The Parliamentary Series of The Phoenix Daily

Yara Dally, Contributor

June 7th, 2021

The Parliamentary Series of The Phoenix Daily is an exclusive series of interviews and discussions with current, former, or prospective members of the Lebanese Chamber of Deputies in an attempt to directly bring transparency, accountability, yet also knowledge from the Parliament to the eyes of the general public.

On June 5th, 2021, The Phoenix Daily met exclusively with his honorable the head of the Parliament's health committee, MP Assem Araji, for an interview. The interview encompasses discussions exclusive to The Phoenix Daily around the health sector - mainly the medical crisis and the COVID-19 situation in Lebanon.

The Medicine Shortage

The Subsidy Program

 Lebanon is currently dealing with many overlapping crises, foreign currency shortages, and the devaluation of the Lebanese Pound, all of which have had disastrous implications on the country. According to the World Bank’s most recent “Lebanon Economic Monitor” (LEM), Lebanon’s economic and financial crisis could rank as one of the three most severe that the world has seen ever since the mid-19th century. At a national level, a shortage of dollars means that you cannot buy nor acquire importations. The Central Bank of Lebanon had been subsidizing the purchase of essential importations, including medicine, but now, the government is trying to raise $1.3 billion in order to be able to fund medical importations: from medicine, and medical supplies, to infant milk, and raw materials for the pharmaceutical industry. As of now, hospitals are running short on medicines, which led to the cancelation of non-urgent surgeries: the situation is getting worst by the day. 

 

According to Dr. Assem Araji - head of the Parliament’s health committee, the current subsidies program adopted by the Lebanese government is a huge failure: Banque Du Liban had been subsidizing imports at a monthly cost of $500 million – which tallies to a stunning $6 billion annually. By doing so, Lebanon was the country with the most affordable medicines in the entire region. Consequently, subsidized medicine was and still is being smuggled outside of Lebanon to Egypt, Kuwait, Libya, Syria, Turkey and making its way to far-away countries such as the Democratic Republic of Congo, all for higher profits. 

However, the Ministry of Public Health and the Parliamentary’s Health Committee were both against this entire program in the first place. It should have only targeted families in need, by providing them with a monthly payment of $200, whereby they would have had the liberty to purchase whatever would satisfy their needs, depending on their priorities. For instance, as reported by the Ministry of Social Affairs, 800 families are currently in need of a subsidy program, tallying to a total of $160 thousand a month ($200 per family) and around $2 million annually: As long as keeping on subsidizing the medication supply in all cases, as it’s a necessity. That’s a 68% decrease in the monthly cost for the whole BDL’s medical subsidies added Araji.

 

The Central Bank of Lebanon VS. the Medical Importers

When looking at the statistics and figures, in 2020, the total amount of foreign currency that was sold to banks by the Central Bank of Lebanon at the official exchange rate in order to fund medical imports such as medicine, medical supplies, infant milk, and raw materials for the pharmaceutical industry stands at $1173 million. However, the total amount of medical imports between January and May of 2021 accounts for $1310 million: an increase of 11.67% is seen and this is only as a result of the first five months of the year. 

 

To a certain extent, the differences in the amount of money could be due to inflated bills presented by medical suppliers in order to take advantage of the current situation in Lebanon -either to transfer fresh dollars abroad or to stockpile the medicines in order to be able to sell them at higher prices. Additionally, in some cases, medical supplies are being sold at a parallel market rate (in other words, the rate of the black market), which had hit 13 000 Lebanese Pounds to the dollar most recently: rather than selling 85% of the supplies’ cost at 1,515 pounds to the dollar and the rest 15% at 3,900 pounds to the dollar as required, stressed the head of the Parliamentary’s Health Committee.

Medical suppliers argue that BDL had only supplied them with foreign currency for importation in 2020, yet with only 10 to 11% of the amount of dollars required for importation in 2021. The latter negates what was formerly mentioned, added Araji. 

The Central Bank of Lebanon is raising questions about the accuracy of medical importers’ numbers and data; thus, an investigation committee saw the light of day in order to inspect and compare the numbers of both parties, continued Dr. Assem.

 

Medicines and supplies seized in importers’ warehouses account for 70% of the market’s need, including 87 medicines for cancerous and incurable diseases. The immediate solution is to release them as a result of the state’s decision and to distribute them to pharmacies and preserve the rights of importers after verifying the validity of their bills and coming up with a compromise with the Banque du Liban, who would promise to pay the subsidy later on. This matter will be discussed in the upcoming meeting on Tuesday, June, 8th where medical importers will present all their bills in order for them to be compared to BDL’s data, expressed Araji.

Of course, the Banque du Liban is still delaying their acceptance to fund the medical importations, following the mismatch between the data at hand and the medical importers’ ones. Nonetheless, we cannot deny the greediness of the importers: for instance, in the latest years, they earned 300% in profit from selling medical supplies, emphasized Dr. Assem.

