MEXICO CITY — Mexico’s president is inaugurating a “super pharmacy” in a bid to end the woes of patients throughout the country who are often told they need a specific medicine – but the hospital in question doesn’t have it.
President Andrés Manuel López Obrador’s solution was to outfit a big warehouse on the outskirts of Mexico City to centralize a supply and send it to hospitals throughout the country.
“The pharmacy is going to be big, big, big, and it is going to have all the medications that are used in the heath system,” López Obrador said Friday.
The idea is that a hospital in rural Mexico can put in an order for a certain medication, which will be stored at the huge 430,000 square-foot (40,000 square meter) Mexico City warehouse. The armed forces, or the government-run pharmaceutical company Birmex, will then ship the drugs out by land, sea or air “within 24 to 48 hours,” López Obrador pledged.
The question is whether Mexico can overcome its history of being bad at regulating the pharmaceutical industry, bad at buying medicines, bad at storing them, and bad at distributing them. Extreme centralization also hasn’t helped Mexico much in the past in many areas.
The most visible face of this problem are the parents of children with cancer, who frequently stage protests because they say that in recent years chemotherapy and other drugs have been impossible to obtain.
Desperate parents blocked traffic at the Mexico City airport last year, holding up a banner reading: “There isn’t any chemotherapy, treatment or medicines, have some empathy and sensitivity.”
The problems have killed otherwise healthy people. Because Mexico has had problems in obtaining enough morphine, anesthesiologists in Mexico have had to carry around their own vials of the sedative, drawing multiple doses out of a single vial for routine procedures like spinal blocks during births.
In the United States, where there is no shortage of morphine, doctors are advised to draw a single dose from a vial and throw the remainder out. But Mexico can’t do that. That has led to contamination of the vials, leading to outbreaks of injection-induced meningitis in two Mexican states that have killed dozens of people, some of them Americans who sought treatment at clinics in the border city of Matamoros, across from Brownsville, Texas.
To López Obrador’s credit, he mounted a major effort to obtain COVID vaccines in 2021, using the armed forces to distribute them and volunteers to help apply them, and by the end of that year just about anybody in Mexico who wanted a vaccine got one, for free.
But trying to replicate that model of centralized government purchasing and army distribution on a national scale for thousands of medications is not the same, according to Mauricio Rodríguez, a professor at the School of Medicine at Mexico’s National Autonomous University.
“This is crazy,” said Rodríguez, noting the government is opening the centralized warehouse without answering how the system will operate, especially for urgently-needed medications. He noted that concentrating all the drugs at one site increases risks, and could sideline some already-existing distribution systems.
Many of the problems pre-date López Obrador, who took office in late 2018. For decades, there have been scandals involving of millions of dollars worth of medicines going out-of-date at warehouses while hospitals couldn’t get them.
The country’s medicine regulatory agency, known by its Spanish acronym as Cofepris, was already so riddled with corruption prior to López Obrador that regulators would hide applications for approval of new medicines for years, and demand bribes to approve them.
And with alarming frequency, regulators in Mexico send out alerts about falsified or knock-off medications being sold for treating everything from cancer to heart disease. Boxes, labels, vials and certifications are copied with amazing accuracy, but the bottles often contain little or none of the medication.
The fake medicine trade is so common, and so lucrative in Mexico because patients or their relatives are often told by doctors to buy medications at private drug stores when they are unavailable at government hospitals.
The civic group “Zero Shortages” said there was an increase of 142% in the number of alerts about falsified medicines between 2021 and 2022.
But part of the problems are of López Obrador’s own making. Angry at what he claimed were inflated profits made by drug distributors and importers, the president simply cut the private companies out and decided the government should directly buy all medications.
Because the government did not have much infrastructure, contacts or experience in such a massive effort, López Obrador signed an agreement with the World Health Organization to help Mexico in purchasing. But even with that help, Mexico was unable to obtain some specialized medication, something López Obrador blamed on sabotage by pharmaceutical firms.
Rafael Gual, the director of the National Pharmaceutical Industry Chamber, said the government’s own actions created “bottlenecks” in distribution.
According to the group “Zero Shortages,” the number of prescriptions that went unfilled in Mexico rose from 1.5 million in 2019 to 22 million in 2021; disruptions due to the COVID pandemic probably also played a role.
But even in 2022, there were still about 12.5 million prescriptions that went unfilled.
Dr. José Moya, the Mexico representative of the WHO, said centralized medical warehouses can be a solution, but the key is to have a good logistical system.
“If they are considering a warehouse like this, it’s because there is a need,” Moya said, “and this has to be very well organized.”