Lebanon is facing a critical shortage of essential drugs and will be short of many drugs by the end of July, 2021, including those used for the treatment of diabetes, cancer, multiple sclerosis, and other diseases, recent media reports have revealed.
Importers of medicines in Lebanon have warned that hundreds of essential drugs have run out and there could be further shortages. As a consequence of the serious financial crisis in Lebanon, the government is talking about lifting subsidies because they are not affordable, and this decision has led to shortages of petrol, drugs, and various other supplies in the country.
Souha S Kanj (American University of Beirut Medical Center, Beirut, Lebanon) said that, in the midst of increasing social, political, and security challenges, Lebanon has been facing its worst economic crisis in decades.
“This crisis was further exacerbated by both the COVID-19 pandemic and the 2020 Beirut port explosion, which put even more strain on an already struggling health-care system [in the country],” she pointed out. She explained that the rapid devaluation of the Lebanese Lira and the lack of foreign currency have made it extremely challenging for Lebanese importers to pay foreign suppliers, which has led to disastrous shortages in medicine and crucial drugs for diabetes, heart disease, and even chemotherapy.
In Lebanon, the Medical Equipment and Devices Importers Syndicate, a medical trade body, has already given the second warning in 2 weeks that the economic crisis will adversely affect the health sector of the country. The health sector of Lebanon used to be among the best in the Middle East, but it is falling apart thanks to the country's dismal economic situation.
80% of the drugs used in Lebanon are imported, but currently there are substantial delays and inadequacies in the payments for the drug imports, owing to the central bank's low foreign currency reserves. Because the bank did not reimburse the suppliers, drug importers in Lebanon have stopped buying drugs for over a month. The central bank is currently in debt for the drugs bought since December, 2020, which prevents drug importers from getting new lines of credit.
Cancer drugs, in particular, have always had a tremendous financial burden on the Lebanese Ministry of Public Health (MoPH), as more than half of the total caseload of cancer drugs is usually provided free of charge by the MoPH to patients with no insurance or social security, said Kanj. She said that shortages in cancer drugs are being reported in pharmacies and hospitals across the country, such as targeted and hormonal therapies for breast and prostate cancer (eg, exemestane, goserelin, fulvestrant, and abemaciclib). “Immunotherapies like pembrolizumab, a breakthrough drug in the world of oncology, became almost completely unavailable as of July, 2021,” she noted. “Some wealthy patients have had to personally buy their cancer drugs from abroad to continue their treatment. However, while the exchange rate keeps losing value, poverty is rising sharply and many can no longer afford to buy these costly drugs from abroad,” she explained.
“The situation [relating to drug shortages] in Lebanon seems to be especially aggravated by [the country's] financial problems,” said Marcel Bouvy (Utrecht University, Utrecht, Netherlands). Drug shortages are a global concern, he noted. “The underlying causes of these shortages are complex,” he told The Lancet Oncology. According to Bouvy, the production and logistic chain of medicines involves different parties, including manufacturers of active ingredients and excipients, producers of the actual drug product, packaging firms, wholesalers, and others.
A substantial inflation in Lebanon has resulted in more than half of the population being sunk into poverty. However, despite this, drugs stayed affordable for a large number of people in the country, because the government has provided subsidy on the imports of essential items, including drugs. But, the lower price of drugs has led to smuggling and hoarding, making the situation of shortages worse.
As Kanj pointed out, in Lebanon, if sustainable and efficient solutions are not found quickly, the consequences will be catastrophic. According to her, Lebanon has played a major role in advancing cancer chemotherapy treatment, and in running internationally accredited stem-cell transplant centres. Also, Lebanon has served many patients: from inside the country and also from other countries (from the Arab league). “It is now hoped that wealthy countries lend a hand to salvage this critical situation,” Kanj added.
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