Nancy Raouf failed to find “Yasmin”, her chosen contraceptive, in many different pharmacies in downtown Cairo and Zamalek. A shortage of imported contraceptive drugs in the Egyptian market began in late May 2019, leading some to turn to the black market to find them.

31-year old Raouf told Raseef22 that she now has to buy additional supply only days before the old runs out, for the first time feeling the crisis - pointing out that she has taken to asking her contacts to look for the contraceptive in the pharmacies near their homes and places of work.

Meanwhile, 27-year old and Giza resident Mahmoud Sayed complains of the same problem. He has been unable to purchase “Gynera” - one of Egypt’s most commonly prescribed contraceptives - for his wife for more than two weeks. Sayed says that he has been purchasing the drug for more than a year, wanting to delay having a child for the first two years; he too would also have to resort to seeking assistance from his friends to find the drug on the black market. Sayed told Raseef22 that he subsequently took to searching for the drug in small pharmacies in poor areas - where the demand is weaker - eventually succeeding in finding a single strip.

A Shortage Due to Demand

On Thursday the 3rd of November 2016, the Egyptian government decided to float its currency, leading to a sharp increase in the price of foreign currencies - especially the US Dollar - vis a vis the Egyptian Pound, with the price of the Dollar reaching almost 18 Egyptian Pounds, after it had been previously stable at 8.88.

The increase in the value of the Dollar against the local currency had a significant impact on pharmaceutical companies that import the raw ingredients, prompting them to ask the Egyptian government to raise the price of the drug in order to avoid losses.

Here, during the tenure of former Health Minister Ahmed Imad al-Din, the pharmaceutical market witnessed waves of price-increases for medicines - with the largest increase in Egypt’s history taking place in January 2017, after Imad al-Din agreed to an increase in the price of 3,000 pills in one go. The increase in medicine prices would repeat itself several times, with prices increasing between 30-50% on each occasion.

Faced with chronic medication shortages, the director of Egypt’s ECPRM confirms that nobody knows how many Egyptians take contraceptives, and what the annual rate of increase is. In a market of 100 million, this can be problematic.

A severe currency devaluation, a lack of market data, and a refusal to take generic drugs have all resulted in severe medication shortages in Egypt, not least with contraceptives, in a population hitting the 100 million mark.

Today however, pharmaceutical companies have adopted an illegitimate method to pressure the government to approve price-rises in stores, through reducing the stock available on the market (either gradually or suddenly) - thus hoping to agitate public opinion to demand the return of medicines to stocks, even if at a higher price. In 2019, the annual shortage crisis in contraceptive drugs has been particularly exacerbated, with a severe shortage in contraceptives likely once again.

Muhammad Fouad, the director of the Egyptian Center to Protect the Right for Medicine (ECPRM) told Raseef22 that the reasons for the intermittent shortage of certain medications stems from the lack of any price-controls imposed by the government - not least before the floating and devaluing of the currency - as well as the absence of long-term policies at the Health Ministry.

Meanwhile, a source in the Egyptian Company for the Trade of Drugs (Egydrug) denied that contraceptive manufacturers intentionally reduced the stock of contraceptives in order to raise the price, instead saying that the crisis is due to a shortage in raw materials, or misplanning during the production stage.

Despite this, the source did not deny the desire of the pharmaceutical companies to raise the price of their drugs: “We all know that the medicines will become more expensive, and this has indeed already begun; all of the pharmaceutical companies in the business sector are submitting requests to raise the price of the medication because they are suffering losses, and it is well-known that prices will inevitably increase over a number of stages: every four months the prices of 5 types of medicine will increase, unlike during [the tenure of] previous ministers.”

It should be noted that the Egyptian government adopted the nationwide initiative of “Enough 2” in October 2017, focusing in particular on the Sa’id region in Upper Egypt, in order to tackle Egypt’s overpopulation problem, with the latest Egyptian census estimating that the country’s internal population has reached 99 million.

However, Fouad saw that there was no relation or link between the “Enough 2” initiative promoted by the Ministry of Social Solidarity - aiming at regulating the size of families and encouraging parents to only have two children - and the shortage in contraceptives in the market, stating that the drugs are imported by private companies, and that the problem likely lies in a shortage in raw materials.

The Equivalent or a Substitute?

Fouad adds that there are no bodies or agencies in Egypt that know the demand for contraceptives, explaining: “No one knows how many women take contraceptives, and what the annual rate of increase is; if we knew the number we can provide the required [drugs], but our ignorance of what is needed makes the crisis repeat itself.”

The director of ECPRM also denied that estimates are drawn from the percentage of contraceptive sales to discern the required quantities and subsequently provide it, which creates a crisis with the expiration of the medicine available in stock.

Meanwhile, Egyptians will not take equivalent (generic) or substitute medicine - with the “equivalent” medicine here referring to medication that has the active chemical component but is sold under a different commercial name, while the “substitute” medicine relies on a different active chemical component but one which is close to the required component, and carries out the same function.

“The global brand has twelve equivalents with the same active ingredient, but the consumers prefer the medicine that was mentioned by the doctor, and the pharmacist does not dispense the similar substitute” Fouad said.

According to the aforementioned employee at the Egyptian Company for the Trade of Drugs (Egydrug), the current crisis is not a novel one, but has taken place repeatedly - pointing out to Raseef22 that the Egyptian Pharmacist Syndicate (EPS) has met with the Health Ministry to agree to provide a quota to pharmacies, with Egyptian drug companies tasked with distributing them to pharmacies.

The source - who preferred to speak on condition of anonymity - also said that the state has worked to provide locally-produced alternatives manufactured by the pharmaceutical company ACDIMA (the Arab Company for Drug Industries and Medical Appliances), especially for the most famous brands prescribed by doctors (“Gynera, Yasmin, Cyclo Progynova”); it is estimated that the local brand could be 50% cheaper than the imported contraceptives.

Following the Egyptian government’s decision to float the currency, the majority of pharmaceutical companies producing effective drugs and medicines for chronic conditions called on the government to increase the price of the drugs due to the higher cost of the imported raw materials - however, the government deferred the decision to do so, while intermittently raising the prices of certain types of important drugs.

It should be noted that Egypt’s population exceeded the 100 million mark this year, with an estimated annual increase of 2-4 million persons. The increase in population leads to a lower share per person of the Nile’s water, the decrease in the citizen’s allotment of agricultural lands, an increasing reliance on imports to satisfy the nutritional needs of citizens, and a leakage of students from education due to the overcrowding of classrooms - as well as the absence of national development projects taking place parallel to the population increase.

Egypt’s President Abdel Fattah al-Sisi has also long declared that the population rise serves as an obstacle to the state’s development, leading to waste and even ultimately representing a form of terrorism in his eyes, declaring: “If the population increase continues at this rate, no development efforts can succeed in improving the life of the people.”