutical trade bodies (the Pharma Bureau, Pakistan Pharmaceutical Manufacturers Association, and Pakistan Chemists and Druggist Association) jointly met with the then health minister and advisor to PM on Commerce Razzak Dawood, in August 2019.

In this meeting, an apology was tendered to all the pharmaceutical trade bodies by the ministry of commerce, for not considering how important trade with India was to sustain the pharmaceutical business in Pakistan.

Pursuant to this meeting, SRO 977 and 978 was issued. This SRO is crystal clear. However, if imports outside the ambit of this SRO have been made, it should be determined and investigated by the ministry of commerce. The violators should be taken to task.

These SROs were notified after the government was convinced that ban on pharma material imports from India, would cripple our pharma industry. The reason being that this material was not available from China or other countries, and even if available, the cost was prohibitive.

The same holds true for finished products, which include anti-cancer products, vaccines (rabies, typhoid, measles, dpt, hib, hepatitis B, tetanus), anti-rabies serum, anti-snake venom serum, products for solid organ transplants, general anaesthesia, biologicals for dialysis and anaemia patients, recombinant biologicals, anti-retroviral for Hepatitis C, products for cardiology, etc.

With recent ban and useless hue and cry and panic it would be absolutely counterproductive. Unfortunately, the health sector and its sustainability relies extremely heavily on India, and this precious trade relation should not be used as a political stunt. We contemplated similar ban at the height of Pakistan-India tension in 2001 but the move was dropped when the commerce ministry strongly opposed it.

The local pharma industry does not even cater to a small fraction of the raw material requirements, and is neither facilitated by the government in any way. Similarly, if the finished products are suspended for import from India, there is no telling what will happen to patients, which include infants awaiting vaccinations/cancer patients/rabies and snake bite patients, dialysis patients and many more.

As far as vaccines are concerned there are very select vaccines available from China, such as bivalent oral polio vaccine, Japanese encephalitis vaccine, Hepatitis A vaccine, flu vaccine, which are WHO prequalified/approved, but they are costlier than Indian vaccines with similar accreditations, and their supply chain is not reliable.

Not a single vaccine is manufactured or produced in Pakistan, unlike India. There are a couple of vaccines such as Tetanus and Hepatitis B, which are imported in bulk and locally packaged.

However, this is not manufacturing. Setting up a basic manufacturing plant for even the most basic vaccine, in terms of tech transfer and plant and machinery, would cost several million dollars.

India is a biotech hub of not only our region, but of the world.

Equine serum products, such as rabies anti serum, anti-snake venom serum, anti-thymocyte globulin for solid organ transplants/aplastic anaemia, Tetanus anti serum, diphtheria anti serum - 80 percent of these lifesaving products are manufactured in India only.

For example, the anti-snake venom serum that is being used in Pakistan, for bites of snakes found in Pakistan, and rabies anti serum are currently only available from India. Such equine serum products manufactured elsewhere in the world including China are very expensive.

Oncology products from India, including chemotherapeutic products, monoclonal antibodies, are extremely important to sustain the oncology practice in Pakistan. Similar products coming from developed markets, if available at all, are far more expensive.

The minimum price differential is around 75 percent. The state should act prudently as we are not in a position to destroy our health system further.