Dr Amina Yousaf
Before the Iran War shattered global supply chains and the Hormuz blockade rewrote the economics of international trade, Pakistan’s medicine prices were already climbing. The crisis did not begin with geopolitics. It began with years of structural neglect, regulatory weakness, and a government more interested in managing public perception than in managing public welfare. What the regional upheaval has done is expose, with brutal clarity, how fragile Pakistan’s pharmaceutical sector truly is and how poorly equipped the state is to protect ordinary citizens from the consequences.
The price of essential medicines had been rising at a troubling pace long before any blockade entered the conversation. The causes are not mysterious. Raw material costs have increased significantly over the last several years. Fuel prices have risen. The rupee has depreciated. These are real pressures, and critics who demand the government control drug prices without acknowledging these underlying realities are not being entirely fair. But the government’s response has been worse than imperfect. It has been dishonest.
Faced with mounting evidence of price increases, the government’s consistent position has been that all price changes fall within government-approved selling ranges. This statement is technically defensible and practically misleading. Approved ranges exist precisely because some degree of price fluctuation is anticipated and permitted. But when the government presents compliance with an approved ceiling as evidence that no meaningful price increase has occurred, it is engaging in deliberate obfuscation. A medicine that cost one hundred rupees and now costs one hundred and forty rupees has increased in price. The fact that one hundred and forty rupees sits within an approved range does not make the patient’s bill any smaller. The government knows this. It chooses, nonetheless, to frame compliance with a ceiling as though it were evidence of stability. It is not. It is a rhetorical trick dressed as a policy defence.
The political consequences of this dishonesty have been entirely predictable. Public perception has hardened far beyond what the actual price data justifies. In reality, only a limited number of medicines have seen significant price rises. But the government’s defensive and unsympathetic posture has convinced large segments of the public that the increases are steep, widespread, and deliberately ignored by those in power. Perception, in public governance, carries its own weight of truth. When citizens believe that the state is not protecting them, the belief itself becomes a political and social fact, regardless of what the data says. The government’s failure to communicate honestly, to acknowledge partial price rises while explaining their causes, has allowed a manageable narrative to become an entrenched public grievance.
Then came the Hormuz blockade. The closure of this critical maritime chokepoint has introduced a new and more serious dimension to Pakistan’s pharmaceutical vulnerability. Experts have been careful to contextualise the direct impact: imported finished medicines account for only approximately fifteen per cent of Pakistan’s domestic pharmaceutical market. A disruption to this channel is significant but not immediately catastrophic. The real danger lies elsewhere, and it is considerably more alarming.
Up to ninety per cent of the raw materials used in Pakistan’s locally manufactured medicines are imported. These active pharmaceutical ingredients and chemical compounds flow through global supply chains that pass through, or are priced in relation to, the very corridors now under disruption. If the blockade persists, or if the uncertainty it has created translates into sustained price increases for these raw materials, Pakistan’s domestic drug manufacturers face an impossible choice. They either absorb the increased input costs and operate at a loss, which no sustainable business can do indefinitely, or they raise prices on locally produced medicines, which will hit a far larger share of the market than the fifteen per cent already exposed to import disruption. The experts are warning of this second-order effect with some urgency. The government has, characteristically, been slow to respond.
The options available to Pakistan are limited, and honesty demands that this be stated plainly. Subsidising medicine prices at a time of severe fiscal constraint would almost certainly be unaffordable. The state does not possess the budgetary headroom to absorb pharmaceutical price pressures on behalf of a population of 240 million people. This option sounds humane in political speeches. It does not survive contact with a balance sheet.
Transitioning to domestically produced raw materials is a more structurally sound aspiration, but it is not a short-term solution by any meaningful definition. Building the industrial and chemical manufacturing infrastructure necessary to reduce Pakistan’s ninety per cent import dependency on pharmaceutical raw materials would require years of sustained investment, regulatory development, and capacity building. Even after that investment, domestic production may not be price-competitive with established global suppliers. This is not an argument against pursuing domestic pharmaceutical self-sufficiency. It is an argument against pretending that the pursuit can protect Pakistani patients from the current crisis.
What can be done now, and what should have been done years ago, is the reform of the prescription system. Pakistan currently operates an environment in which antibiotics and other critical, potentially dangerous medicines are routinely sold without valid prescriptions. The consequences of this are dual and compounding. It creates artificial demand that strains supply and contributes to shortages. More gravely, it is a principal driver of antimicrobial resistance, the slow-moving catastrophe in which life-saving antibiotics lose their efficacy because of overuse and misuse. Enforcing prescription requirements for antibiotics and a defined list of essential medicines would not solve the supply chain problem. But it would reduce unnecessary consumption, ease pressure on limited stocks, and begin to reverse one of the most dangerous public health trajectories Pakistan faces.
Pakistan is not a country without options. It is a country that has consistently chosen the easiest option — denial — over the necessary ones. The medicine crisis is real. The structural vulnerabilities are deep. The regional disruptions are not going away. What is required now is not a press release. It is a policy.
