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Drug Storage and Shortages: in Lebanon, The Vicious Circle Sets In

According to the president of the importers association, Karim Gebara, we are moving towards a gradual and planned lifting of subsidies.

Drug Storage and Shortages: in Lebanon, The Vicious Circle Sets In

Pharmacists are under pressure: their work volume has almost doubled due to the high rate of walk-in customers. Photo A.-M.H.

Since the authorities have raised the possibility of lifting subsidies on medicines and other basic necessities, the Lebanese have been in a state of panic. They have been rushing to pharmacies to buy medicines in stock that they cannot do without, fearing shortages or skyrocketing prices. Scorched by the banking crisis, they simply no longer have confidence. As a result, many drugs are nowhere to be found, particularly those intended to treat chronic diseases such as diabetes, hypertension, heart disease or serious illnesses such as cancer, rheumatism and Alzheimer's. Of the four medications he is responsible to provide for his elderly aunt who suffers from chronic illness and cancer, Walid has found only one. He has just come out of a pharmacy in Ain Saadeh and is preparing to continue his tour. "This is my third stop, and my tour is far from over. I am going to stop at every pharmacy that is open," he said.

It Goes Away Like Candy

The comings and goings are incessant at the First Aid Pharmacy in the small town in Metn. The customers enter masked, after disinfecting their hands, queue up respecting the distance, carry out their order and take what they find, sometimes even leaving empty-handed. "I only got a small box of Panadol, the one you take for any ailment, but none of my diabetes and hypertension medication," said another client who regretted not being able to "afford to buy his medication in quantity because he is out of work." On the phone with a supplier, the owner of the premises, Carla Hayek, negotiated quantities of zinc and vitamins. "It is crazy! It goes away like candy," she said. And the rush is not limited to supplements and vitamins that can boost immunity, in these times of explosion of the Covid-19 pandemic. "Over the past two months, when there was talk of lifting the subsidies, the clientele has massively bought the drugs they cannot do without because of chronic diseases," the pharmacist said. "While some do indeed fear the shortage, others have made reserves for one and a half years sometimes, by swarming pharmacies, due to expected price increases in the near future. The drugstores cannot meet this demand, which is much higher than the normal market volume, so there is a shortage of medicines: those for hypertension, reflux or diabetes," she added.

The lack is felt by many patients who did not realize the seriousness of the situation, or who never felt the need to build up reserves. Maya has just returned from a two-week trip. As she does every month, she went to her local pharmacy to buy her mother's medication. "Like the vast majority of Lebanese, she suffers from diabetes, hypertension and heart disease. I was told they were out of stock," she said. It was only after making the tour of a dozen pharmacies that Maya managed to get her mother's treatment for just one month. "I am already on the waiting list for next month," she said half-heartedly. It is the "stress" that overwhelms her when she considers the possibility of seeing her mother deprived of her medical treatment. Ms. Keyrouz was not fortunate enough to find the medication to treat her diabetes. However, she has swarmed pharmacies, a dozen or so as well. "My pharmacist gave me a generic until the crisis passes," she said.

Medicines Distributed in Dribs and Drabs

Despite appearances, the situation is difficult for the pharmacies. Their clientele has certainly doubled, especially the transient clientele. But the benefits do not follow. "Our dollar is still at LL1,500," Hayek said. “We also have to deal with a stressed clientele, who sometimes raise their voices, who make many phone calls to ask about a drug, its price and its expiry date and who insist on having more and more, while we have to be fair and supply our usual clientele." The image is the same at the al-Chifa Pharmacy in Furn el-Chebbak. The owner, who prefers not to be identified, shows his lists of products that are out of stock, or at best "of medicines that are distributed to him in dribs and drabs."

He reviews the lists "every night with his suppliers at the end of an exhausting day." "Customers rushed to take the drugs out for fear that the subsidies will be lifted. What will they do when their supplies reach their expiration date?" he asked. But at the same time, he understands the popular people’s reaction. "If the subsidies are lifted, it will be catastrophic," he said, referring to a possible increase in the prices of the drugs.

Flu Vaccine Soon Available in Large Quantities

According to Karim Gebara, the head of the Syndicate of Pharmaceutical Importers, the problem stems from the panic created by the eventual lifting of subsidies on drugs. "The population's re-action is normal. They have been stockpiling medication for several months because they need to feel safe. After all, it is about health," he said. But this reality leads to abuses. "When people go from one pharmacy to another to buy the same drug, it leaves other patients without medication," he added.

It is therefore this situation that, according to Mr. Gebara, gives the impression that the drugs are out of stock, while "ordinary deliveries are sufficient for one month." Hence the panic that ac-companies the lack of flu vaccine in pharmacies. "Influenza vaccine will be available as early as the end of October and the quantities will be doubled compared to previous years during this pandemic period," he said. In numerical terms, "the quantities may reach an estimated 500,000 doses," whereas under normal circumstances, the quantities required do not exceed 200,000 dos-es.

It may take weeks for the drug market to stabilize. "But this is if and only if a personality who enjoys popular confidence promises a lifting of subsidies that is neither brutal nor chaotic, but planned and progressive," Gebara said. It is in this context that the discussions between the various concerned public actors, including the Health Ministry, the Banque du Liban and the Grand Serail, are taking place. A representative of the drug importers involved in the discussions, said he is "more confident," even if nothing has been decided on this matter for the moment.


(This article was originally published in French in L'Orient-Le Jour on the 7th of October)



Since the authorities have raised the possibility of lifting subsidies on medicines and other basic necessities, the Lebanese have been in a state of panic. They have been rushing to pharmacies to buy medicines in stock that they cannot do without, fearing shortages or skyrocketing prices. Scorched by the banking crisis, they simply no longer have confidence. As a result, many drugs are nowhere...