No medicines? How to face the shortage in our country

There is a shortage of medicines in Mexico, and it has worsened in recent years. This is shown by the official data analyzed by the well-organized citizen collective Cero Desabasto in its Mapping of Drug Shortages. The conclusion of the study is devastating: the authorities underestimated the complexity of the chain of access to medicines, they changed the acquisition and distribution processes in a hasty and unstructured manner; and have affected the general population of all the states of the republic and multiple medical care needs, from cancer, diabetic and psychiatric patients, to people with transplanted organs or healthy children and babies in need of vaccinations.

Based on official data from the Mexican Social Security Institute (IMSS), the increase in unfilled prescriptions began in 2019 when the institution did not fully fill 5 million prescriptions; in 2020 there were 15.8 million; in 2021, 22 million and, with figures as of August 2022, the accumulated figure was already at 9 million prescriptions. It is important to dimension what this implies for families. According to the 2018 National Household Income and Expenditure Survey (ENIGH), the share of spending on medicines (prescription and non-prescription medicines and healing materials) represented 28% of health care spending. However, by 2020, due to the COVID-19 pandemic, families spent 40.5% more on health compared to what they spent in 2018 on the same item, with those located in the first population decile -the poorest- being most affected. –, which increased their spending on medicines by up to 68%.

The current administration has repeatedly blamed past governments for drug shortages. He argues corruption and an inefficient model for purchasing and distributing medicines, which is partially true. However, the federal government has not been able to solve the problem nor has it really held responsibilities; on the contrary, the situation has worsened.

Let us remember that in that year 2020, President López Obrador made structural modifications to the medicine supply system. First, it failed to entrust the consolidated purchase of medicines to UNOPS –the United Nations office in charge of assisting developed countries in humanitarian work–, which caused delays in the delivery of medicines, a lack of transparency and accountability in the acquisition process, high costs and doubtful quality of the acquired medicines. That year, he also promoted administrative reforms that implied for the Federal Commission for the Protection against Sanitary Risks (Cofepris) an administrative degradation that forced it to change its status to a “direction” of the Ministry of Health under Undersecretary López Gatell. Cofepris has promoted inspections of local manufacturing plants that, to date, have resulted in the suspension of production activities for alleged breaches of official regulations. Although the work of the State is to carry out an effective work of regulation and inspection, it is worrying that –as happened with the fight against fuel theft–, by penalizing some, there will be a shortage in the supply to the detriment of patients.

It would have been smarter to follow Cofece’s policy of investigating and penalizing drug providers without breaking the value chains, which are the main reason for shortages. According to the reports of said body, its interventions in the sector have been constant. From 2017 to 2020, it has sanctioned companies that supply health supplies for colluding – the most serious crime in economic matters typified in the Federal Penal Code – in public tenders of the Mexican Institute of Social Security (IMSS) and the Institute of Security and Services Social Workers of the State (ISSSTE), to the point of initiating complaints against people who could have participated in collusive agreements in various markets for condoms, probes, gloves and toothbrushes. In May 2016, it began an investigation for possible absolute monopolistic practices in the market for the production, distribution and commercialization of medicines in the national territory, according to the categories of medicines indicated in the General Health Law.

Cofece concluded that there was sufficient evidence to prove collusion that caused damage to Mexican families, particularly those with lower incomes, who in 2014 spent approximately 24 billion pesos on the purchase of prescription drugs, non-prescription drugs, and medical supplies. of healing. Thus, it estimated that the sanctioned conduct caused damage to the pocket of Mexicans of more than 2 thousand 359 million pesos. According to public information, Cofece accredited the performance of three anti-competitive conducts in the distribution market, and as a result, the economic competition authority identified that the distributors Marzam, Casa Saba, Fanasa, Nadro and Almacén de Drogas and 21 natural persons established conditions for pharmacies based on collusive agreements implemented since 2006, which were intended to restrict supply and fix, manipulate and increase the price of distributed medicines. The Cofece applied the maximum possible sanction, equivalent to fines that together amounted to 903.5 million pesos, and disqualified various directors of the sanctioned companies from acting as directors, administrators, directors, managers, executives, agents, representatives or attorneys-in-fact. The foregoing, derived from the analysis of fraud, intentionality and the time of each person who participated in the conduct.

The drug market is relevant due to its impact on health and life, both for individuals and for the national economy. Therefore, it is urgent that the supply chains of the sector be restored, regardless of ideologies or partisan colors. Perhaps, with the arrival of a new president at Cofece –who, by the way, was unanimously appointed in the Senate and enjoys legitimacy–, it will be possible for the institutions to coordinate better. Good things could happen if Cofece and Cofepris worked as a team. It is urgent to open spaces for dialogue with the private initiative and relevant actors, such as patient groups and medical associations, which until now have shown great interest in solving the problem of shortages, and have been able to build an effective capacity organization to exercise their right to citizen participation.