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Dawn Editorial 11 July 2020

Pricing medicine

THE drug-pricing issue has once again taken centre stage in the debate on affordable healthcare triggered by the Covid-19 crisis. The government is reported to have approved a proposal to amend the Drug Pricing Policy 2018 to do away with the existing mechanism that allows pharmaceutical manufacturers an automatic, inflation-adjusted increase in their prices. The suggested change may appear innocuous as it doesn’t alter the CPI inflation-based pricing formula. But it isn’t. It stops pharmaceutical firms from enhancing prices by just informing the health ministry 30 days before implementing the new rates. In other words, the drug regulator Drap will get back its arbitrary powers to decide if and when to increase the prices. The present drug-pricing policy was developed on the orders of the apex court, which was hearing several hundred hardship cases filed by drug manufacturers seeking an upward revision in their prices. Thus, the amendment is likely to reopen the floodgates of litigation, besides increasing bureaucratic interventions in purely business decisions, and spawning corruption. More important, the failure of the regulator to notify the price increase in a timely manner would make production of certain life-saving medicines and vaccines unviable, resulting in their disappearance from the market as was the case for several years because of a 13-year freeze on drug prices.
Drug pricing has always been a political issue in Pakistan. There is no denying the fact that medicines are a public good. But at the same time drug manufacturing is a ‘for-profit’ business for investors, who would have to earn enough margins on their products to stay economically viable. No government can expect medicine producers to bear the burden of healthcare costs for it. While it is important for the government to control the prices of essential life-saving drugs, as is the case in Bangladesh and India, the blanket application of such a policy can be detrimental to new investments where capacity expansion, new technology, quality assurance and exports are concerned. Little wonder that several foreign companies have already exited Pakistan and the industry lags far behind its regional counterparts. Unlike Bangladesh, we don’t have a single FDA-approved firm in Pakistan and only one out of over 600 manufacturers has been able to secure certification to sell its products in Europe and the UK.
To ensure affordability, the government should improve its oversight of the market to encourage fair competition, improve Drap’s capacity to make quick decisions on, say, drug approval, and help the industry reduce its cost of doing business rather than denying manufacturers their legitimate inflation-based price hike. Further, the authorities also need to create a market for generic drugs, the formulations sold under their original chemical name at a massive discount compared to branded ones. The government needs to learn from the regional industry and follow best practices instead of suffocating manufacturers through price control for short-term political gains.

 
 

Back to school?

AFTER a nearly five-month closure due to Covid-19, schools and universities in Pakistan are scheduled to reopen on Sept 15. Education Minister Shafqat Mahmood made the announcement at a press conference, saying that educational institutes will reopen with SOPs in place. Mr Mahmood also said that authorities are mulling several options: scheduling classes on alternate days, conducting classes outdoors, training teachers, recalling students to hostels with maximum 30pc occupancy and enforcing mask wearing and social distancing. All this, however, is contingent upon the lowering of the coronavirus infection rate. If the crisis is not curbed, Mr Mahmood said, schools and universities will not open.
There is no doubt that the closure of educational institutions has been a huge setback for students all over the world. In Pakistan especially, where internet access in many areas is limited, virtual classes have been tremendously difficult to hold if not impossible. For young children, too, the disruption in learning has had consequences for their emotional well-being. Therefore, the authorities’ concerns regarding school closure are legitimate. However, taking any decision before the Eidul Azha holiday, which is a couple of weeks away, and Muharram, may not be feasible as there is a fear that infection rates will rise during this time. These fears are evidenced by the government’s repeated statements that Eid gatherings and flouting of SOPs will undo the lower reported figures. The prime minister has appealed to the public to mark Eid with simplicity and take precautionary measures. Unfortunately, no SOPs are being enforced at gatherings in animal markets. As a result, one infectious disease expert has predicted a frightening scenario of 5,000 new infections per day. If these violations continue and infections rise, the government should, as it has already indicated, reconsider its decision. Even when the time comes for schools to open — whenever that may be — the planning needs to be meticulous. Temperature checks, distancing, mask wearing and rigorous training of teachers on SOPs will be essential. A safe system will have to be chalked out for those using public transport to get to school. Children who are immuno-compromised or who live with a vulnerable family member may have to be offered an alternative to physical attendance. Teaching staff should be given paid sick leave, adequate PPE and quick testing. This is an uncertain time and uncharted territory for all educational institutions. However, authorities must support students and faculty by providing and enforcing clear guidelines.

 
 

Yemen famine

THERE is yet more grim news from Yemen, as the UN says the Arab state is once more on the brink of famine. According to the World Food Programme, around 10m people face an acute shortage of food and that the people’s suffering is “unimaginable”. Moreover, the country, battered by over five years of war, is ill-prepared to face the coronavirus pandemic. While the official tally says there are around 1,300 cases, experts warn the real number may be over a million, as Yemen’s fragile health infrastructure is in no shape to give accurate data. If hunger and disease were not enough, Yemenis live in the constant shadow of death either from the skies, in the shape of Saudi-led bombardment of Houthi positions, or fighting on the ground between multiple factions.
In the immediate future, the international community cannot let Yemen’s vulnerable people starve to death. While the Covid-19 situation has greatly complicated matters, funds, foodstuff and safe passage must be guaranteed so that immediate succour can be provided to Yemenis, along with medical aid. But in the long run, there is only one workable solution to Yemen’s myriad problems: bringing this horrific war to a swift close. While truces have been called, and broken, it seems the world community has lost interest in Yemen and its forsaken people. Saudi Arabia, the UK and the US have indeed pledged large amounts of aid at a recent donors’ event for Yemen. But if they really want to help the country, these states must declare an indefinite ceasefire, and stop providing the weaponry that is helping prolong the war. Moreover, the principal Yemeni actors — the government, the Houthis, the southern separatists — as well as their primary foreign backers including the Saudis, the Iranians and the Emiratis, respectively, must hammer out an agreement that can help end hostilities forthwith, ensure the integrity and stability of Yemen, and give Yemenis a chance to rebuild their shattered country.
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