pharma industry pakistan

WelcomWelcome e

to to

The Pharma The Pharma Discussion Discussion

Pharmaceutical Industry Pharmaceutical Industry Pakistan (A brief Overview)Pakistan (A brief Overview)

A discussion withA discussion with

Mr. Afaq Ali KhanMr. Afaq Ali Khan&&

Students of Analysis Of Pakistani IndustriesStudents of Analysis Of Pakistani Industries

PresentersPresentersKamran Shahid Kamran Shahid

Bukhari (Sp06-bb-0042)Bukhari (Sp06-bb-0042)Muhammad Danish Muhammad Danish

Anwer (Sp06-bb-0056)Anwer (Sp06-bb-0056)

AgendaAgenda

PharmaceuticalsPharmaceuticals Historical BackgroundHistorical Background Importance Of Pharmaceutical IndustryImportance Of Pharmaceutical Industry Current SituationCurrent Situation------------------------------------------------------------------------------------------------------------------------------------------ Category of local productionCategory of local production LinkagesLinkages PricingPricing GrowthGrowth Imports/ExportsImports/Exports------------------------------------------------------------------------------------------------------------------------------------------ Role of GovernmentRole of Government Health SectorHealth Sector Health PolicyHealth Policy------------------------------------------------------------------------------------------------------------------------------------------ ProblemsProblems Impact of WTOImpact of WTO Social ImpactsSocial Impacts------------------------------------------------------------------------------------------------------------------------------------------ RecommendationsRecommendations Questions?Questions?

PharmaceuticalsPharmaceuticals

Pharmaceuticals are substances that Pharmaceuticals are substances that are aimed to treat, cure, prevent, or are aimed to treat, cure, prevent, or recognize diseases and relieve pains recognize diseases and relieve pains through their applications.through their applications.

Industry producing pharmaceutical Industry producing pharmaceutical products is called pharma industry.products is called pharma industry.

Historical BackgroundHistorical Background At the time of independence there were two small units At the time of independence there were two small units

which were unable to meet the local demand.which were unable to meet the local demand.

The rest of the medicines were imported.The rest of the medicines were imported.

The decision taken in 1972 to abolish brand names, The decision taken in 1972 to abolish brand names, restrict availability of essential drugs to 850, fix restrict availability of essential drugs to 850, fix maximum retail prices across the board and freely allow maximum retail prices across the board and freely allow local manufacturer of all the essential drugs was in fact local manufacturer of all the essential drugs was in fact a life line for the national segment of the industry.a life line for the national segment of the industry.

Due to several reasons, especially inaccessibility of new Due to several reasons, especially inaccessibility of new researched medications this policy was ultimately researched medications this policy was ultimately reversed in 1976. reversed in 1976.

Historical Background Historical Background (Cont)(Cont) There were only 3636 registered drugs in 1977. There were only 3636 registered drugs in 1977.

The number, however rose to 6228 in 1981,and The number, however rose to 6228 in 1981,and almost 9900 were reported in 1999.almost 9900 were reported in 1999.

In 1993, there were 256 national pharmaceutical In 1993, there were 256 national pharmaceutical units and 38 Multinational Companies . units and 38 Multinational Companies .

Pakistan pharmaceutical industry was valued at Pakistan pharmaceutical industry was valued at $900 million which grew @ 20% in 1996$900 million which grew @ 20% in 1996

At the end of 1999 more than 75,000 medicines At the end of 1999 more than 75,000 medicines were being sold in the market.were being sold in the market.

At the end of 1999, according to the Ministry of At the end of 1999, according to the Ministry of Health, there were 300 registered units producing Health, there were 300 registered units producing medicines and other pharmaceuticals. medicines and other pharmaceuticals.

Historical background (Cont)Historical background (Cont)

Since 1999 the government has invested US$ 133 Since 1999 the government has invested US$ 133 million in the pharmaceutical industry.million in the pharmaceutical industry.

The last 10 years have been eventful for Pakistan The last 10 years have been eventful for Pakistan pharmaceutical industry as they have developed a pharmaceutical industry as they have developed a large number of domestic manufacturers. large number of domestic manufacturers.

