KARACHI: The Russia-Ukraine war has put Pakistan’s healthcare system under a test of another kind, as the import of inexpensive medicines for cancer treatment from Russia has come to a halt since the conflict began.

This has heaped misery on thousands of patients and their families, mostly belonging to the middle and lower-middle classes, according to sources in the industry and medical management professionals.

They said the import of inexpensive cancer medicines and advanced treatment packages from Russia to Pakistan was suspended after the invasion of Ukraine on Feb 24 as Pakistani banks stopped opening Letters of Credit (LCs) for trade.

The packages include monoclonal antibodies (MABs), a targeted drug therapy to treat different cancers.

Cancer patients have to resort to smuggled, unregistered drugs due to unavailability of inexpensive treatments

Due to the halt in the supply of inexpensive medicine, health professionals said, thousands of patients are in distress and unable to continue their treatment.

“We don’t know what the solution is, but what we do know is that there is an overwhelming demand for such medicines from public and private hospitals, rural and urban health facilities and hundreds of families of cancer patients,” said an importer.

“We have conveyed our concerns to the people at the top, but they seem helpless. The government has to step in. It’s not only about business; human lives are at stake, as thousands of patients rely on cost-effective Russian products.”

The unavailability of cheap medicines from Russia also offers certain quarters a golden opportunity to “exploit the situation”, insiders say.

“MABs offer an effective treatment for different kinds of cancer, but since alternative products imported from western Europe have a higher price tag, people are forced to use cheap but illegal and ineffective drugs from India and Bangladesh,” said Dr Muhammad Asghar, an oncologist at the Karachi Institute of Radiotherapy and Nuclear Medicine (Kiran), one of the largest cancer treatment facilities under the administrative control of the Pakistan Atomic Energy Commission.

He said the Drug Regulatory Authority of Pakistan (Drap) should ensure the provision of registered cancer medicines, mainly biosimilar drugs from Russia.

“Most Pakistani cancer patients can’t afford the expensive, next-generation medicines being marketed by multinational pharmaceutical companies,” said Dr Asghar.

Senior health professionals from leading public and private hospitals in different parts of the country confirmed that a number of cancer drugs, including chemotherapy medicines — including those sourced from Russian ally Belarus — have stopped arriving in Pakistan for the last couple of months.

This has forced patients to either buy expensive chemotherapy drugs offered by multinational companies or switch to smuggled, unregistered medicines.

They recalled that MABs like Trastuzumab, Rituximab and Bevacizumab — all from Russia — were being sold at half the price set by Drap under its maximum retail price (MRP) mechanism.

But after supplies from Russia are suspended, they fear multinational companies will raise their prices exorbitantly.

‘Ineffective’ alternatives

“Physicians and patients have no other option now but to use smuggled Indian cancer treatment packages. The federal government and Drap should treat this matter seriously and ensure the availability of cheap medicines for thousands of cancer patients across the country,” said an oncologist from Lahore’s Mayo Hospital.

“Due to the high cost of next-generation cancer medicines and equipment produced by American and European pharmaceutical companies, Pakistani authorities should collaborate with countries like Russia, Belarus, Cuba and Iran. These countries are fairly advanced in the field of biotechnology and produce inexpensive medicines and therapies.”

Hundreds of patients using inexpensive cancer drugs, including MABs as well as chemotherapy drugs to treat breast cancer, lymphoma, leukaemia, and gastric and lung cancers, are suffering due to the suspension of trade with Russia.

According to oncologists, MABs offer a type of targeted drug therapy that recognises and finds specific proteins on cancer cells. There are various MABs to treat cancer and they work in different ways.

“Monoclonal antibodies can trigger an immune system response that can destroy the outer wall (membrane) of a cancer cell. This blocks the growth of a cell. Some monoclonal antibodies block the connection between a cancer cell and proteins that promote cell development — an activity that is necessary for cancer growth and survival,” said Dr Khurram Ahmed, an oncologist.

Financial burden

Anas Rehman, whose 54-year-old mother was suffering from breast cancer, is personally witnessing the impact on both sides — the quality of treatment and financial burden.

“Since March, I have been spending Rs14,000 extra on medicines for my mother every month,” he said. “These Russian medicines were introduced several years ago. Before that, only certain companies and multinational pharmaceuticals had the privilege of distributing these particular medicines.”

However, the entry of Russian medicines forced these old players to reduce prices in the face of competition, though they were still expensive, he said. “If the situation persists and these companies start feeling that the competition is over, they will definitely raise the prices again.”

Published in Dawn, May 10th, 2022