The Ministry of Health Public of Cuba recognized that the country’s community pharmacies face a “practically total shortage,” something that reflects the perfect storm facing the health sector in the midst of an epidemiological crisis, coupled with chronic and acute diseases that are being neglected in their pharmacological treatment.
“There is a practically total shortage in the pharmacy. That is real, the medications are not there,” said Cristina Lara Bastanzuri, director of Medicines and Medical Technologies at Minsap, in a reportage published this Tuesday on the portal Cubadebate.
Sector officials pointed out that it is not even possible to guarantee the permanence of drugs intended for chronic patients, such as hypertensive patients, diabetics or epileptics, and that the shortage has become a structural phenomenon.
The basic picture, national production and Washington sanctions
The Cuban pharmaceutical system is organized around a basic table of 651 medications, of which 62% should be produced by the national industry, while the rest is imported. For years, local production guaranteed pharmaceutical sovereignty at affordable prices, supplying 80% of medicines.
However, that capacity has eroded in just a few years. Bastanzuri explained that the national industry “has stopped responding to requests for medicines on a regular basis,” due to difficulties in importing raw materials, technological obsolescence and energy problems.
The authorities point to the United States economic embargo as the main factor that multiplies the difficulties. Even when Cuba has financing, transactions are blocked in the international banking system for fear of suppliers and banks of secondary sanctions designed by Washington.
“Really after COVID we have had a quite complex situation,” said Lara Bastanzuri, highlighting that the pharmaceutical industry and Medicuba, the two fundamental sources of entry of medicines, face debts and financial restrictions that paralyze operations.
Withdrawal of international suppliers and supplies for emergencies
Another critical factor is the progressive departure of foreign suppliers. Every time a supplier leaves the Cuban market, replacing it is difficult due to the strict drug qualification and registration processes.
The pandemic aggravated the global supply crisis and made maritime transportation more expensive, multiplying shipping costs by five or six and reducing the availability of shipping companies willing to call at Cuban ports.
The direct consequence is visible in the network of community pharmacies, the primary point of contact with the population. The availability of imported medicines is only around 40%, so scarce financial resources are concentrated on critical supplies for hospitals and emergencies, leaving community pharmacies without regular supplies.
Irregularity generates distortions in medical practice: doctors must adapt treatments to what is available, rather than to what patients need.
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Personal importation, illegal market, robberies and drug trafficking
Faced with the crisis, the government authorized the personal importation of medicines without taxes in 2021. The measure alleviated individual problems, but opened the door to an unprecedented illegal market, which manifests itself both in public areas and in the shelter of homes.
“This has unleashed a sale of medicines that is illegal, which represents a health risk due to quality,” Lara Bastanzuri warned. Products imported for personal use are resold at exorbitant prices, while some medications are diverted from laboratories, drugstores or pharmacies.
For her part, the head of the Department of Pharmacies and Optics of the Minsap, Maylin Beltrán Delgado, informed Cubadebate that until October, 33 serious incidents had been recorded in the pharmacy system, including 18 robberies. Around 10 cases involved controlled substances such as psychotropics and narcotics.
“Anyone who submits to illegally selling medications that are classified as drugs may be involved in drug trafficking,” Beltrán Delgado warned, mentioning examples such as tramadol, alprazolam and carbamazepine.
At the same time, the authorities warned about the dangers of consuming medicines purchased on the informal market.
Cecmed, the state regulator, has identified cases of counterfeit medicines. Furthermore, the breaking of the cold chain compromises the effectiveness of sensitive products such as insulin, which loses pharmacological action after 15 hours outside of refrigeration.
The shortage of medicines remains in Cuba due to lack of raw materials
Coercive vs. coercive policy urgent needs
At the beginning of December, the official press reported a police operation against resellers of medicines and other items stationed in the Puente market at 100 and Boyeros – a common practice for years – with the result of a dozen arrests for acts of illegal marketing, and the imposition of fines of thousands of pesos for illicit sale of products.
Also this month, the Popular Municipal Court of Diez de Octubre held an oral and public trial against two people who were dedicated to the illicit acquisition and marketing of medications with abusive prices. One of the accused was sentenced to ten months of deprivation of liberty, while the other received one year of deprivation of liberty.
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Right now, several surface groups are moving on the networks that sell imported medicines, most with a courier service, while the debate around the illegal market, for many an alternative, ranks among the most intense and accessible, swinging between the pros and cons of such practices combated by the State in a matter that can become life or death for the patient.
“One issue, the sale of medicines, be careful how you deal with it, it is illegal, good, but there is nothing at all in the pharmacies and we are in the middle of a health crisis, they must investigate the supply chains and if they come from the network of factories, pharmacies and hospitals, and then the weight of the law, those that sell brought from abroad, alert them so that they know that they cannot do it, but as long as the government does not have a way to guarantee, be careful!”, stated one of the forum members, seeking a balance in his opinion.