In 2006 there were over 400 licensed In 2006 there were over 400 licensed pharmaceutical companies in Pakistan, including pharmaceutical companies in Pakistan, including 30 multinationals who had over 53 percent of 30 multinationals who had over 53 percent of market share. market share.

Today, the industry has developed technology, Today, the industry has developed technology, production and an infrastructure of imports. It's a production and an infrastructure of imports. It's a well regulated industry. It has Domestic companies well regulated industry. It has Domestic companies which are quite confident of doing good business.which are quite confident of doing good business.

Importance Of Pharmaceutical Importance Of Pharmaceutical IndustryIndustry

Produces medicines and life saving drugsProduces medicines and life saving drugs

Contributes towards GDP (0.16%)Contributes towards GDP (0.16%)

Generates employment (70,000 directly Generates employment (70,000 directly and 150,000 indirectly) and 150,000 indirectly)

Supports Health facilitiesSupports Health facilities

Current SituationCurrent Situation Pharmaceutical industry of Pakistan is aromnd Pharmaceutical industry of Pakistan is aromnd

US$ 2 billqwn with an annual growth rate of US$ 2 billqwn with an annual growth rate of 12.9% per annum .12.9% per annum .

The 600 firms (The 600 firms (over 400 domestic over 400 domestic manufacturers and approximately 200 major manufacturers and approximately 200 major importersimporters) together produce 40,000-odd ) together produce 40,000-odd formulations in the country. Despite high formulations in the country. Despite high competition and price wars ,drug prices are competition and price wars ,drug prices are controlled by a strict regulatory policy.controlled by a strict regulatory policy.(Thursday, September 13, 2007)(Thursday, September 13, 2007)

Current situationCurrent situation The pharmaceutical market comprises of large The pharmaceutical market comprises of large

Multinational Companies which are producing and Multinational Companies which are producing and marketing research based products and also marketing research based products and also other big and small National companies which other big and small National companies which pre-dominantly produce and market generic pre-dominantly produce and market generic products. products.

Out of total market of US$ 2 billion, 53.3% is Out of total market of US$ 2 billion, 53.3% is captured by Multinationals and 46.7% is taken up captured by Multinationals and 46.7% is taken up by National companies. The top 50 companies by National companies. The top 50 companies enjoy more than 80% market share. There are 20 enjoy more than 80% market share. There are 20 multinationals in the top 50 companies, while the multinationals in the top 50 companies, while the top 100 companies have 94.0% market share.top 100 companies have 94.0% market share.

Only 2 manufactures are involved in the Only 2 manufactures are involved in the manufacture of raw materials.manufacture of raw materials.

Current situationCurrent situation Having no recourse to a single price increase since Having no recourse to a single price increase since

December 2001, the pharmaceutical sector will be December 2001, the pharmaceutical sector will be under pressure to maintain its profitability in the under pressure to maintain its profitability in the face of inflationary pressures and currency face of inflationary pressures and currency devaluation devaluation

The total outlay on the health sector is budgeted at The total outlay on the health sector is budgeted at Rs.38.0 billion, which has increased by 15.8 percent Rs.38.0 billion, which has increased by 15.8 percent over last year. over last year.

The existing network of medical services consists of The existing network of medical services consists of 12,260 hospitals, 113,000 doctors practicing, 4582 12,260 hospitals, 113,000 doctors practicing, 4582 dispensaries, 5301 Basic Health Units (BHU), 552 dispensaries, 5301 Basic Health Units (BHU), 552 Rural Health Centers (RHC), 906 Maternity and Child Rural Health Centers (RHC), 906 Maternity and Child Health Centers (MCH) and 289 Tuberculosis Centers Health Centers (MCH) and 289 Tuberculosis Centers (TBC). total expenditure on health has increased (TBC). total expenditure on health has increased from PKR 4.37 billion to PKR 6.04 billion, which is from PKR 4.37 billion to PKR 6.04 billion, which is 31.86% higher than the last year.( as of 2006)31.86% higher than the last year.( as of 2006)

Any Questions till nowAny Questions till now

We have discussed We have discussed

PharmaceuticalsPharmaceuticals Historical BackgroundHistorical Background Importance Of Pharmaceutical Importance Of Pharmaceutical

