The availability of medicines in Cuba is a sensitive issue that receives priority attention from the national government, due to the social dimension that it implies.
To find out about the national production of medicines at the end of 2021, and the behavior in the month of January, Granma spoke with Dr. Eduardo Martínez Díaz, president of the business group of the Biotechnological and Pharmaceutical Industries of Cuba (BioCubaFarma).
–What is the current situation of the supply of medicines to the National Health System?
-In 2021, the complex situation of drug shortages in our country worsened, both those produced by BioCubaFarma and those imported by the Ministry of Public Health (MINSAP), a difficulty that persists today.
BioCubaFarma supplies the Health System with more than 900 products, including medicines, vaccines, for dental use, diagnostic systems, medical equipment and devices, among others.
«Last year, the lack of medicines produced by the Group had a monthly average of 121, of the 359 that we had to guarantee to the basic staff. Some of them were affected for several months, of others, partial deliveries were made and only a part has been guaranteed with a certain stability.
–Which medicines have been delivered in a stable way?
–A control card that we supply steadily in 2021, for example, Timolol 0.5% eye drops, a widely used ophthalmological medication, which reached a demand of 1,139,700 units in the year and 1,278,500 were delivered.
“On several occasions we have explained the causes of this situation. The fundamental one is not having all the raw materials and inputs that are required for production. Some medications were also missing or had low coverage due to equipment breakage; but it is a minor cause, thanks to the great effort of the engineers, innovators and rationalizers of our companies and the support of other sectors».
“In turn, the non-availability of raw materials is due to several factors, first of all, lack of the necessary financing to be able to acquire them. To give you an idea, if we were to buy the products that BioCubaFarma supplies to the National Health System on the international market, more than one billion US dollars would be needed. However, production in our country is financed with around 160 million.
“Half of the financing available last year was used in the development and production of vaccines against COVID-19, and drugs included in the treatment protocol for this disease. We have had to use a significant part of the resources in the fight against the pandemic, and only 50% of the financing that was needed to acquire the raw materials for the basic medicines was available.”
–How is that the impact of the blockade imposed by the US directly affects this situation?
–For example, in the last three months of last year we were able to export vaccines against COVID-19 and other products to several countries. However, due to financial persecution, including the refusal of several banks to work with Cuba, millionaire figures have accumulated that have not been collected, causing delays in payment commitments to suppliers of raw materials, among other damages.“As a consequence, even having the financing, on multiple occasions suppliers have declined to supply us with the materials. We have proof of what we are saying."Another objective element that causes this acute shortage of medicines is the worldwide shortage of materials and raw materials for pharmaceutical use, as a consequence of the global health situation."
–What raw material has supply problems at an international level?
–An example is the shortage of vitamins, which affects drugs such as Truabin and Polivit, which have been affected for a long period of time. Added to this scenario is the fact that the pandemic caused a collapse in international logistics, which also affects the arrival of raw materials. We have loads in different ports waiting to be transported to the Island.
–When do you estimate that this situation will begin to improve with the medicines produced by BioCubaFarma?
-In the first months of this year, the scenario will continue to be difficult, we have to say it clearly and not create false expectations. However, we have an action plan, we look for alternatives, we continue to take all kinds of steps to overcome the objective problems explained, and we intend to transform these realities with initiatives and innovating in management. We have done a lot to circumvent the blockade, and thanks to this, the situation is not even more complex, but we must continue to put the maximum into all kinds of actions to reverse this problem.
“According to the analyzes carried out, with the greatest possible objectivity, we think that as of June we could begin to have improvements in the global supply of medicines and other products, especially those of higher priority, such as those with control cards. It will not be before, because for that we already had to have the raw materials, or that they were sailing to the country, and that is not what is happening.
“As part of the measures that we have adopted, together with the MINSAP, for three years, priorities were established with the classification of medicines in three levels, so that the procedures, the allocation of financing and the contracting of the materials premiums is made with those priorities in mind. The situation in the month of January is as follows: of the medicines that BioCubaFarma supplies to the basic table, 136 have been missing.
«Of the total, 262 are Priority 1, leaving 88 missing in January. «Of the latter, 11 are in the production process and will be delivered in February; 64 have the raw materials contracted and financed, but they are pending arrival in the country; another seven depend on raw materials that have not yet been financed; and four are affected by problems in the production lines. «There are two medicines whose raw materials have not been contracted due to lack of suppliers.
«Of the medicines considered to be of first priority, 63 are control cards. 23 will be affected, of which 21 depend on raw materials already financed, pending arrival in the country. One drug is affected by broken equipment, in the process of being solved, and the raw material for another has not been financed.
“By further detailing the information, we can say that of the Priority 1 medicines, there are 12 that are given the most attention, because they are the ones that pay the largest number of patients, more than five million people. It is the priority within the priority. At the end of January, three are missing, all of them have financed the raw materials, but they are pending arrival in our country.
«I would like to clarify that it is not that these medicines lack all the raw materials, it is enough that there is not a single component, and it cannot be manufactured. For example, Enalapril could not deliver the 42 million tablets needed in the country to cover a month's demand, leaving two provinces partially out of supply; therefore, it is considered at national fault. This drug uses more than 15 components for its manufacture, and the reason why not all the necessary quantity was produced was due to not having the primary packaging material.
“On the other hand, we have 110 drugs that pay attention to seriously ill patients. Of these, 19 are missing, of which four are in production and will be supplied in February; 13 have financed raw materials, pending arrival in the country; and two pending financing.
"We have a work system for the permanent and detailed monitoring of the situation of each medicine, which allows us to know in real time what the state of production is, the coverage in each province, the situation with each raw material, in what is the status of the contracting, the status of the shipments, etc. This system has a high level of computerization, which helps decision-making.
“In the context of this complex situation, the phenomenon of the illegal sale of medicines has worsened, causing irritation in our population and we must resolve it with the participation of all, as the country's highest leadership has requested.
“At BioCubaFarma, with the aim of increasing drug control, we have established a comprehensive plan of measures throughout the production and distribution chain. In this plan, the first thing is the permanent call to the conscience of our workers and to the sense of responsibility.
"Another type of action is, for example, the installation of closed circuit television in all factories, whose fundamental purpose is to supervise operations and comply with good manufacturing practices, but, without a doubt, it also helps the control and avoid theft.
"The workers of the Cuban biopharmaceutical industry are aware of our responsibility, and we can ensure that a great effort is made to minimize the effects and be able to reverse this situation," he said.