Ensuring supply security of medicines is the need of the hour

Haggling over a few rupee increases in our pharmaceutical prices at this point in time will not help anyone. In fact the urgent need right now is to ensure our supply security

Many may feel the battle between the National Medicines Regulatory Authority (NMRA) compared to the COVID-19 fall out. But ignored, it has the potential to turn ugly i.e. what is now a mere difference of opinion on the price of a vitamin C tablet, might become the precursor to a much bigger problem connected to the health sector of this country.

About three weeks ago, the NMRA issued notices of cancellation of registrations and import licenses to five pharmaceutical companies in relation to 10 medicines on grounds they were selling imported pharmaceutical products at prices higher than what was agreed. The pharmaceutical companies say that they only raised prices of products that did not come under price control regulation.

NMRA Chairman Prof. Asitha De Silva has responded to the pharma companies’ claim saying that under a gazetted order, the prices of all medicines are regulated and cannot be increased willy-nilly, and to claim there’s no price regulation on all medicines is patently false. With regard to regulatory provisions, the Professor said that the NMRA will not only look at safety, quality and efficacy of the drugs but also the key aspect of affordability.

Bravo! If that’s the case, he sounds like a man of the people. But the problem is, his statement smacks more of a politician’s rhetoric rather than that of an administrator. He said this when elections are round the corner, and when the time is ripe for making such statements, however the fact remains that words such as these are expected to drop from the mouths of aspiring lawmakers rather than the chief of the NMRA.  

The word ‘affordability’ is a double edged sword. Although on one hand, it may sound like a bid to bring down the cost of the drug, the quality may also drop. On the other hand, good quality drugs may be made available at a price and in this case affordability would relate to those who can afford to pay the price for a brand that is known for its quality assurance.

The question therefore is whether Prof. De Silva is trying to bring the level of pharmaceutical standards in Sri Lanka, down to the lowest common denominator. If that’s the case, his motive has to be questioned in context of the overall agenda, especially since the subject of branded vs generic has been discussed ad nauseam in the past 10 years and many a battle on this field has been fought and won on what’s best for the Sri Lankan patient. 

Be that as it may, there is talk of the big pharma companies (western based) moving their representative offices out of the country. Whilst one might think Sri Lanka can do without the big brands of the pharmaceutical industry, and instead go with generics and branded generics, this might be a hasty move. We need to rethink the situation, taking the larger canvas into consideration.

Geopolitical ripples are fast turning into massive waves which will have drastic effects on supply chains sooner rather than later. Sri Lanka depends a lot on India for supplies of generic and branded generic pharmaceuticals. India in turn is currently embroiled in a skirmish with China in connection with their northern borders. This has had a knock on effect on trade and it is against this backdrop that the Indian government has decided to reduce their dependence on active pharmaceutical ingredients (API) from China.  Experts say this is not going to be an easy affair, because API is a necessary chemical compound in producing finished medicines and until now, 68% of India’s API requirement came from China – if India is to indigenously manufacture drugs the cost would be 20% more. In the wake of this, India’s Technology, Information Forecasting and Assessment Council (TIFAC) has issued a report, calling for the preparation of a national stockpile of generic medicines for critical illness and to API security.

If this is the general lay of the land, what path should we take? We need to play it especially smart because very large numbers of our pharma generics and branded generics come from India. Therefore, haggling over a few rupee increases in our pharmaceutical prices at this point in time will not help anyone. In fact the urgent need right now is to ensure our supply security. 

One would think the NMRA’s role is very clear here because it will better serve the public by addressing the elephant in the room, i.e. the nexus between unscrupulous medical practitioners and pharma companies where it is alleged that incentives are given for prescribing particular pharmaceutical brands that may not be affordable to the patients they attend. If the NMRA Chair is trying to prove a point, then we can only hope he has a plan to deal with that situation rather than alienate suppliers, which will put our well-balanced health sector at risk. To this agenda we need to keep all suppliers at all levels of the market i.e. so to give the patient the choice to purchase medicine in different price brackets.

In these COVID days, we as an island nation need to be keeping our focus on our national foreign policy, which over the last 50 years has been non-aligned. We need to have an inclusive approach, because every type of foreign investment is necessary for the country in a scenario where our national budget cannot sustain development on our own steam. This also means the treasury cannot sustain our development programs. 

We have had many countries wanting to invest in the Sri Lankan economy, in the recent past and we really cannot afford to shun them, whatever the investment i.e. road development, port extensions, the energy sector, or the pharmaceutical sector. Good governance and transparency must prevail, but investment by the international private sector into our economy is the way forward for Sri Lanka. Financiers of these projects will see that their investments are protected and they will bear the cost of a fallout. 

Nationalising projects immediately after the colonial era was a strategic priority in taking control of property that belonged to the country, but holding on to that philosophy in a globalised world is self-defeating. The government should not be in the business of doing business. Authorities concerned must ensure that there is a level playing field and fairness. They should ensure that there will be no monopolies and make products and services available to different income groups. They should ensure the maintenance of uninterrupted supply chains, where those investing in Sri Lanka will see opportunity and not stumbling blocks.

Today, Sri Lanka’s selling point should be our non-alignment politically; this also means our alignment with all of them. Sometimes the portion of the pie may not be equal, but we must endeavour to find win-win situations for everyone. As much as we need Sri Lankan business to thrive we also need the world to invest in our economy. For this, a careful balance needs to be maintained when dealing with geopolitics and local ambitions.