IndustryIndustry Current SituationCurrent Situation

Category of local productionCategory of local production

Market potential of Pakistan is good forMarket potential of Pakistan is good for Antibiotics, Vaccines, Analgesics, Tranquilizers Antibiotics, Vaccines, Analgesics, Tranquilizers

Hormones, Anti-hypertensive, Anti-ulcer ants, Hormones, Anti-hypertensive, Anti-ulcer ants, Cardiovascular, Anti-cancer, Psychiatric, Cardiovascular, Anti-cancer, Psychiatric, Contraceptives and birth control drugs. Contraceptives and birth control drugs.

There are close to 125 categories of medicines There are close to 125 categories of medicines produced locally including all kind of vitamins, produced locally including all kind of vitamins, anti-allergic, alkaloids, ointments, cough syrups, anti-allergic, alkaloids, ointments, cough syrups, etc. Many of the manufacturing units are ISO etc. Many of the manufacturing units are ISO certified adhering to UK and US Pharmacopoeia, certified adhering to UK and US Pharmacopoeia, according to a study by Frost & Sullivanaccording to a study by Frost & Sullivan

LinkagesLinkages

Backward LinkagesBackward LinkagesActive Pharmaceutical Ingredients (API’s)Active Pharmaceutical Ingredients (API’s)(Alkaloids, Amino Acids, Antibiotics, Hormones, Peptides, (Alkaloids, Amino Acids, Antibiotics, Hormones, Peptides, etc)etc)

Forward LinkagesForward LinkagesGlass bottlesGlass bottlesPlasticsPlasticsPaperPaperPrintingPrintingPackagingPackagingEngineeringEngineering

PricingPricing

Prices of many pharmaceutical Prices of many pharmaceutical products are much higher in Pakistan products are much higher in Pakistan as compared to India. The main as compared to India. The main reason behind this is that most of the reason behind this is that most of the basic pharmaceutical raw materials basic pharmaceutical raw materials are imported.are imported.

GrowthGrowth Total population of Pakistan is approximately 161 Total population of Pakistan is approximately 161

million (2006 statistics) and the population million (2006 statistics) and the population growth rate is 2%. growth rate is 2%.

Pharmaceutical industry in Pakistan is at PKR Pharmaceutical industry in Pakistan is at PKR 70.89 billion and growing at 12.9% per annum ($ 70.89 billion and growing at 12.9% per annum ($ 2 billion ) and showing a positive trend hence 2 billion ) and showing a positive trend hence attracting local and foreign investment in attracting local and foreign investment in Pakistan. Pakistan.

Since 1999 , 2,500 new drugs have been Since 1999 , 2,500 new drugs have been registered registered

Growth (cont)Growth (cont)

Although it registered a fairly Although it registered a fairly robust growth during 2006-07, robust growth during 2006-07, the total market in Pakistan the total market in Pakistan remains small in relation to our remains small in relation to our population size. If the industry population size. If the industry maintains this growth rate, it is maintains this growth rate, it is projected to reach 2.2 Billion in projected to reach 2.2 Billion in the next for years. the next for years.

Imports/ExportsImports/Exports Nearly 95% ( Approx $ 450 million) of the basic Nearly 95% ( Approx $ 450 million) of the basic

raw material used for manufacturing is imported raw material used for manufacturing is imported from countries like China, India, Japan, UK, from countries like China, India, Japan, UK, Germany and others. Germany and others.

Aided by the conducive policy initiatives, Pak Aided by the conducive policy initiatives, Pak firms have emerged successful in the export firms have emerged successful in the export front, as well. According to reports, Pakistan front, as well. According to reports, Pakistan exported drugs worth fifty million US dollars exported drugs worth fifty million US dollars during the year 2004. Middle East, Far East, during the year 2004. Middle East, Far East, Africa, Ceylon and Latin American countries are Africa, Ceylon and Latin American countries are other locations where Pakistani drugs are now other locations where Pakistani drugs are now being exported.being exported.

