Tunisia has experienced a significant escalation in its drug crisis in recent months, prompting several pharmacists and pharmaceutical manufacturers to declare a state of emergency due to the loss of a large number of medications, particularly those prescribed for patients with chronic conditions who urgently need pain relief drugs or similar treatments. This week, as the shortage of essential goods from commercial outlets intensified, the medical community raised the alarm about a staggering number of missing drugs from pharmacies, posing a serious risk to the lives of many, according to pharmacy owners and drug distributors.
Currently, Tunisia is facing a severe shortage of various medicines in pharmacies, with the trend worsening month by month. In June, the number of missing medicines was around 320 types. This number has dramatically increased in November to approximately 700 drug types, according to sources from the Pharmacists' Chamber. Among the affected medications are those critical for patients with serious diseases such as diabetes, cancer, respiratory issues, and hypertension. Other essential medications such as sedatives are also needed to avoid psychological symptoms and neurological crises.
Sources from the Tunisian Pharmacists' Chamber reported that the current number of missing medications ranges from 500 to 700 types, while pharmacies face a significant shortage, particularly of insulin injectables for diabetic patients and medications prescribed for neurological patients. Conversely, some other medicines are available but face distribution disruptions or scarcity in pharmacies, exacerbating the drug crisis and increasing the suffering of patients, 90% of whom reportedly cannot find the medications prescribed to them in hospitals, according to the Pharmacists' Chamber.
Some patients or their relatives find themselves on exhausting daily searches for medications without success, leading to accusations against pharmacies of refusing to distribute medicines even though the Health Insurance Fund usually covers most of the cost of medications for chronic diseases requiring long-term treatment. While some patients have partially or wholly blamed pharmacists for the medication shortage, pharmacist Chadhli Fandri stated that the root causes of the drug crisis stem from the mounting debts owed to social security funds, which have impacted the National Health Fund's budget, preventing it from covering certain medications. This has reflected on the distribution pace at the central pharmacy, which is also struggling with a severe crisis that makes it unable to meet its commitments to foreign suppliers.
According to Fandri, in statements to Sky News Arabia, the drug shortage crisis in Tunisia is fundamentally structural and comprehensive. There are no specific medicines missing and others available, as the issue encompasses nearly all types of medications. The problem lies in the pharmaceutical laboratories’ inability to produce due to financial difficulties, which leads to a halt in the production of many drug types. Pharmaceutical laboratories have had to cease production for several periods due to worsening financial difficulties and increasing claims from the central pharmacy.
Regarding the debts owed by the central pharmacy to pharmaceutical manufacturing companies in Tunisia, Fandri stated, "The central pharmacy's debts reached nearly 700 thousand dinars, but the problem is not just that these amounts are large; it’s also that the laboratory owners have not received reassuring signals from the government (the central pharmacy) to settle these amounts or find an optimal way to pay off the debts so that laboratories can resume work." He added, "Amidst the worsening crisis, the solution remains settling the debts of the central pharmacy; some chronic disease sufferers have found solutions in generic drugs, although they too suffer from severe shortages, while others have turned to doctors to change their prescriptions for substitutes. However, the greater danger is that certain diseases require a specific type of medication, and if the dosage is not taken, the patient's life is at risk at all times."
Mustafa Aroussi, a pharmacy owner, confirmed that the drug sector is indeed experiencing an escalating crisis, with all parties involved in the sector bearing part of the responsibility for the ongoing suffering of patients and their families to find specific types of medications. In a statement to Sky News Arabia, Aroussi, who runs a pharmacy in Bizerte province in northeastern Tunisia, said, "We are indeed suffering from a severe drug shortage. Pharmacies are not refusing to distribute medications; many patients come here in dire need of medicine, but the failure to meet their needs cannot be blamed solely on private pharmacies. The crisis lies in the disruption of distribution and the halt of most laboratories in drug manufacturing."
Last year, the Ministry of Health adopted a plan to reduce drug shortages by establishing a strategic stockpile of vital and necessary medications in light of the increasing demand for drugs and the worsening COVID-19 crisis. However, the indicators of drug loss have remained high, particularly for medications prescribed for chronic and serious conditions such as diabetes, hypertension, cancer, and respiratory issues.
The shortage crisis is not limited to private pharmacies; public pharmacies in hospitals, which provide medications for free to patients, especially those covered by social insurance or low-income individuals, have been even more affected. Imad Khalifi, the Secretary-General of the General Union of Public Health Physicians, Pharmacists, and Dentists, highlighted the severe drug shortage in public hospitals, affirming that the crisis is not recent but longstanding, worsening over the years due to neglect and a lack of serious search for practical solutions to mitigate it.
In a statement to Sky News Arabia, Khalifi said, "The drug sector crisis, which appears to be sharply escalating in public health and hospitals, has been around for more than seven years. Public pharmacies have never achieved self-sufficiency in medications, despite laboratories' efforts to limit shortages and provide types of medications usually prescribed for chronic and serious diseases. The numbers of missing drugs are on the rise and peaked in the last two years, possibly due to the prevalence of the COVID-19 pandemic in Tunisia since 2020, as laboratories and pharmacies dedicated all efforts to mitigate the pandemic's impacts. In any case, the sector today needs a comprehensive study to address the severe shortage and restore balance, even partially."
The freeze on the prices of some medications for years amid rising costs has burdened some laboratories, leading them to stop producing certain medications to avoid further losses. It is worth mentioning that the Ministry of Health in Tunisia previously acknowledged the severe financial crisis facing some pharmaceutical laboratories and the central pharmacy, emphasizing the need for immediate reforms in the drug sector, including licensing for foreign market promotion and establishing a National Drug Agency to address the debts of the central pharmacy in Tunisia.
