Medicine shortages remain a thorn in the side of President Andrés Manuel López Obrador’s government. Many attribute the crisis to the centralisation of the medicine procurement and distribution system in 2019. The overhaul supposedly aimed to reduce costs, root out corruption and de-monopolise the market. However, the reality has seen a sustained lack of critical medicines, prompting repeated protests, criminal investigations and profound frustration over a system that does not seem fit for purpose. López Obrador started the year faced with mounting pressure to fix the problem, with direct appeals from the medical community, the political opposition and from within his own party.
When the Movimiento Regeneración Nacional (Morena) government overhauled the medicine procurement and distribution system, López Obrador claimed the former process had been plagued by corruption and price gouging. Under the revamped system, the federal finance ministry (SHCP) purchases medicines with the instruction of the wellbeing institute (Insabi) and the assistance of the United Nations Office for Project Services (Unops). State-owned medicine distribution company (Birmex) then distributes the medicines to public health provision organisations.
However, the new system has not functioned as planned. Under López Obrador, Mexico’s social security institute (IMSS), which provides healthcare to 51% of Mexicans, has received a twelve-fold increase in complaints from those unable to find the medicines they require. The IMSS received 5,850 complaints between January and October 2021. This compares to 443 in the last year of former president Enrique Peña Nieto’s term (2012-2018), according to figures obtained by Mexican newspaper Animal Politico via a freedom of information request. Despite repeated assertions from López Obrador that the issues would be ironed out, the shortages have intensified over time. In its most recent report, Cero Desabasto (‘zero shortage’), a collective for groups of patients, their relatives, and organisations supporting them, recorded 1,823 complaints of shortages between May and August 2021 – the highest number it has reported in a four-month period since launching in February 2019.
Critics attribute the shortages to a lack of planning and an underappreciation of the complexities of medical procurement and distribution. Structural issues hamper each stage of the process, from procurement to distribution [SSR-21-07]. Coordination between the various bodies involved has been inefficient, leading to protracted procurement processes. Unops lacks experience with projects of this scale or nature prompting many, including the technical council of the IMSS and the Mexican association of pharmaceutical laboratories (Amelaf), to question its suitability for the task. Birmex, a pharmaceutical laboratory which was initially created to produce, import and sell vaccines and active pharmaceutical ingredients, has noted itself that it does not have the capacity or specific infrastructure needed to undertake the large-scale storage and distribution of medicines.
Off the back of building pressure – including several criminal complaints - at the end of last year, López Obrador ordered health minister Jorge Alcocer and Juan Antonio Ferrer, the head of Insabi, to resolve the medicine shortages problem “without excuses”. The answer, as has oft been the way with the Morena government, was to turn to the armed forces. On 30 November, López Obrador announced that Jens Pedro Lohmann, a former general major, would take over operations at Birmex. Under Lohmann, members of the army, navy, air force and national guard have been assisting the distribution of medicines across the country. The appointment is yet another example of López Obrador’s reliance on the armed forces to carry out civilian activities [SSR-21-11].
On 1 July a lawyer representing 220 parents of child cancer patients filed a complaint before the attorney general’s office (FGR) against deputy health minister, Hugo López-Gatell, for genocide, discrimination and negligence in relation to shortages. A complaint has also been filed against health minister Jorge Alcocer over the failure to guarantee the supply of medicines. On 26 July, the supreme court (SCJN) added to the legal pressure, ruling that the government had a duty to guarantee patients’ access to medicines and treatments.
The armed forces, who have also assisted in the distribution of coronavirus (Covid-19) vaccines in the country, committed to transporting 54.2m units of medical supplies to warehouses and medical centres in all 32 Mexican states in December. The military’s role in medicine distribution was then extended, as the armed forces continued to distribute medicines in January. According to Alcocer, as of 4 January, 59.6m units of medical supplies had been transported with the help of the defence ministry (Sedena), the navy and the national guard, surpassing the original target.
However, those in the pharmaceutical industry are dubious of this quick fix. “The army may have the capacity, but it is a very delicate issue,” Arturo Morales Portas, president of Amelaf, told Mexican newspaper La Razón. “It's not easy to distribute medicines: it's a logistical issue because they have to be consolidated in one place, in a warehouse, and they have to be distributed to different places.” It is also true that the logistics of transporting and distributing thousands of different types of medicine is a very different and more complex task than delivering just seven kinds of Covid-19 vaccine.
The main cause of complaint, however, is that the solution does little to address the root causes of the delays and will not prevent future shortages from occurring. Insabi and Unops presented the 2022 tender for the purchase of medicines at the end of November, which many in the pharmaceutical industry flagged as being too late, given that the companies that win contracts will need several months to manufacture the medicines. Juan de Villafranca, executive director of Amelaf, says he can foresee a “barrage of shortages” this year.
Indeed, pressure has mounted from various sides for López Obrador’s government to put an end to the problem this year. Members of the opposition centrist Partido Revolucionario Institucional (PRI) issued a statement on 3 January saying that 2022 must be the year that the medicine shortage ends. The party’s national executive committee (CEN) also launched a social media campaign, #RetoPorMéxico, to highlight issues including the shortages. “Let this year bring truly good things for our country, like the supply of oncology medicines that our children so need,” read a CEN Twitter post. On 10 January, the party launched another campaign, ¿#YLasMedicinas?, stating that Morena’s “misplaced priorities” had cost the lives of millions of Mexicans. The campaign referenced two of López Obrador’s flagship infrastructure projects, the Tren Maya railway and Dos Bocas oil refinery, saying the Morena government was injecting “unlimited resources” into “whimsical” projects, while ignoring the health crisis.
Cancer patients have been particularly affected by the shortages. One in four reports of shortages recorded by Cero Desabasto between May and August 2021 was related to this disease. Parents of child cancer patients have been at the forefront of the campaign to end the shortages, staging weekly protests outside Mexico City (CDMX) airport.
A press conference given by Alcocer on 4 January has done little to alleviate the pressure. A journalist asked him about issues in the final stage of the process, which have seen patients going to collect prescribed medicines from the pharmacy only to be told the medicines are not in stock. In Alcocer’s answer, he appeared to insinuate that healthcare workers were to blame, stating that “doctors are the ones who manage this link”. In response, directors of Mexican medical federations, associations and colleges wrote to López Obrador, Alcocer and his deputy Hugo López-Gatell to object to the “inappropriate declarations” made by the health secretary. The medical representatives said the comments would lead the public to blame healthcare workers for shortages, “when we all know exactly what the real cause is”.
The medical community were not the only ones to take issue with Alcocer’s performance at the conference, in which he stated that 21.3m units of medical supplies had been distributed in the past six days. Morena minister Patricia Armendáriz, a member of the lower chamber of congress and usually a staunch supporter of López Obrador and his government, took to Twitter to ask why, if so many medicines were being distributed, did the public remain without them. “Why not give the percentage that is missing and tell us why children are going without chemo[therapy]?” asked Armendáriz. “More needs to be done.”
Alcocer appeared confident in the January press conference, declaring that Insabi had procured 201m units of medical supplies for the first quarter of 2022, whereas Unops had purchased 87m units to meet the demand of federal entities until June 2022. However, all eyes will remain on the health minister and the president to ascertain whether promises have substance and whether, finally, the shortages are over. In the likely event that problems persist, the legal, political and medical pressures will only mount further.