Imports 2001-2005Imports 2001-2005Product group: 542 - Medicaments (including veterinary medicaments)Product group: 542 - Medicaments (including veterinary medicaments)

Product group: 541 - Medicinal and pharmaceutical products, other than Product group: 541 - Medicinal and pharmaceutical products, other than medicaments of group 542medicaments of group 542

Value Value 20012001 US$ '000 US$ '000

Value 2002Value 2002US$ '000US$ '000

Value 2003Value 2003US$ '000US$ '000

Value 2004Value 2004US$ '000US$ '000

Value 2005Value 2005US$ '000US$ '000

24,51824,518 128,259 128,259 154,605 154,605 151,26151,269 9

193,17193,174 4

Value 2001Value 2001 US$ '000 US$ '000

Value 2002Value 2002US$ '000US$ '000

Value 2003Value 2003US$ '000US$ '000

Value 2004Value 2004US$ '000US$ '000

Value 2005Value 2005US$ '000US$ '000

106,02106,020 0

95,863 95,863 119,23119,236 6

120,23120,238 8

141,35141,359 9

Exports 2001-2005 Exports 2001-2005

Product group: 542 - Medicaments (including veterinary medicaments)Product group: 542 - Medicaments (including veterinary medicaments)

Product group: 541 - Medicinal and pharmaceutical products, other than Product group: 541 - Medicinal and pharmaceutical products, other than medicaments of group 542medicaments of group 542

Value Value 20012001 US$ US$ '000 '000

Value 2002Value 2002US$ '000US$ '000

Value 2003Value 2003US$ '000US$ '000

Value 2004Value 2004US$ '000US$ '000

Value Value 20052005US$ '000US$ '000

33,815 33,815

35,066 35,066 41,642 41,642 46,691 46,691 57,146 57,146

Value Value 20012001 US$ US$ '000 '000

Value 2002Value 2002US$ '000US$ '000

Value 2003Value 2003US$ '000US$ '000

Value 2004Value 2004US$ '000US$ '000

Value 2005Value 2005US$ '000US$ '000

7,350 7,350 3,535 3,535 8,742 8,742 11,082 11,082 20,547 20,547


Category of local productionCategory of local production LinkagesLinkages PricingPricing GrowthGrowth Imports/ExportsImports/Exports

Role of GovernmentRole of Government The total outlay on the health sector is budgeted at Rs.38.0 The total outlay on the health sector is budgeted at Rs.38.0

billion, which increased by 15.8 percent in 2006 over last year.billion, which increased by 15.8 percent in 2006 over last year.

Government of Pakistan had invested Rs.8 billion in the Government of Pakistan had invested Rs.8 billion in the pharmaceutical industry since 1999 to guarantee good quality pharmaceutical industry since 1999 to guarantee good quality drugs at competitive prices. drugs at competitive prices.

Pakistan Health Ministry is considering to constitute a Pakistan Health Ministry is considering to constitute a committee comprising of the World Health Organization committee comprising of the World Health Organization (WHO), Pakistan Pharmaceutical Manufacturers Association (WHO), Pakistan Pharmaceutical Manufacturers Association (PPMA) and Health Ministry to keep check on the quality of (PPMA) and Health Ministry to keep check on the quality of drugs available in the market. According to statistics by drugs available in the market. According to statistics by Ministry of Health 41.2% of the Pakistani population cannot Ministry of Health 41.2% of the Pakistani population cannot afford procuring medicines due to high prices in the country.afford procuring medicines due to high prices in the country.

Role of Government (cont)Role of Government (cont) The government has set up an independent Drug The government has set up an independent Drug

Registration and Pricing Authority. In Pakistan the Ministry Registration and Pricing Authority. In Pakistan the Ministry of Industries decides about the drug pricing.of Industries decides about the drug pricing.

In the biotechnology sector, Pakistan has initiated many In the biotechnology sector, Pakistan has initiated many programs. It is planning to set up biotechnology plant worth programs. It is planning to set up biotechnology plant worth Rs.400 million to meet the growing needs of quality Rs.400 million to meet the growing needs of quality medicines in the country. medicines in the country.

