cable- In a country exhausted by wars and conflicts for decades, the crisis of imitated medicines in Afghanistan is one of the most dangerous challenges that threaten the lives of citizens, and exacerbates the fragility of the health system under harsh economic conditions.
The country is almost completely dependent on the import of medicines, while smuggling spreads and the black market spreads amid weak control and limited government capabilities, which made Afghanistan an open arena for trading adulterated and expired drugs, according to observers.
Almost total dependence on imports
For many years, Afghanistan has not been able to build a complete local pharmaceutical industry, which made it depend on import by 90 to 95% of its drug needs, according to the estimates of the Afghan National Food and Drug Authority.
These imports come mainly from Pakistan, India, Iran, and China, and their annual value is about 800 million to one billion dollars, according to local estimates and economic analyzes, including medicines (about 70%), and medical supplies and equipment.
This excessive dependence made the country’s pharmaceutical market, subject to exchange rate fluctuations, trade policy changes in neighboring countries, as well as chronic supply delayed delay.
With every delay or crisis on the border, pharmacies suffer from the lack of basic drugs, especially in remote areas, which causes patients to resort to informal sources.
Smuggling networks
On the border with Pakistan and Iran, it moves daily – according to local and international reports – complex smuggling networks that enter drugs without official control, often not suitable for use or imitator, and are later sold in popular markets at low prices.
The National Food and Drug Authority estimates that about 20% to 30% of the drugs traded in the Afghan market enter through smuggling, including counterfeit medicines that make up about 10% of the market, according to the World Health Organization estimates.
This worrying number indicates the size of the black market that competes with the official importer and hinders efforts to control the quality of medicines.
In the Kotel Jerekhaneh area in Kabul, wholesale stores are a major center for the distribution of medicines and medical supplies, but poor control makes it sometimes a channel for leakage of counterfeit medicines to local markets.
Medical sources in the Afghan capital, Kabul, say that some of these drugs come without a production or end date, and sometimes without original posters, while they are stored in inappropriate conditions.
Observers suggest that some of these networks are linked to strong local parties, which makes it difficult to monitor and hold accountable, and feeds the informal economy that Afghan authorities are trying to control.
Pharmacists in the fist of adulterated drug
In one of the alleys of the Karti Brown neighborhood in a cable, Nurin Qadi Zadeh, a mother of 3 children, talks about her painful experience with an antipyretic drug she bought for her young son Amir (5 years) from a nearby pharmacy.
She says: “He was suffering from fever and I bought a cheap drug for him, thinking that I was helping him. But his condition worsened, and after examining the medicine, it was found that it was free from the active substance.” Nourin was forced to transfer her child to a private clinic and pay a large amount for treatment.
“I lost confidence in pharmacies, I no longer know how to distinguish between the real and balanced medicine,” she said, she wipes her tears.
Abdul Rahman Azizi, a pharmacist in the state of Kandahar, southern Afghanistan, faces a daily challenge between providing medicine for citizens and maintaining professional standards.
He narrates with sorrow: “Sometimes we receive shipments of diabetes and pressure that look good in terms of packaging, but they do not give results in patients. Upon examination, we discover that they are smuggled and counterfeit.”
Abdul Rahman believes that the weak oversight and the absence of a clear central policy in managing the medicine market made pharmacies deal with great caution, until the sale of the drug became an ethical adventure.
“There is pressure from patients to get a cheap drug, but cheap may be killed,” he added.
Local production
In the industrial zone “Badakhi” on the outskirts of Kabul, Haider Ali Zadeh, the owner of a small local factory, stands between the makers of analgesics and antibiotics, and faces challenges that exceed the mere production.
“We are trying to produce reasonable quality medications and acceptable prices, but competition with smuggled and counterfeit medications puts us in a difficult situation,” said Haider.
He says that the raw materials are expensive, imported, and the market control is weak, which is tempting merchants to bring adulterated drugs.
“We bought a raw material once from an unofficial broker, so that it was later turned out to be adulterated, and we had to get rid of the entire shipment,” added Zadeh – who is inspecting his final product.
What is the opinion of the National Food and Drug Authority?
Dr. Javed Higer, a spokesman for the National Food and Drug Authority, confirms to Al -Jazeera Net that the government is making efforts to control the market, despite the great challenges.
He says: “There are between 50 to 100 local factories, most of which are small and medium, which produces about 600 types of drugs, covering about 5% to 10% of the market size, although they constitute 20% to 25% of the types of drugs circulating.”
Haiter adds that the authority has established laboratories to examine medicines on border ports, and conduct periodic control campaigns on pharmacies.
At the same time, local pharmacists in Kabul indicate that the current authorities have made remarkable progress in reducing smuggled drugs compared to the previous government, by tightening control over border ports and activating inspection mechanisms.
But he admits that smuggling and counterfeit drugs are a dangerous challenge. “The matter requires regional and international coordination, and also cooperating with citizens in reporting suspicious drugs.”
Risks threatening health security
Specialists in public health and pharmacy, with the support of the reports of the World Health Organization, confirms that the spread of adulterated drugs leads to catastrophic results, including high disease resistance to antibiotics, and the exacerbation of chronic cases due to the ineffectiveness of treatment.
Large areas of Afghanistan suffer from an acute shortage of basic drugs, such as insulin, pressure medications, and antibiotics, which makes the weaker groups, such as children and the elderly, most at risk.
The absence of a coherent national policy of drug security weakens citizens’ confidence in the health system.
The solution in local production and regional cooperation
Afghan experts agree that the key to the solution lies in supporting the local industry by reducing taxes on raw materials, providing energy at subsidized prices, and attracting investments from the Gulf countries, Turkey and India.
These experts demand a priority to establish a national central laboratory with advanced examination capabilities and train professional inspection teams.
“We welcome any support from international organizations such as the World Health Organization and the Qatar Development Fund, as international cooperation is necessary to build a health system that protects the Afghan citizen.”
The crisis of counterfeit medicines exceeds the borders of Afghanistan, to pose a threat to public health in the region, especially with active smuggling networks that may sink the markets of neighboring countries with unsafe drugs.
For example, counterfeit drugs may reach the markets of Pakistan and Tajikistan through smuggling networks, and this threatens public health in the region.
As the gap between demand and supply continues, the Afghan citizen remains the weakest link in a complex healthy equation that requires a sustainable solution, political will, and urgent regional and international cooperation.