 

The Central Bank of Lebanon is unable to cover the cost of the subsidies medication supply, unless there is a dipping in the mandatory reserves

The Ministry of Public Health and the Parliamentary’s Health Committee had asked the Central Bank of Lebanon to provide them with the maximum amount possible in order to cover the cost of medical subsidies monthly. Based on the amount, a list of priorities would be set, including antihypertensive and debilitating drugs, as well as drugs for diabetes and chronic disease. As well, it is important to have serums, anesthetics, and anything that is essential to ensure a successful operation or surgery, highlighted Dr. Araji. It’s worth mentioning that some medical supplies are subsidized and imported above the required needs by the health sector, which denotes the avidity of the importers as well. 

 

Lebanese Caretaker and Prime Minister Hassan Diab and his government had failed to meet and reach a decision regarding the rationing of the subsidy program. It’s said that rationing the subsidy program is not negotiable before implementing the ration cards for Lebanon’s poorest families. However, the source for financing these cards is not yet clear. The International community including the IMF and the World Bank are not willing to give a penny to Lebanon without forming a non-political and non-partisan government with competent individuals, aside from implementing the needed reforms. “We live in a vicious circle”, said MP Assem Araji.

 

The head of the Parliamentary Health Committee highlighted that the doctors’ sit-in that took place on Saturday, June 5th, 2021 as a result of them not paying their full earnings for a year and a half is one of the repercussions of the Lebanese Pound’s collapse, waste, and corruption. And, inevitably, it will lead to more collapses that will land on top of the health services, and we will be facing a very big dilemma. International institutions must provide support to the sector in order to save it, especially since it must bear a great deal, given the Syrian displacement. 

 

Lebanon is not only facing arduous challenges when it comes to medication supply, but also, brain drain is becoming more and more frequent among doctors in the country.  

30% of the subsidized medicine is consumed by the Syrian refugees. In Dr. Assem’s opinion, the international community must be the one responsible for the Syrian refugees, at least with everything concerning the health sector, given the multiple crises that the country is currently facing. 

 

What’s next for the medicine shortage?

Two plans are available and could be implemented. In the long-run, the government should approve the Medication/Drug Law, which is one of the most important laws that was proposed over the years, as mentioned by Dr. Assem Araji. This law would specify everything related to the importation of the medication, the local production of medicines, a National Central Laboratory for drug testing and so on.  

 

In Lebanon, 7 to 11% is the overall consumption of locally produced medication from 11 different manufacturers. The Ministry of Public Health and the Parliamentary Health Committee had demanded from the Banque du Liban to support local drugs manufacturers by granting them around $100 million instead of $30-$40 million: this would cover at least 40% of the general consumption.

In the short term, any plan implemented without tighter border controls and restrictive screening measures would be a failure. The state should control the voraciousness of the importers by enforcing regulations and restrictions.

 

The COVID-19 Situation

At present, the number of COVID-19 cases has immensely decreased and this hasn’t been witnessed in months: local positivity is around 2%, and it is relative to the number of PCR tests that are done daily. A substantial percentage of the population has developed some antibodies to the virus, and a vaccine program is currently ongoing. We are witnessing several closings of COVID ICUs, the number of used ventilators is minimal, and Oman and France removed Lebanon from the red zone regarding the Corona Virus Pandemic. Despite that, precautions and social distancing should still be implemented until at least October, as per Araji’s belief. Around 10% of the Lebanese population has taken the first shot of the COVID-19 vaccine, and around 8% has taken the second dose as well. As of June 4th, 2021, Lebanon is ranked 80 among 207 countries concerning its vaccination program. 

New Vaccine patches are coming our way: previously we had received an average of 40 000 doses of the Pfizer vaccine and meanwhile, we are awaiting an additional 170 000 doses of the same vaccine. As well, the Privation Institutions that are giving the vaccine are working closely in coordination with the Ministry of Public Health. 

Five universities have been supplied with 750,000 doses of Pfizer vaccines, whereby 410,000 doses will be used for their staffs, students, and some professors who have not yet been vaccinated, along with vaccinating a portion of the Lebanese community, said Dr. Araji. The 340,000 remaining would be available for selling to any sector that is facing delay issues with vaccination delivery such as the Russian vaccine - Sputnik.

 

The health sector is confronted with numerous issues, including medicine and medical supply shortages, as well as underpaid employees fleeing to work in other countries. To meet these issues, a clear subsidization policy is required. Otherwise, hesitation would lead to a never-ending crisis. The healthcare system is collapsing at a breakneck speed, and soon enough, the harm done would be irreversible. When a disease is ignored, it tends to get worse rather than better over time, and similarly, it is the same case with public health services.