The move is being taken in the field of medicine by the The move is being taken in the field of medicine by the private sector in collaboration with investors The plant private sector in collaboration with investors The plant would start production within the next few years. Several would start production within the next few years. Several countries have expressed keen interest to invest in countries have expressed keen interest to invest in Pakistan due to the pro-active policies of the government.Pakistan due to the pro-active policies of the government.

Role of Government (cont)Role of Government (cont)

While substantial increases in public sector spending have While substantial increases in public sector spending have been witnessed in recent years.been witnessed in recent years.

Some major public sector programs have been initiated to Some major public sector programs have been initiated to address the healthcare needs of the population. These address the healthcare needs of the population. These include:include:

The National Program for Family Planning and Primary Health CareThe National Program for Family Planning and Primary Health Care The Expanded Immunization ProgramThe Expanded Immunization Program National Program for Hepatitis Prevention and ControlNational Program for Hepatitis Prevention and Control National Tuberculosis Control ProgramNational Tuberculosis Control Program National Malaria control ProgramNational Malaria control Program National HIV/AIDS Control ProgramNational HIV/AIDS Control Program Women's Health Program.Women's Health Program.


The public sector health development expenditure The public sector health development expenditure increased from PKR 4.3 billion in 2003-04 to Rs.6 billion increased from PKR 4.3 billion in 2003-04 to Rs.6 billion in 2004-2005, and Rs.9.5 billion in 2005-06. While these in 2004-2005, and Rs.9.5 billion in 2005-06. While these increases are impressive in percentage terms (40% and increases are impressive in percentage terms (40% and 58% respectively), they remain low when placed in the 58% respectively), they remain low when placed in the context of the country's population size. context of the country's population size.

Tariff protection is generally allowed to encourage local Tariff protection is generally allowed to encourage local manufacture of APIs.manufacture of APIs.

Federal Government is working on the important subject Federal Government is working on the important subject of DRA and will make sure that it accommodates the of DRA and will make sure that it accommodates the expectations and objectives of the local pharmaceutical expectations and objectives of the local pharmaceutical industry without compromising on good standards industry without compromising on good standards


The government has also formed a policy recently The government has also formed a policy recently allowing companies to produce raw materials allowing companies to produce raw materials locally. Companies in Pakistan rely heavily on locally. Companies in Pakistan rely heavily on China, India, Germany, UK and Japan for raw China, India, Germany, UK and Japan for raw material imports.material imports.

The Ministry of Commerce has given 50% subsidy The Ministry of Commerce has given 50% subsidy to pharmaceutical companies for registration of to pharmaceutical companies for registration of their exported products in foreign countries for their exported products in foreign countries for export from 1998 to 2003. export from 1998 to 2003.

Health SectorHealth Sector The stockiest operates at 4-5% margins while The stockiest operates at 4-5% margins while

distributor's margins are around 10%. The margins distributor's margins are around 10%. The margins for retailers are fixed upon industry standards on for retailers are fixed upon industry standards on maximum retail price which can be 10-12%. maximum retail price which can be 10-12%. Retailers enjoy greater margins on drugs which Retailers enjoy greater margins on drugs which can be as high as 20%. There also exists provision can be as high as 20%. There also exists provision of free samples and cash discounts to channel of free samples and cash discounts to channel members by manufactures The margins vary for members by manufactures The margins vary for different participants in the supply chain. different participants in the supply chain.

Only 0.7 percent of the GDP is being allocated to Only 0.7 percent of the GDP is being allocated to the healthcare sector in Pakistanthe healthcare sector in Pakistan

Health Sector (cont)Health Sector (cont)

Some Major Causes of death in PakistanSome Major Causes of death in Pakistan

Infectious diseasesInfectious diseases MalariaMalaria TuberculosisTuberculosis Accidents, poisoning and violenceAccidents, poisoning and violence Heart and circulatory system diseasesHeart and circulatory system diseases DiabeticsDiabetics TumorsTumors

Health Sector (cont)Health Sector (cont)

Other Issues:Other Issues: Poor quality of available health services in both sectors.Poor quality of available health services in both sectors. High focus on curative, rather than preventive, health and medical care.High focus on curative, rather than preventive, health and medical care. Most facilities located in the urban areas.Most facilities located in the urban areas. Access to health and facilities determined by wealth and income.Access to health and facilities determined by wealth and income. Huge Private SectorHuge Private Sector Poor delivery of health services and no accountability.Poor delivery of health services and no accountability. Pakistan has Pakistan has 0.73 0.73 physicians per 1000 population and physicians per 1000 population and 0.310.31 nurses nurses

per 1000 population.per 1000 population.

