Beirut, The Fear City of the Middle East ( LPSA, Lebanon

BEIRUT, THE FEAR CITY OF THE MIDDLE EAST WRITTEN BY: CALINE J. SAADE LPSA, LEBANON

You have most likely seen and heard of enumerated atrocities in Lebanon across widespread news outlets for the past couple of years; it would almost seem unusual if Lebanon was not headlining international news coverage. Lebanon has long been and currently is in a state of absolute chaos attributed to an incompetent ruling class, the peak of inflation rates, the devaluation of our currency (the Lebanese Lira), the Coronavirus pandemic, and following the Beirut explosion. This hasn't only rendered around 55% of the population under the poverty line according to UNESCWA (2021), but it has also prohibited the general population of its fundamental human rights, one of which is directly related to the pharmaceutical field; access to services and individualised medication.

The Pharmaceutical industry has always been of utmost importance yet is subjected to the highest levels of threat due to the gaps it faces.

Due to the general population's increasingly restricted purchasing power (even before the rising rates of poverty) and due to the overpriced physician consultations, citizens have always consulted pharmacists free of charge for counselling, guidance or even diagnosis; which defies our regulations and policies as pharmacists. Unfortunately, Pharmacists are still not recognized as an integral part of the health care body; mostly by other healthcare professionals

Currently, the two most crucial healthcare challenges in Lebanon are, acute shortage of medications (both branded and generic types), and smuggling of medication. Smuggled medication could also be counterfeit, thus making the situation worse.

When tackling the former, according to the Medicine Importers Syndicate, Lebanon imports around 80% of its medicines. These are generally subsidised by the Central Bank rendering them somewhat still affordable amid inflation. However, the fear of an increase in pricing in the near future and lack of medication has prompted citizens to purchase their medicines at a more-than-needed basis. Unfortunately, Lebanese community pharmacies are not equipped with patient profiles and are subsequently unable to control patient purchases to maintain fairness in supply. Medication shortage is extremely concerning particularly in the case of chronically ill individuals (Diabetes, Cancer, Hypercholesterolemia, Cardiovascular Disease Patients…) since they find themselves unable to purchase neither their preferred medication nor a substitute. This would only exacerbate their medical condition, alter their functionality, worsen their quality of life and boost rates of morbidity and mortality.

Regarding the latter, Fraud has been on the rise especially due to medication shortage. Counterfeiting attempts most commonly target high demand and expensive medication as chemotherapeutic drugs, antibiotics and vaccines to name a few. Counterfeit medications are relatively cheaper than genuine medications, all while deceptively seeming legitimate to users due to similar packaging and labelling as genuine products. Therefore, patients trust the wrong suppliers which could lead to serious consequences. Smuggling of genuine drugs also would lead to an increase in the artificial demand for medication further worsening drug shortages.

Both the Pharmacists and the Patients are as affected by the issues mentioned above. The Pharmacy profession has been losing its integrity and credibility attributed to the lack of products and services which has led to the closure of many pharmacies or has left pharmacies with little to no profit. As for patients, the failure to optimise treatment regimens based on what is deemed most suitable for them has increased hospitalisation rates, morbidity and mortality.

On a brighter note, promising initiatives have unfolded to help make living circumstances slightly more bearable. Non-Governmental Organisations have played a very important role in satisfying the needs of the less privileged despite the limited funding they receive. These include Dawrati (Fighting Period Poverty), Relief International (Poverty Alleviation), Paracetamour and Lebanon Al Akhdar-نﺎﻨﺒﻟ ﺮﻀﺧﻷا) Medical Relief) and others. In addition, Social Justice advocates have been of great help; spreading awareness and cases on their platforms and calling for action. As for the fight against counterfeit drugs, a newfound independent drug control laboratory is currently under study by the National Association for Social Health and the Academic Health Association in order to maintain medication uniformity and to decrease the rates of fraud and subsequent harm and hazard. In addition, the Ministry of Public Health has been working closely with the Order of Pharmacists in Lebanon (OPL) to secure a wide range of Generic drugs that are considerably more cost effective for both parties; the Pharmacists and the Patients. The OPL has also set a theoretical plan and a Memorandum of understanding regarding the establishment of electronic platforms such as an electronic patient profile with medication safety and management all while maintaining pharmacovigilance standards.

In conclusion, paving the way for reform in Lebanon requires far more than a theoretical approach. Implementation using adequate allocation of resources is necessary for the best possible outcome. A collective and genuine effort by the government first, as well as. The healthcare personnel and general population is required to uphold the standards and virtues of the pharmaceutical industry.

References:

1. ACT alliance alert: Lebanon crisis, 16 march 2021 - Lebanon. Reliefweb.int. Accessed July 5, 2021. https://reliefweb.int/report/lebanon/act-alliance-alert-lebanon-crisis-16- march-2021 2. Sacre H, Hallit S, Hajj A, Zeenny RM, Sili G, Salameh P. The pharmacy profession in a developing country: Challenges and suggested governance solutions in Lebanon. J Res Pharm Pract. 2019;8(2):39-44. 3. Everything you need to know about human rights in Lebanon. Amnesty.org. Accessed July 5, 2021. https://www.amnesty.org/en/countries/middle-east-and-north africa/lebanon/report-lebanon/