Medicine shortages grow in Iran as US tightens sanctions, blockade

Tehran, Iran – Farah, a 59-year-old resident of Iran's capital Tehran, applied to fill her autoimmune prescription with a Swiss-made drug.

Key points

• Pain and fever pill Acetaminophen has risen by 375 percent, antibiotic Amoxicillin by 285 percent, and anti-depressant Fluoxetine by 100 percent.
• Regarding 800 pharmaceutical products are at present in short supply nationwide, including 90 considered essential and life-saving, according to Hadi Ahmadi, a spokesman for the Iranian Pharmacists Association.
• According to Pirsalehi, two major pharmaceutical businesses that were bombed by the US and Israel, including Tofigh Daru, were participating in the B2B exhibition, called Pharmex.
• According to local media, the debt amounts to regarding 8 quadrillion rials ($3.56bn).
• The shortages have worsened since the US and Israel's war on Iran.

"I switched to the Iranian-made version because of the price and availability, " she informed Al Jazeera, giving only her first name. "You might not find the foreign-made version later, and you can't keep switching because they don't have the same quality and effectiveness." She's now bracing for shortages of the Iranian-made drug, too.

As the United States leans on military pressure, sanctions and a naval blockade to squeeze Iranians, iranian news outlets have documented growing shortages of medicine for cancer and other serious illnesses against the backdrop of a crisis in Iran's pharmaceutical sector.

Regarding 800 pharmaceutical products are at present in short supply nationwide, including 90 considered essential and life-saving, according to Hadi Ahmadi, a spokesman for the Iranian Pharmacists Association. Four hundred of those drugs, he informed local media last week, are manufactured inside Iran. Rates, meanwhile, have surged.

Notably, the state-run Mehr News Agency documented last week that the rate of gabapentin, applied to treat epilepsy and nerve pain, has risen 220 percent over the past year. Pain and fever pill Acetaminophen has risen by 375 percent, antibiotic Amoxicillin by 285 percent, and anti-depressant Fluoxetine by 100 percent. Insulin, a daily necessity for diabetics, now costs up to six times what it did a year ago.

In practice, the increases are part of a wider inflationary spiral in the country. Iran's inflation rate is among the highest in the world, with the cost of essential food items up more than 123 percent year-on-year as of August, and a number of staples like cooking oil more than tripling in rate. Damage from the war.

As it has in other industries, building domestic capacity to manufacture active pharmaceutical ingredients, equipment and finished drugs, for years, Iran has pursued self-sufficiency in medicine. But the sector still heavily relies on imports for a number of critical ingredients, equipment and rare medications.

Washington's years-long "maximum pressure" sanctions have hobbled the financial and logistics networks facilitating procurement of medical imports, leading to significantly higher costs despite existing humanitarian exemptions.

For context, the shortages have worsened since the US and Israel's war on Iran. It began in February, damaged and destroyed some 44 pharmaceutical and medical equipment firms. According to Iranian authorities, some 50 industry workers were additionally killed or wounded.

One of the main pharmaceutical firms bombed during the war was Tofigh Daru. It is owned by Iran's largest pension fund.

Maryam Farahani, the company's director of sales, informed Al Jazeera that Israeli air strikes had struck all of its research and production lines, including those producing peptide and narcotic active ingredients as well as anticancer drugs.

"Our target audience are predominantly cancer patients and people with chronic diseases, " Farahani remarked. "Some of the medicine we used to produce were exclusive."

For context, the firm has since rented an alternate production line to keep output above zero, she went on, even as the US's naval blockade and sanctions drive up import costs by blocking shipping through the Strait of Hormuz and disrupting air, rail and overland routes.

As well as numerous specialised equipment purchased over 26 years of operation, were destroyed since of the Israeli air strikes, farahani remarked databases and server sites. She estimated that partial rebuilding would require at least two years and tens of millions of dollars. In the meantime, she remarked, the company's researchers are working to preserve institutional knowledge that was lost when its data was destroyed.

Meanwhile, the Israeli military remarked in late March that it targeted Tofigh Daru as the firm was a principal supplier of fentanyl to SPND, a top Ministry of Defence research body. It accused the SPND of using the drug in chemical weapons research.

Tofigh Daru has disputed that account, saying it produced only the citrate-salt form of fentanyl, in small quantities, for approved medical uses such as surgical anaesthesia.

Farahani remarked Tofigh Daru additionally manufactured glatiramer acetate, an injectable drug applied to treat relapsing forms of multiple sclerosis. The original version, Copaxone, was developed and marketed by the Israeli firm Teva and long dominated the global market before generic versions were developed elsewhere.

"It is truly regrettable that many of the places targeted across Iran were research sites, and what leads to the development of a country, " she remarked. Authorities play down crisis.

Despite the rapidly deteriorating conditions, Iranian authorities have sought to project resilience, saying the pharmaceutical industry – like other sectors of the Iranian economy – is refusing to collapse under the pressure.

"The enemy has identified medicine as one of the sensitive areas of the country, and is trying to denigrate and portray Iran's conditions as unfavourable by releasing content in the press and social media, " Mahdi Pirsalehi, head of Iran's Food and Drug Administration, remarked on Tuesday at the opening of a three-day pharmaceutical exhibition in Tehran's sprawling Iran Mall.

He remarked Iran was facing fewer drug shortages than last year, but did not provide figures to backing the claim.

According to Pirsalehi, two major pharmaceutical businesses that were bombed by the US and Israel, including Tofigh Daru, were participating in the B2B exhibition, called Pharmex. The event was mostly attended by Iranian businesses, but a handful of Chinese and other counterparts had representatives.

Still, doctors in Tehran worry regarding the threat to public health from the drug shortages, including vaccines.

Meanwhile, a gastroenterologist and university professor in Tehran. This person spoke on condition of anonymity, described the recent rise in rates, including for domestically produced generics, as "staggering" and stated it had become an insurmountable barrier for plenty of vulnerable Iranians.

She remarked the government's gradual removal of subsidised foreign currency for medical imports, and quadrillions in unpaid debts that insurers owe pharmacies, have additionally contributed to the current situation. According to local media, the debt amounts to regarding 8 quadrillion rials ($3.56bn).

"Reports that rotavirus vaccine imports have been halted because of the maritime blockade – and that influenza vaccines may soon face the same problem – represent a serious and alarming threat to nationwide efforts to prevent vaccine-preventable communicable diseases, " she remarked.

In practice, the doctor additionally cautioned of the impact of the worsening conditions on vulnerable groups.

"Runaway inflation, poverty, and inadequate access to essential food groups among vulnerable populations, including infants, children, and pregnant women, signal the onset and spread of malnutrition, " she remarked. Consequently, this raises the risk "of both communicable and non-communicable diseases, creating a vicious cycle in which malnutrition develops and progressively worsens", she continued.

For now, medicine shortages grow in Iran as US tightens sanctions, blockade remains the part of the story worth watching, and further updates are likely as more details are confirmed.