The annual per capita expenditure on human priority areas of basic The annual per capita expenditure on human priority areas of basic education, primary health care, family planning , safe drinking water, and education, primary health care, family planning , safe drinking water, and nutrition programs is just $3 in Pakistan.nutrition programs is just $3 in Pakistan.

The total health expenditure on per person is approx The total health expenditure on per person is approx Rs.4.5.Rs.4.5.

Health PolicyHealth Policy

Ministry of Health along with Government of The Pakistan is Ministry of Health along with Government of The Pakistan is working on working on health policy 2010health policy 2010 for planned enhancements in for planned enhancements in overall health sector by the way of promoting and upgrading overall health sector by the way of promoting and upgrading healthcare facilities.healthcare facilities.

Features Of The policy are;Features Of The policy are;

1.1. to improve effective access to healthcareto improve effective access to healthcare 2.2. Reduction in communicable diseasesReduction in communicable diseases3.3. Good governance at both directorate and agency levelGood governance at both directorate and agency level

Drug Act 1976 Drug Act 1976

Another weakness of the National Medicine Policy is the lack of Another weakness of the National Medicine Policy is the lack of appropriate human base and expertise in the field of health and appropriate human base and expertise in the field of health and pharmaceutical policy. pharmaceutical policy.


Role of GovernmentRole of Government Health SectorHealth Sector Health PolicyHealth Policy

ProblemsProblems The pharmaceutical industry in Pakistan needs to The pharmaceutical industry in Pakistan needs to

catch up on the problems faced likecatch up on the problems faced like

#. Pricing of drugs#. Pricing of drugs#. Private public partnerships at government #. Private public partnerships at government ministriesministries

The Patent Ordinance, which has been brought to The Patent Ordinance, which has been brought to ensure intellectual property protection and data ensure intellectual property protection and data exclusivity as per the WTO norms has recognized exclusivity as per the WTO norms has recognized provisions for pre-grant opposition, compulsory provisions for pre-grant opposition, compulsory licensing etc.licensing etc.

There are 28,000 registered drugs in the country There are 28,000 registered drugs in the country of which 70% are unnecessary or harmful.(2005)of which 70% are unnecessary or harmful.(2005)

Counterfeit drugs Counterfeit drugs

Impact of WTOImpact of WTO Pakistan, on its part, signed the

contract in 1994. At that time, the industry standards did not comply with the WTO standards.

The WTO era brings about the law of the jungle where only the fittest shall survive – and IT will be a critical factor in determining that.

Impact of WTO (cont)Impact of WTO (cont) PatentsPatents

To comply with WTO standards the product should To comply with WTO standards the product should be patentedbe patented

PricesPricesIncreased competition lowers the price which Increased competition lowers the price which would result in low profitability for local would result in low profitability for local manufactures.manufactures.

Due to product patents rights new drugs could be Due to product patents rights new drugs could be unavailable or unaffordable.unavailable or unaffordable.

CompetitionCompetitionWhen there would be equal opportunity for other When there would be equal opportunity for other nations to trade their Pharmaceutical products in nations to trade their Pharmaceutical products in Pakistan. The competition in the local industry Pakistan. The competition in the local industry would rise. (India alone can attain 25% of the would rise. (India alone can attain 25% of the Pakistani Pharmaceutical market).Pakistani Pharmaceutical market).

Impact of WTO (cont)Impact of WTO (cont) Development of Health SectorDevelopment of Health Sector

Harmonization of standardsHarmonization of standardsGlobally recognized standards will become the Globally recognized standards will become the benchmark of the Pakistani Pharmaceutical benchmark of the Pakistani Pharmaceutical Industry, which would require intensive capital Industry, which would require intensive capital expenditure.expenditure.

