Table 2

Theme 1; current situation of medicines shortages in Pakistan

SubthemeCategories and subcategoriesQuotations
Understanding of the term ‘medicines shortages’Definitions of medicines shortages included:
  • Imbalance between the demand and supply or production.

  • Inadequate or intermittent supply.

  • Unavailability of product at any given time.

  • Unavailability for all age groups and entire dosage regimen.

‘Drug shortage or medicine shortage is actually a gap between the supply and the demand. If the supply or the manufacturing is less or done less than the demand then the shortage is created.’ (Regulator 10)
‘All the registered drugs if not adequately supplied in market and which can threaten the patient need, are called shortages.’ (Manufacturer 2)
‘When any medicine is not available in the market for a particular time due to any interruption in the supply is called as medicine shortage.’ (Manufacturer 6)
‘When the medicine is not freely available for the patients of all age groups as well as for the entire dosage regimen, it is termed as shortage.’ (Pharmacist 10)
Types of medicines shortages included:
  • Generic shortage and brand shortage.

‘Basically shortages are of two types. One is generic shortage and other is brand shortage. Molecule itself, like if it’s all brands are short then this is generic shortage, and other is if any specific known brand is short then it is brand shortage.’ (Regulator 3)
  •  Simple shortage, high shortage and critically high shortage.

We have categorised three categories; number one shortage; number two high shortage; number three critically high shortage. The shortage complaint that is received from any consumer, we issue explanation letter of drug shortage. If the shortage is in more than one city but is available in some cities then we issue the explanation letter of high shortage and if that medicine is dead short in whole country then we issue the explanation letter of critical shortage.’ (Regulator 4)
Last 1 year trend of medicines shortageSituations aroused many times during last 12 months‘Yes, number of the times, such type of situation aroused in the market when the drugs were short.’ (Regulator 1)
Types of medicines undergoing shortages included:
  • Essential medicines (ie, antibiotics and seasonal medicines like antidiarrheal, antiasthmatic, antiallergy, analgesics and antipyretics, etc).

  • Life-saving medicines (ie, antiangina and antihyperthyroidism) were short.

  • Orphan drugs (eg, penicllamine).

  • Controlled drugs (ie, narcotics, sedatives and hypnotics) were short.

‘Basically in general, there are two types of medicines, one is essential medicine and other is lifesaving medicine. In essential medicine, it involves all medicines in the market, from analgesic to antibiotics, they are considered to be essential. And other category is lifesaving that include those products which are used in emergency situations.’ (Manufacturer 5)
‘‘Orphan drug’ is actually a term which indicate a product having very low price and company has no profit in this and very limited companies are manufacturing… some controlled drugs undergo shortages.’ (Regulator 8)
Notification systemThere was proper notification system at health regulators level‘Patients also inform us. Some of the notifications are received from the chief drugs controller office and sometimes letters are received from DRAP, so these are our sources of notification…we send notification to manufacturers and their concerned distributors.’ (Regulator 8)
Lack of proper notification system at manufacturer level‘Generally, in Pakistan there is no such trend, but multinationals sometimes do that. When there are high level shortages, means when alternative is not available, then multinationals are bound to notify. But we don’t notify when alternative is available in the market.’ (Manufacturer 1)
Lack of notification system at distributor level‘No, we don’t receive or send any notification. Rather manufacturers never inform but one or two companies informed us that medicine is short and its reason is shortage of raw material…’ (Distributor 1)
Preventive measuresDrug regulatory authority of Pakistan asked, compelled and prosecuted non-complaint manufacturers and distributors to prevent medicine shortages‘We take preventive measures like if there are limited brands available, then we encourage other manufacturer to manufacture that product after taking its registration. Plus those who are not manufacturing, we pressurise them to resolve their issues… we also try to facilitate them if they are facing any problem.’ (Regulator 3)
Health department conducted surveillance of the shortage items and tried to ensure the availability of alternatives‘We have developed surveillance system, in which we check; which medicines are short; which medicines are not supplied and are short for such time span; whether their alternate is available or not.’ (Regulator 11)
Manufacturers tried to prevent the shortage of medicines in market‘We make plans for the whole year and assure that sufficient product remain available throughout the year and try to maintain its supply…If there is shortage of drug even after producing sufficient product then we check distributors that whether proper supply is maintained or not.’ (Manufacturer 1)
Distributers were not taking preventive measures properly and declared themselves handicap in doing so‘We are handicap in this case. We could not do anything. It is obvious that when company stock is limited then distributors from all over Pakistan will also have limited stock. So we could not do anything in this regard.’ (Distributor 2)