The lack of medicines in Brazil is chronic and is not restricted to the public network. But sanitary doctor Walter Cintra, professor at Eaesp (São Paulo School of Business Administration) at FGV, member of FGVsaúde, recalls that poor people and blacks suffer more from the lack of medication. “The first impact is on the underprivileged, who suffer first, live less and die more”, he says.
Increasing domestic production, planning purchases and spending money more efficiently, better monitoring stocks, implementing public policies and a strategic vision would be the solution to the problem, according to the specialist. Cintra talked to the reporter about the subject and commented on his expectations for the government of Luiz Inácio Lula da Silva (PT) in the area.
Why drug shortages are a chronic problem Brazil? You have a basic SUS problem [Sistema Único de Saúde] that we never get tired of talking about. We have an underfunded system and it’s not just for drugs, but for everything. If you take the universal system, like the English one, it spends on average the equivalent of US$ 4,000 per head/year [R$ 20.868,40 em 29/12/2022]. In Brazil, we spend US$ 1,500 on health. If you look at what actually goes into public service, it’s less than half of that. The medicine, in particular, also depends on a good definition of the list, which are available.
There needs to be a public policy to ensure that we have sovereignty over the production chain for medicines and basic health supplies. “Ah, but importing is cheaper than producing here”. I’m not saying that we have to do everything at home, but that we need a strategic view of the health system and know what we have at home, even if eventually I will pay more for one or another item.
Is the lack of strategic vision also the reason when the lack of medicine affects the private network? Sure! What I said is not just for public service. You have drugs that have stopped being produced or are being produced on a much smaller scale, because they are no longer interesting from the point of view of revenue for pharmaceutical companies. If you look at the pharmaceutical market, today the concern is with rare diseases and biological drugs, which are very expensive. We have to think about structuring the Brazilian health legislation to guarantee the proper functioning of health, even in the private system. Public policies are not just for the SUS, they should also serve the private network.
How can laboratories help to at least minimize the lack of medicines?
It is necessary to have a clear policy, a State policy and not a government one, in relation to the manufacturers and distributors of medicines and other health inputs. Otherwise it is barbarism.
This policy must be transparent to society as a whole. A policy that guarantees equitable access to medicines and supplies, that prevents abuse on the one hand and that, on the other hand, guarantees the survival of actors in the production and distribution chain. Laboratories that only aim at profit without understanding their social role in health are not in Brazil’s interest. When there is no agreement, the state has coercive mechanisms that can and must be applied, always in a legal, impersonal manner, within morality and with due publicity and transparency.
What is the impact of the lack of medicines on society?
In one of the most unequal countries in the world, the impact begins with the poor and black people, who are the ones who suffer most from the lack of public policies. One of the principles of the SUS is to guarantee to the underprivileged —for reasons that are not justified— that these people have the same type of access as those with more resources. So, the first impact is on the underprivileged, those who suffer first, live less and die more. Evidently, the whole society will suffer. Whoever has more resources to import a medicine will suffer less.
There is a solution to the lack of medicines in the Brazil?
Yes. Increase national production. It needs to have adequate funding for the health system. Plan purchases and money spending more efficiently, monitor stocks, implement public policies and strategic planning vision based on the health needs of the population. These are general prescriptions that serve both the public and private sectors.
The health sector lacks strong regulation that, on the one hand, ensures that the population is not left unattended and, on the other hand, that there is stability and security in contracts. For example, it is not possible that the private or public system has to cover each and every new medicine or therapeutic procedure that is invented. The SUS and the Supplementary System must have defined the coverage of services, medications, etc.
The lack of medicines specifically has to do with good management of purchases, stocks, distribution and supply, but it also has to do with the production chain and its dependence on imported inputs. That is why it is necessary to have a strategic vision in the elaboration of public policies and not just an economistic vision. If we run out of inputs in the drug production chain, the public and private sectors will suffer. A public policy that subsidizes and/or finances certain links in the production chain can protect the market and the population from shortages.
It is also necessary to have structure in the Ministry of Health. The information structure of the Ministry of Health was destroyed [na gestão Bolsonaro]. We are very concerned about the return of diseases like polio. If that happens, it will be a catastrophe for the country.
What can we expect from the Lula administration regarding the issue of medicines?
The year 2023 will be very difficult for the government and nobody has any doubts about that. These budget issues are daunting, given the annual budget bill that this last government passed to Congress, where, for example, the Popular Pharmacy was practically extinct, due to the resources they left there.
We hope that there will be a recovery. The problem is that the destruction was too great. It will certainly be a government that is much more sensitive to health and social issues than the government of the president who simulated shortness of breath and mocked the patient with Covid.
I have over 8 years of experience in the news industry. I have worked for various news websites and have also written for a few news agencies. I mostly cover healthcare news, but I am also interested in other topics such as politics, business, and entertainment. In my free time, I enjoy writing fiction and spending time with my family and friends.