There's deficiency, and then there's deficiency: to whom and why the country does not have enough medicines

Information swept through Russian social networks that supposedly doctors had already been officially warned about the cessation of the supply of foreign drugs for asthma, and that it was necessary to urgently purchase the appropriate drugs. True, within a few hours, the Moscow Health Department issued an official refutation, saying that everything was in order with the medicines:

“The Moscow Department of Health does not confirm the fact of receiving a letter with a request to purchase drugs with specific trade names, as well as sending such letters to medical organizations.

In medical organizations subordinate to the Moscow Department of Health, there are no problems with drugs for the treatment of asthma. To date, a sufficient supply of these drugs has been created in the capital to provide preferential categories of citizens.

As for the drug "Pulmicort", used through a nebulizer, generics are registered in the Russian Federation, approved for use in children aged 6 months and older. All of them have been purchased and are available in sufficient quantities.

Also, city polyclinics are provided in sufficient quantities with all the necessary vaccines. At the moment, the drug under the trade name Pentaxim (vaccine against diphtheria, tetanus, haemophilus influenzae, poliomyelitis and whooping cough) continues to be used for vaccination, the ROTA-V-Aid vaccine is supplied for vaccination against rotavirus infection, and for hepatitis A vaccination there is a domestic vaccine "Algavak M".

Nevertheless, the issue of drug shortages continues to worry Russians. In this regard, the economist Dmitry Prokofiev turned to Vitaly Polushkin, the deputy chief physician of one of the Moscow clinics, with him. Here is what he replied:

“Deficiency, both existing and expected, is diverse. At a minimum, two groups can be distinguished - an absolute shortage, when something is not available without clear prospects for reproduction in Russia, and a relative one, when there is something, but it is difficult to get to it, and a relative one, when there is a drug globally, but it is difficult to use it. Consider the most likely options.

1. There are few examples of absolute shortage of technology, substance, drug, the most famous is probably the cessation of import of equipment for CAR-T therapy. The situation is extremely dramatic, but it concerns the minimum number of patients. Mostly we are talking about experimental treatment or complex therapies. At the same time, one should not think that they will not have any alternatives at all - but, of course, there may be fewer of them.
2. There is an absolute shortage by trade name - when the original product or drug is not available, but its analogues (generics) are present. This is the same story that is being talked about today in the news about Golikova's letter. This discussion is highly subjective. On the one hand, subjectively, the German manufacturer seems to be more reliable than the Indian one. On the other hand, all generics undergo bioequivalence studies - and try to prove that they differ in effect. Therefore, within the framework of the general rules, the prescription of drugs by trade name under state guarantees is carried out within the framework of the decisions of the medical commission in the absence of the effect of the generic or its fixed intolerance.
3. Relative scarcity by value represents the broadest class of scarcity. There are also problems of exchange rate differences, and logistical difficulties in the delivery and storage of the drugs themselves, their precursors and means of production, and then there are situations when the price of the drug for the seller begins to exceed the state maximum selling price, and when the combination of these factors affects the possibility of purchasing drugs medical organizations.
4. The relative deficit in hype is what we faced a couple of weeks ago. Thyroid hormone drugs (and also antiepileptic drugs, anti-anxiety drugs, mucolytics) are drugs of "almost healthy people" that they take from young age to old age and which have little or no effect on life expectancy. At the same time, the absence of the drug creates great risks for life and, as a rule, is associated with very unpleasant fluctuations in well-being. Those. they treat energetic, motivated and experienced people who dared the drugs they needed. Most of these drugs require readily available and reproducible technologies or can be purchased from abroad.
5. Relative shortage in the technological chain - we are talking about drugs manufactured in Russia and having a significant share of foreign components in the production structure. The most obvious situation is some elements of the drug substance, but do not forget about special devices, media, types of polymers and other products.

Calculating the quantitative effects of such a deficit is now an almost unrealistic task for those analytical centers that are available to the authorities and society.

But it is clear that with small individual values in each option, the synergistic effect of such a sharply reduced availability of drug care will worsen public health outcomes and significantly increase costs, especially for the elderly”.