National drug policy

In 1996 a comprehensive national drug policy was drafted that included the objective of increased local production and procurement of essential medicines (Mirza, 1996). This policy was opposed by the pharmaceutical industry, and the upshot was that the initiative largely failed (Mirza, 1996). In 1997 another drug policy was announced. According to critics, it had an industry bias and was full of ambitious, incoherent and non-committal plans (Tahirkheli, 2006; The Network, 1998). It did not address difficult tradeoffs and competing interests, such as reconciling the promotion of exports with the rational use of drugs. There is also little evidence that policy makers have since made any serious attempt—or have the capability—to tackle such issues. The current national drug policy, which claims to be a draft to meet the challenges of the medicines sector, is available on the Ministry of Health website. A more comprehensive drug policy and more effective implementation are clearly required (Tahirkheli, 2006).

The government does support the drug industry, for reasons of economic development. In 2007 the import duty on pharmaceutical products was reduced, but manufacturers did not lower prices in response. Moreover, one of the challenges for pharmaceutical production for exports is the nonavailability of a bioequivalence test laboratory (Anon, 2011; Yasir, 2007). Many potential export markets will no longer accept generic medicines that cannot present bioavailability and bioequivalence certificates (TRTA, 2007).

There is tension between support for industry growth and national medicines policies in most countries. In developed countries, however, such issues are widely debated and the trade-offs are well understood. But in Pakistan there is little academic and scholarly research on such problems, and industrial achievements are too often considered a panacea. This approach is evident when the Pakistan government disregards environmental destruction in favour of production as a source of revenue and jobs. Industrial growth is then viewed as a means of generating resources for the health sector. But there is little evidence that financial earnings have been properly used for better healthcare. While the country's GDP has risen, Pakistan in 2010 spent a mere 0.7 per cent of its budget on health (Perera,

2010). The pharmaceutical industry claims to manufacture a wide range of research-based medicines (Mooraj, 2005), but its research capacity is insignificant (Babar et al., 2011). As noted, most raw materials are imported and the industry is mostly producing finished products. Despite the rhetoric, in 2006 the pharmaceutical industry's share of Pakistan's exports was a mere 0.34 per cent (Export Promotion Bureau, 2007).

Developed countries such as Japan, Germany, Switzerland and the UK have created enormous wealth from the pharmaceutical industry through innovation, while maintaining a strong emphasis on access and affordability. In the UK, drug companies have to invest in research and development (R&D) proportionate to their revenues, but in Pakistan there is little regulation or monitoring of how much the industry is spending on drug promotion versus R&D. Another example of the weakness of Pakistan's national medicine policy is the lack of skilled human resources and expertise in the field of health and pharmaceutical policy. For example, the former Pricing Board of the Ministry of Health did not include a health economist (Drug Control Organization, 2008).

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