TRIPS (TRIPS (Trade-Related Aspects of Intellectual Property RightsTrade-Related Aspects of Intellectual Property Rights) ) AgreementAgreement

The TRIPS agreement will push Pakistani The TRIPS agreement will push Pakistani companies out of the competition in the new companies out of the competition in the new high value generating products. Where high value generating products. Where Pakistani industry which is a generic Pakistani industry which is a generic manufacturing industry would not be able to manufacturing industry would not be able to bring generic copies of new products for at least bring generic copies of new products for at least ten years.ten years.

Impact of WTO (cont)Impact of WTO (cont)

Research & DevelopmentResearch & Development

Increase focus on patent rights Increase focus on patent rights will will force companies to come up force companies to come up with with newer better products which newer better products which would would require R&D require R&D

Local companies cannot justify Local companies cannot justify the cost the cost due to already high cost due to already high cost structure.structure.

Social ImpactsSocial Impacts With increased production of medicines, there are more With increased production of medicines, there are more

chances of aggressive marketing as chances of aggressive marketing as 70%70% of patients in of patients in Pakistan are treated with antibiotics, although the Pakistan are treated with antibiotics, although the majority of them don't need these medicines majority of them don't need these medicines

Medicine is also wasted due to incorrect dispensing Medicine is also wasted due to incorrect dispensing practices. practices.

There is no mechanism to monitor drug promotional There is no mechanism to monitor drug promotional campaigns.campaigns.

Drugs are freely available without prescription and a Drugs are freely available without prescription and a study in one of the districts showed that only 19% of the study in one of the districts showed that only 19% of the pharmacies meet the licensing requirement. pharmacies meet the licensing requirement.

Social Impacts (cont)Social Impacts (cont) Industry is only interested in producing profitable Industry is only interested in producing profitable

medicines and there is a severe shortage of medicines and there is a severe shortage of essential drugs in the country. essential drugs in the country.

Physicians are known to accept gifts . Only 35% of general practitioners consider it unethical to accept gifts from pharmaceutical companies

Irrational prescribing habits and prescriptions for costly drugs continue unchecked.

Poor consumer protection by the government.

Poor implementation to ethical codes of pharmaceutical promotion and poor implementation of Drug Act 1976 and the National Drug Policy 1999


ProblemsProblems Impact of WTOImpact of WTO Social ImpactsSocial Impacts

RecommendationsRecommendations Initiatives for business opportunities:Initiatives for business opportunities:

#. API business#. API business#. Research based products#. Research based products#. Generics#. Generics#. Pharmacists role in community#. Pharmacists role in community#. Strategic alliances for exports#. Strategic alliances for exports#. Diversification of Pakistan local companies#. Diversification of Pakistan local companies

In all these initiatives, India can take a leading role In all these initiatives, India can take a leading role to assist in developing pharma market of Pakistan.to assist in developing pharma market of Pakistan.

Recommendations (cont)Recommendations (cont) Other than just producing more medicines, the Other than just producing more medicines, the

government needs some decisive actions to government needs some decisive actions to promote public health and wellness through promote public health and wellness through education and information. education and information.

An approach to establish a balance between An approach to establish a balance between economic interests and public health objectives is economic interests and public health objectives is required. The government should focus on how the required. The government should focus on how the innovative capacity of the industry can be increased innovative capacity of the industry can be increased without compromising on public health. without compromising on public health.

The need is now unavoidable to create awareness The need is now unavoidable to create awareness among lawmakers, healthcare professionals, and among lawmakers, healthcare professionals, and economic managers and among concerned citizens. economic managers and among concerned citizens. Without these steps the objectives of equity, access, Without these steps the objectives of equity, access, safety and affordability seem hard to be fulfilled safety and affordability seem hard to be fulfilled

Recommendations (cont)Recommendations (cont) Existing evidence indicates a need to equip physicians-in-training

to handle interactions with the industry.

The need to introduce early and ongoing trainings in ethical concepts, moral reasoning and development of skills necessary to address these issues.

Registering and regulating authorities in Pakistan have must ensure inclusion of the existing Code of Ethics in undergraduate and postgraduate curricula and should regulate industry collaboration with teaching institutes; developments that are necessary to raise the standard of clinical practice and improve patient welfare.

Right to live is the most basic human right

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