By Kathleen Bohné
Below you will find an excerpt from the Mar. 20 edition of “La Semana” newsletter. To read the full article and subscribe, please visit www.themexpatriate.com.
“If the pandemic doesn’t kill them, the medicine shortages will.”
This was written on a sign held by a parent protesting the lack of chemotherapy in May 2020, a few months into the COVID-19 lockdowns in Mexico. The protests have continued ever since.
“What is the magnitude of the shortages? In truth, this is a difficult question to answer,” according to Xavier Tello in his book “La Tragedia del Desabasto”. “The complexity of the response is caused by the inconsistency in how supplies have been procured in the last three years.” Sifting through the morass of data, “much like archaeologists excavating”, is how analysts have tried to gather precise numbers.
“The number of different agencies, methods and data make it difficult to establish tracking mechanisms that would help in the timely identification of issues affecting access to drugs and other medical supplies,” note researchers in the report “Radiografía del Desabasto” by Colectivo Cero Desabasto and Nosotrxs. Based on their extensive research, they conclude that 9.7% of prescriptions issued by public health institutions (24 million total) were unfilled because of the shortages in 2021.
As a reference, only 1.4% of prescriptions were recorded as unfilled in 2017, and the biggest annual increase happened between 2019-20 (2.7% to 7.7% unfilled). While 9.7% may seem an insignificant number, its effects on the population have been deeply felt. Every medicine unavailable at a public pharmacy has either had to be purchased at a private one out of pocket, not obtained or administered at all, or even purchased on the black market. Reported sales of fake or stolen drugs have gone up by 137% since 2017 according to COFEPRIS (the Mexican FDA equivalent).
In addition to the unfilled prescriptions, doctors at public hospitals have been frustrated in their efforts to treat patients by not having access to essential drugs, devices or supplies. Some find themselves in a grotesque bureaucratic labyrinth: according to the administration’s most recent legislation, all public healthcare must be provided free of charge and the law prohibits obtaining certain prescription medicines or other medical supplies via private pharmacies or vendors. This used to be a last resort available to patients and healthcare providers if the public institution could not provide for their needs.
Who has been most affected by these public health failures? Lower and middle-class Mexicans who rely on the public healthcare system and particularly those with chronic illnesses. The most dramatic proportional increase in out-of-pocket medication expenses was experienced by the poorest segment of the population (92.8% increase from 2018-20 according to the Center for Economic and Budgetary Research, CIEP).
The patients most impacted in 2021 by drug shortages were those with cancer, diabetes, organ transplants, hypertension and neurological/mental illness. Residents of Mexico City, Estado de México, Jalisco and Michoacán have registered the highest number of reports of shortages on the Cero Desabasto platform, but institutional complaints have been logged all over the country, in both urban centers and rural areas.
While shortages have also been reported in the private sector, they have been more occasional than chronic. Private pharmacies may at times have been out of stock of certain medications that patients suddenly couldn’t get at public pharmacies, and of course, they have not been immune to the supply chain disruptions caused by the COVID-19 pandemic.
In the face of the obfuscation and disinterest on the part of the administration regarding the “desabasto”—after all, AMLO notoriously has claimed to have “otros datos” (other data) when confronted with unflattering statistics—the challenge of documenting, researching and addressing the needs of those affected has been taken up by NGOs.
Colectivo Cero Desabasto is made up of 81 organizations “all committed to the idea that together we can achieve more and are concerned by the situation faced by the most vulnerable patients,” notes an article in Nexos about the efforts of civil society. “We cannot forget that…there is a story of pain, desperation and systematic lack of access to healthcare behind every report, every figure and every unfilled prescription: interrupted treatment, lack of medical supplies and the problems to which anyone who has had to go to a public health institution in Mexico can attest.”
For the 2019-20 reports compiled by Cero Desabasto, the organization filed 360 requests for information from over 200 public health and human rights institutions. Their efforts have provided a map, showing the patterns of the landscape many doctors, patients and families have been navigating without any guidance. While this organization focuses on collecting citizen reports on shortages and analyzing data, others are focused on providing legal counsel for those filing injunctions against the government, and there are those that have been supporting certain vulnerable populations for years—such as Nariz Roja, A.C., which provides resources for cancer patients—which now raise funds to purchase medicines.The government narrative has been tweaked to address some of the public indignation over the past two years, particularly after Deputy Secretary Hugo López-Gatell’s cringe-worthy remarks in an interview in June 2021: blaming a “golpista” (coup-seeking) movement for hoodwinking Mexicans into believing the parents of children with cancer who have denounced the shortages, and alluding to a “right-wing” conspiracy behind it…
